Signs & Symptoms of Perimenopause and Menopause
Many women start experiencing symptoms even before reaching their last period, i.e. during the perimenopause or the menopausal transition. About 30 -40 % of women have none or very few symptoms that affect them or their quality of life. Nevertheless, these women should still be counseled for long-term effects of menopause i.e. to the heart, bone, and brain.
Irregular Periods
As the estrogen levels slowly drop the Follicular Stimulating Hormone (FSH) levels rise. The period cycles may then get shorter and then subsequently longer. Some women experience heavier, clottier and more painful periods during this time due to the hormonal imbalance (more estrogen in the system with less progesterone available).
Problems such as fibroids, adenomyosis, uterine hyperplasia (thickening of uterine lining), cancer and ovarian cysts should be ruled out. Please see a doctor if there are changes in the menstrual cycles.
Changes in the breasts (tenderness, tingling, nipple sensitivity, heaviness) can occur at the same time.
Vasomotor Symptoms (VMS)
Vasomotor symptoms such as hot flushes (heat accompanied by sweating and flushing, especially around the head, neck, chest and upper back) and night sweats (waking up in the middle of the night sweating) affects 60 to 80 % of women entering the menopause. In about 25% of these women, these symptoms affect the quality of their lives.
Although most postmenopausal women experience hot flashes for less than 7 years, 15% of women continue having hot flushes for 15 years and more.
Perimenopausal women can experience hot flushes and night sweats pre periods which often worry them that menopause is around the corner.
Local Malaysian studies have shown the incidence of hot flushes to be about 57% in our women
Night sweats: when hot flushes happen at night followed by episodes of sweating. There can also be cold sweats and clammy sensations. This causes sleep disturbances.
Mood Disorders
Fluctuating estrogen and progesterone levels during the menopause transition increase the risk of mood disorders and depression.
Symptoms can range from irritability, palpitations, poor sleep, crying spells, anxiety and feelings of low mood. Feelings of doom, dread, and depression may occur. Depression is 2.5 times more likely to happen during the menopause transition than at any other time.
Women who have more intense premenstrual mood swings and post-natal blues and depression, have a higher chance of menopausal depression.
Serotonin levels (which have a positive effect on mood) decrease when the estrogen levels drop leading to the emotional disturbances during the transition.
Brain Fog
Brain fog during menopause is a common symptom that many women experience. It involves cognitive issues such as difficulty concentrating, forgetfulness, and mental clarity. This phenomenon is largely attributed to hormonal fluctuations, particularly the decline in estrogen levels, which can affect brain function.
While it can be frustrating, brain fog is typically temporary and can often be managed through lifestyle changes, such as regular exercise, a healthy diet, adequate sleep, and stress reduction techniques. Consulting with healthcare providers can also help in finding effective strategies to alleviate these cognitive challenges.
Joint & Muscle Pains
Joint pains, lethargy and fatigue were other common symptoms experienced by Malaysian women during the menopause transition. A study done in an urban setting in Malaysia found joint pains (73%) and fatigue (59.3%) to be most prevalent followed by vasomotor symptoms (55%).
During the menopause transition, there is also an age-related involuntary loss of skeletal muscle mass and strength. From the 4th decade of life, women will lose skeletal muscle mass and strength, with up to 50% of muscle mass being lost by the age of 80 years.
Factors contributing to these loss include age-related hormonal changes, environmental factors (low levels of physical activity, reduced protein and calorie intake) and increased oxidative stress.
The loss in muscle mass will lead to disability and problems with certain movements, such as rising from a chair, climbing steps or regaining posture after a disturbance in balance.
Osteoporosis
Osteoporosis is a condition where bones become weak and brittle, making them more likely to break. It's more common in older people, especially women after menopause, due to lower levels of estrogen, a hormone that helps protect bones.
During menopause, there is decrease in estrogen levels, which plays a crucial role in maintaining bone density. This hormonal shift accelerates bone loss, increasing the risk of fractures, particularly in the hips, spine, and wrists.
Menopausal women are advised to take preventive measures, including a diet rich in calcium and vitamin D, regular weight-bearing exercise, and lifestyle changes such as quitting smoking and reducing alcohol intake. In some cases, doctors may recommend medications to help maintain bone density and reduce the risk of fractures. Regular bone density screenings in high-risk women are also important for early detection and management.
Genitourinary symptoms
Changes to the vagina, bladder and surrounding areas also known as Genitourinary Syndrome of Menopause (GSM)
Dry vagina and loss of lubrication: This causes painful sexual activity which when added to loss of libido makes a woman turn off sex completely. She may even experience chaffing of the vaginal skin, burning and tearing, and bleeding of the vaginal tissue. The vaginal skin changes with the menopause becoming dry and flaky. This then leads to sexual problems such vaginal dryness, lack of lubrication, discomfort and pain during sexual activity. There can also be tearing of vaginal skin and bleeding with intercourse. The vagina becomes a sensitive area thereafter leading to infections and itchiness.
Bladder problems: The most common symptoms are urgency (feeling of going to the toilet often), painful or difficult urination and recurrent urinary tract infections. The menopausal lady experiences incontinence which may be stress related (leaking while laughing, sneezing or coughing) or due to urge incontinence or overactive bladder whereby she is not able to reach the toilet in time.
The pelvic muscles may get weakened with childbirth and other conditions such as diabetes, nerve damage and muscle sclerosis. Thus these symptoms of leaking may not be solely due to aging and weak pelvic muscles.
Skin Changes
Drier skin can lead to itchiness and a sensation of ants crawling over the skin. There can also be eye dryness and mouth dryness. Thinning of skin causes wrinkles and sagging of skin along with an Increase in pigmentation especially over the face. Skin tags can also increase over the body
Cardiovascular Diseases
Cardiovascular disease (CVD) is the leading cause of death in Malaysian women. After a cardiovascular event, women tend to have poorer long-term outcomes and quality of life when compared to a man.
A woman’s risk for CVD increases dramatically at menopause due to:
Effect of increasing age.
Loss of estrogen.
Changes in body fat distribution and storage.
Decrease in physical activity.
Increase in blood pressure.
Worsening lipid levels.
Worsening glucose tolerance and insulin resistance.
The incidence of coronary heart disease is 2-3 times higher in post-menopausal women than in pre-menopausal women. Women often present with varied, unrelated symptoms to the emergency department which then result in a delayed diagnosis. While angina pectoris is more common in women compared to men, non-chest related symptoms such as fatigue, epigastric pain and shortness of breath may actually be related to a cardiac event.
Weight gain at menopause
The fluctuating estrogen levels in the perimenopause may increase body weight especially around the abdominal area which in turn increases metabolic problems.
After menopause, there can be an average weight gain of 2.0-2.5 kg over 3 years. Weight gain and obesity are the main contributing factors towards metabolic syndrome (obesity, insulin resistance, glucose intolerance, high cholesterol and hypertension).
The increase in visceral fat (especially around the abdomen), which can start as early as 3-4 years before menopause, along with changes in body composition and reduction in muscle mass, further affect metabolic health.
Other common symptoms of menopause
Irregular heart beats or palpitations. Many women see their cardiologist during this time fearful of a heart condition.
Extreme tiredness with no energy to do routine tasks. Finds it unable to get through the day. Restlessness and listlessness.
Breast tenderness and soreness.
Headaches usually increasing in intensity may be secondary to sleep disturbances.
Bloating and stomach disturbances. Flatulence and burping.
Increased sensitivity to certain foods that did not give problems before. Such as dairy products, gluten and wheat.
New allergies to medication that was safe before.
Start of medical conditions such as diabetes, high blood pressure and cholesterol.
Pre-existing medical conditions worsens such as diabetes, hypertension and cholesterol.
Increased risk of coronary heart disease.
Changes in thyroid levels.
Hair loss or thinning, whitening of hair and increase in facial hair.
Changes in body odour with bad breath.
Dizziness, light-headedness and imbalance. Ringing in the ears.
Tingling sensation over any part of body and under the skin.
Gum issues with loosening of teeth and bleeding gums.
Bone loss and osteoporosis.
Changes in nails – softer and more brittle.