Menopause: What to expect

By Laura Henneker, MSN, FNP

Why am I tired, moody, and gaining weight?  Is it my hormones?

I am asked by women at all stages of life to explain hormone changes. These discussions escalate dramatically as women approach midlife and the end of their reproductive years. 

Going through the menopausal transition is a normal part of female aging but can also bring emotional and physical changes beyond irregular periods, which can be distressing.  

What is happening in my body?

Menopause is an event coinciding with a woman’s last period. It signifies the end of her reproductive years.  Most women experience several years of symptoms leading up to the last period. These years and a year or so following the last period is known as Perimenopause. During Perimenopause, ovarian estrogen production becomes inconsistent until it eventually ceases, and periods stop. It is this sputtering of estrogen production that triggers the most common symptoms of perimenopause.

What symptoms should I expect?

Irregular periods: In rare cases a woman will just stop having periods without irregularity. Most women notice period changes in their mid-40s with periods becoming irregular, lighter and often closer together. In later perimenopause, periods become more erratic and more than 50 days apart, sometimes skipping several months at a time until stopping completely. 

Hot flashes are experienced by 80% of women up to three years before the final period but are most intense in the first two years after the final period.  The hot flash is an intense feeling of heat rising from the chest to the neck and face lasting for a few minutes and resulting in heavy sweating. Sleep is disrupted when this occurs at night.

Vaginal tissues are very sensitive to estrogen loss and become dry, thin and easily irritated.  In about 50% of women this can lead to painful sex, avoidance of intimacy and can also trigger urine leakage and incontinence.

Sleep disturbance in perimenopause is frequently due to hot flashes and occurs in about half of women. This can result in poor daytime function, memory problems and loss of concentration.

Moodiness and irritability are common. Clinical depression is not as common but can happen in perimenopausal women with a prior history of depression. 

How do I know my symptoms are due to hormone changes?

Perimenopause is part of normal female aging and often coincides with other mid-life stressors such as health concerns, aging parents, financial pressures and an empty nest. These stressors by themselves can cause poor sleep, moodiness and fatigue.  Normal aging also produces a mild weight gain in mid-life as well as changes in skin and hair. 

Midlife is also a time when serious illness becomes a bigger concern, and consequences of lifestyle choices of reduced activity, overeating, alcohol and tobacco use start to become apparent.

Women today have unprecedented access to medical information thanks to the internet and social media. Most of the time this information is useful, but it can sometimes be vague or even misleading. 

If at any time you have a symptom that doesn’t seem normal to you, it is important to ask for help from a healthcare provider.  It is also important to have regular health checkups for age-appropriate screening, particularly for cancers and cardiovascular diseases.

How long will this go on?

Perimenopause can last seven to 10 years and varies widely between women. The average age of the last period is 52 years, but every woman’s experience is different.

What happens when it’s done?

Symptoms that can persist beyond perimenopause include dry and irritated vaginal tissues and urinary leakage. Vaginal bleeding recurring after 12 months of no periods is never normal and needs immediate medical evaluation. 

The good news is that hot flashes, sleep disturbance, concentration and mood changes usually return to baseline within 3-6 years after the last period.  Most women can look forward to decades without the hormonal fluctuations which characterize the reproductive years.  

What helps?

Estrogen supplementation is safe when used appropriately and is remarkably effective in the treatment of hot flashes, sleep disturbance, vaginal symptoms and moodiness of perimenopause. 

There are also alternative non-hormonal treatments for most symptoms. 

Stay tuned for a discussion of safe and effective treatments in Part 2 Menopause: Conversations about treatments.

Laura Henneker is a family nurse practitioner at Cordova Community Medical Center. This story is part of a monthly informative series by local medical professionals.