Symptoms of the menopause

1. NHS Direct: Health Encyclopaedia - 2008 http://www.nhsdirect.nhs.uk/
2. Mitchell ES, Woods NF. Midlife women’s Attributions About Perceived Memory Changes: Observations from the Seattle Midlife Women’s Health Study. J Women’s Health Gend Based Med. 2001:10:351-362.
3. Rioux JE at al. 17β-estradiol vaginal tablet versus conjugated equine estrogen vaginal cream to relieve menopausal vaginal atrophy. Menopause 2000; 7(3):156-161.
4. Raine-Fenning NJ et al. Skin aging and menopause : implications for treatment. Am J Clin Dermatol 2003:4(6)371-8.

Hot flushes are the hallmark symptoms of the menopause, affecting the majority of women to some degree. Flushes can continue for several years.

They can be triggered by external factors, such as alcohol, caffeine, and hot foods or beverages. They may also be stimulated by emotional upsets.

They tend to be more pronounced at night when night sweats can be so severe that sleep is disrupted. Some women have to change their night-clothes and even their sheets as they may wake up drenched in sweat.

• After the menopause, due to lack of oestrogen, the vagina becomes shorter, less elastic and dryer. These changes are referred to as 'atrophic vaginitis / vaginal atrophy'. Common symptoms are vaginal dryness, itching, burning, soreness of the vagina and pain during intercourse (dyspareunia).
• Changes in vaginal flora may result in more frequent bacterial of fungal vaginal infections.
• Approximately 30% of women experience vaginal symptoms during the early postmenopausal period, and up to 47% of women have them during the later postmenopausal period¹.

1. NHS Direct: Health Encyclopaedia - 2008 http://www.nhsdirect.nhs.uk/.

Sleep disturbance can be part of various psychological symptoms wich many women experience during the menopause. Other psychological symptoms are e.g. mood swings, tearfulness, and feeling depressed.

Sleep can also be disrupted by night sweats and urinary problems, leading to tiredness, irritability and even to exacerbation of depression.

• Oestrogen helps keep the muscles at the base of the bladder tight and strong. As oestrogen levels fall during menopause, these tissues can weaken and many women find that they need to urinate more often. An increase in urinary frequency may occur, especially at night. A sudden need to urinate (urge incontinence), soon after emptying the bladder, is also a common problem.
• Recurrent urinary tract infections are a problem for many postmenopausal women. Lack of oestrogen lowers the acidity of urethral secretions (the urethra is the tube connecting the bladder to the outside of the body), resulting in fewer protective bacteria being present to help to fight infection. A sign of possible infection is burning or stinging when urinating.

In the Seattle Midlife Women’s Health Study³, 62% of participants complained of memory and concentration difficulties around the time of menopause, resulting in daily behaviour problems and difficulty in coping².

Typical symptoms of female sexual dysfunction (FSD) are lack of interest in sex, lack of arousal, difficulty with orgasm and pain during intercourse.

Although up to 40% of postmenopausal women experience vaginal atrophy¹, only 25% of them seek medical assistance². Only a few women receive therapy for vaginal symptoms because of a combination of embarrassment, underdiagnosis and greater attention given to other diseases³.

1. NHS Direct: Health Encyclopaedia - 2008 http://www.nhsdirect.nhs.uk/.

2. Mitchell ES, Woods NF. Midlife women’s Attributions About Perceived Memory Changes: Observations from the Seattle Midlife Women’s Health Study. J Women’s Health Gend Based Med. 2001:10:351-362.

3. Rioux JE at al. 17β-estradiol vaginal tablet versus conjugated equine estrogen vaginal cream to relieve menopausal vaginal atrophy. Menopause 2000; 7(3):156-16.

The skin may become dry and lose its former suppleness as oestrogen sensitive skin tissues such as collagen lose elasticity as oestrogen levels fall. Some women experience skin irritation in the form of severe itching. Hair loss has also been associated with the start of the menopause⁴.

Vaginal therapy includes vaginal tablets, creams, rings and suppositories which are inserted into the vagina to help relieve the vaginal symptoms of the menopause. These deliver oestrogen directly to the tissues of the vagina.They are easy to use and easy to stop. They are sometimes referred to as 'local therapy'.

For women who have only vaginal symptoms, it may be worth trying one of these local preparations.

If menopausal symptoms are more general, a form of treatment which circulates throughout the whole body (known as "systemic treatment" which is most commonly applied by tablets taken by mouth, or skin patches) may be more appropriate.

Some women use medicinal herbs or other supplements such as isoflavones (phytoestrogens), evening primrose, black cohosh and ginseng to help with symptoms such as hot flushes and sleep disturbance. Most clinical studies have failed to demonstrate a major effect of these preparations on symptom relief.

The British Menopause Society recently issued guidance² on alternative and complementary therapies. They state that choice is confusing, that evidence from scientific trials that alternative and complementary therapies improve menopausal symptoms or have the same benefits as hormone replacement therapy (HRT) is poor, that there are concerns over quality of control of production, and that treatments taken this way may interact with prescribed medications with potentially serious consequences.