10 Things No One Ever Tells You about Menopause

The absence of a menstrual period for at least one year is an indicator that a woman is transitioning from a reproductive to a non-reproductive phase in life. This indicates she has entered menopause. For most women, menopause starts around 51.

The transition from one phase to another doesn’t happen overnight. It’s rather gradual and is a different experience for each woman. In fact, the first sign of menopause can begin 10 years before a woman is officially in this phase of her life.

Many women think that menopause can make their life easy as they don’t have to deal with menstrual cycles or shop for hygienic products, and they can plan their days without worrying much.

But in reality, menopause brings about lots of changes in the body other than the classic symptom of irregular periods, and many women only realize it after entering this phase of life.

Here are the top 10 things no one ever tells you about menopause.

1. Hot Flashes Continue for Years

Hot flashes are one of the most common symptoms of menopause. Though flash means fast, they do not stop quickly. In fact, they can last for years.

Also called vasomotor symptoms, hot flashes may begin in perimenopause, the period around the onset of menopause. In some women, they may not start until after the last menstrual period has occurred. Episodes of hot flashes are lengthy and nuanced events that come in stages.

A 2015 study published in JAMA Internal Medicine found that menopausal vasomotor symptoms lasted more than seven years during the menopausal transition for more than half of the women and persisted for four and one-half years after the menopause.

Another study published in Menopause in 2016 reports that women fit into four distinct groups when it comes to getting hot flashes and night sweats, with potential ramifications for therapy and prevention of future health conditions. Hot flashes seem to persist from seven to 10 years and occur at different times for different women.

The sudden rise and drop in body temperature can take a toll in one’s daily life. It can lead to heart palpitations and feelings of anxiety, tension or a sense of dread. As hot flashes can occur during sleep, it may disrupt sleep, causing fatigue and mood changes.

To manage hot flashes, avoid possible triggers like hot beverages, spicy food, warm air temperatures, stressful situations, alcohol, caffeine and some medications. Also, dress sensibly and always keep a change of nightclothes handy.

2. Extreme Tiredness

Whether it’s due to hot flashes or poor sleep, the perimenopausal and menopausal stages can take a heavy toll on your energy level. It can make you feel exhausted and fatigued all the time. The exhaustion is similar to what you experience in the first months of having a newborn baby.

The whole body tingles with exhaustion and coherent conversation is an enormous effort.

During menopause, the estrogen, progesterone, thyroid, and adrenal hormones fluctuate a lot, which can lead to fatigue. All these hormones are involved in regulating cellular energy in the body.

A 2015 study published in Menopause states that early menopause, as well as menstrual abnormalities, endometriosis, pelvic pain, and a hysterectomy, are all related to chronic fatigue syndrome.

To fight tiredness and fatigue, plan your daily routine in a smart manner. Rest whenever you feel exhausted.

3. Weight Gain

Putting on more pounds is common after menopause. But it is important to note that menopause-related weight gain does not happen all of a sudden. This type of weight gain occurs gradually.

According to the National Heart, Lung, and Blood Institute, during menopause women gain an average of five pounds. Some women may even gain as much as 15 to 25 pounds.

A 2004 study published in the American Journal of Epidemiology stated that there is no direct connection between menopausal weight gain and hormonal changes. The study highlights the main contributing factors as lack of physical activity and a slowdown in metabolism.

However, a 2012 study published in Climacteric, the journal of the International Menopause Society, reports that the hormonal changes across the perimenopausal period substantially contribute to increased abdominal obesity. This, in turn, leads to additional physical and psychological morbidity.

Weight gain during menopause is not a good sign, as it poses potential serious consequences to your health. It increases your risk for breast cancer, depression, heart disease and Type 2 diabetes.

Maintaining a healthy lifestyle that includes regular exercise and a balanced diet can help you prevent weight gain.

4. More Bad Hair Days

Thinning hair (or even hair loss) is one of the main symptoms of menopause, but the problem can last for several months. Menopause has an impact on your hair due to fluctuating hormones.

Hair loss can begin in the pre-menopausal stage. During this time, estrogen levels decline and testosterone in the bloodstream is more easily converted to DHT (Dihydrotestosterone). This, in turn, reduces blood flow to the hair follicles, causing the hair to become thinner day by day.

Also, hair is prone to dryness and brittleness as a result of the ongoing hormonal imbalance.

A 2011 study published in the British Journal of Dermatology reports that hormonal changes in menopause have a direct impact on the changing hair parameters.

A study done by the Belgravia Centre based in Central London reports that menopausal symptoms like hair loss lasted many years longer than expected. The conclusion was made from the results of a long-term study of 1,449 women from four ethnic groups in seven American cities as they went through menopause from 1996 to 2013.

The average length of time women endured symptoms was 7.4 years, but half of the women suffered symptoms for longer, some up to 14 years.

5. Sleep Problems

During menopause, there is a significant drop in progesterone and estrogen levels that causes nighttime hot flashes and disturbed sleep.

A 2005 study published in the Journal of Clinical Sleep Medicine reports that there are three major ways in which menopause affects sleep.

The first is the concept of a menopausal mood disorder and the development of menopause-related insomnia. The second is an increase in the prevalence of sleep-disordered breathing. The third is an increase in the development of fibromyalgia.

Another study published in 2011 in Obstetrics and Gynecology Clinics of North America reports that perimenopausal transition is a plausible determinant of worsening sleep in mid-life women.

Along with hormonal changes, a diverse variety of factors, both directly related and unrelated to the transition, contribute to sleep disturbances in the menopausal transition.

Due to sleep disturbance at night, most women after menopause prefer to nap like a baby, which can take a toll on the body, impacting energy levels, emotions and weight.

A nice hot bath of 20 to 30 minutes before hitting the bed can help you deal with hormonal-related sleep problems. It is also important to follow a consistent sleep-wake schedule.

6. Bone Loss

Bone loss and osteoporosis are common in women over the age of 50.

In fact, after the age of 35, there is a gradual loss of bone mass in the body which may contribute to osteoporosis, causing your bones to become fragile and more likely to break.

A 2008 study published in the Journal of Clinical Endocrinology and Metabolism reports that in the late perimenopause, bone loss accelerates substantially and it continues at a similar pace in the initial postmenopausal years. The study also notes that your body weight is also an important determinant of the rate of bone mass density loss during menopause.

The hormone estrogen helps keep the bones strong. Due to menopause, the ovaries stop producing this hormone, even during perimenopause which occurs 2 to 8 years before menopause. This, in turn, affects your bone health and you start losing bone more rapidly.

Be all the more careful to keep your bones strong if you have a strong family history of osteoporosis.

7. Extreme Skin Dryness

After menopause, it’s also time to upgrade your moisturizer because the skin tends to become extremely dry. As estrogen levels drop, so does oil production in your skin, causing excess dryness that can lead to a flaky complexion. Some women also complain of dry, crawly, itchy and red skin.

Along with a low estrogen level, aging also impacts skin health. With age, the skin’s ability to retain water and produce oil diminishes, which makes the condition even worse.

A 2007 study published in Clinical Interventions in Aging reports that although estrogen deficiency is associated with skin changes, intrinsic aging also affects skin physiology.

Aging causes a decrease in skin thickness due to atrophy of the epidermis, dermis and subcutaneous fat. This, in turn, causes dryness, wrinkling and an increased incidence of proliferative lesions.

Try to use a richer, more hydrating moisturizer to prevent skin dryness. Also, it’s crucial to keep yourself hydrated from the inside out.

8. Frequent Mood Swings

The fluctuating hormones that accompany menopause can lead to changes in brain chemistry, which in turn can induce depression.

Frequent mood swings and depression can be debilitating. Depression does not appear for the first time after menopause. However, women become somewhat more vulnerable to depression during the perimenopause period.

A 2011 study published in Psychological Medicine found that women were two to four times more likely to experience a major depressive episode when they were perimenopausal or early post-menopausal.

Mood swings and depression can be stressful and bring on feelings of sadness, irritation, anxiety or hopelessness all of a sudden without any known reason.

Deep breathing, meditation, a healthy diet, proper sleep and support from family can help you deal with the problem to a great extent.

9. A rise in Bad Cholesterol

Menopause can cause your “bad” cholesterol to rise. It is due to the increasing age as well as the hormonal changes associated with menopause, especially the decrease in estrogen.

A 2009 study published in the American Journal of Epidemiology found that total cholesterol, low-density lipoprotein cholesterol, triglycerides and lipoprotein(a) peaked during late peri- and early post-menopause, while changes in the early stages of menopause were minimal.

Another study in 2015 by the North American Menopause Society reports that menopause diminishes the impact of good cholesterol, thus making women more vulnerable to artery hardening during menopause.

A woman’s transition through menopause leads to an increase in good cholesterol, which surprisingly was actually associated with greater plaque buildup. This suggests the quality of HDL “good” cholesterol may get altered over the menopausal transition.

However, a healthy lifestyle can prevent these fluctuations in cholesterol levels. Make sure to get plenty of exercises and eat a heart-healthy diet.

10. Memory Issues

Most women experience lapses in memory from time to time, especially before or during menopause. For some, forgetfulness becomes an issue and impacts daily activities.

Regular forgetfulness during menopause happens due to the reduction in the body’s hormone levels. The drop in estrogen can especially impact memory before or during menopause. It helps regulate levels of another hormone, called cortisol, which affects how the chemicals in your brain work.

Due to the imbalance in the cortisol level, occasional malfunctions occur in the brain, resulting in short-term memory lapses.

A 2011 study published in Obstetrics and Gynecology Clinics of North America reports that perimenopause may have contemporary as well as long-term effects on cognitive function. The impact of perimenopause on cognition appears to be both transient and subtle.

Another study published in 2012 in Menopause confirms that memory problems when menopause approaches are real.

Try to stay sharp by doing crossword puzzles, playing chess, reading or using a computer to challenge your brain.

Expert Answers (Q&A)

Answered by Dr. Monica Christmas, MD (Obstetrician and Gynecologist)

Do joint pains associated with menopause go away?

Most joint pains associated with menopause and aging are due to osteoarthritis. Osteoarthritis occurs when the cartilage between the bones wears down.

Cartilage acts as a protective cover over the bones allowing for pain-free movement. When this layer wears away, the bones rub against one another causing pain, inflammation and stiffness. It is typically worse in the morning and improves throughout the day. The weight-bearing joints (knees, hips, and feet) tend to be the most affected.

Factors like obesity, overuse and joint injury are known to increase the risk of osteoporosis in menopause. Although there is no way to cure osteoarthritis, maintaining ideal body weight and adhering to a regular exercise routine to strengthen muscles, can help reduce pain and progression of the disease.

Evaluation by a healthcare provider is also important to ensure that the joint pain is not due to another cause.

What are the natural remedies to get relief from the symptoms of menopause?

Menopause occurs when the production of the hormones estrogen and progesterone in your ovaries declines due to age, surgery, medical treatments or genetic disorders. The loss of estrogen can result in rather bothersome symptoms, which may differ from woman to woman. Some may experience all of the symptoms related to menopause, while others only a few.

Cessation of the production of estrogen can result in hot flashes/night sweats, vaginal dryness, painful intercourse, decreased libido, urinary symptoms, mood swings, anxiety/depression, joint pains, sleep disturbances, hair loss, weight gain, and thinning skin, just to name a few.

Treatment should be geared towards specific symptoms and can involve lifestyle changes, complementary alternative medicine (CAM), prescription non-hormonal medications and hormone therapy.

Finding the right treatment for you can be tricky and may require combining different strategies to get the best result. Examples of each are listed below.

Lifestyle changes:

  • Exercise/weight loss
  • Dress in layers made of natural fibers that can be easily taken off
  • Use cotton sheets at night and keep the bedroom at a cool temperature
  • Apply cold packs under your feet or pillow
  • Limit caffeine and alcohol intake
  • Don’t smoke
  • Practice relaxation techniques (meditation, cognitive behavioral therapy, etc.)

Complementary Alternative Medicine (CAM)

  • Herbal and vitamin supplements
  • Acupuncture/osteopathy/reiki/yoga/bodywork

Prescription Medicines

  • Non-hormonal: Clonidine, Gabapentin and certain antidepressants can help alleviate hot flashes and night sweats
  • Hormonal Therapy: Estrogen therapy, Progestogen therapy, Combined Estrogen/Progestogen or Estrogen/SERM, Androgens and Bioidenticals. Hormonal therapy is indicated to treat hot flashes/night sweats and vaginal symptoms (like vaginal dryness and painful sex) related to menopause.

Although many of the CAM modalities are popular treatments for managing menopause, most have not been shown to work better than placebo in studies.

In addition, herbal medications and supplements can interact with prescription medications you may be taking. It is best to discuss with a healthcare provider before starting any of the above-mentioned treatments.

How can one slow down the process of menopause?

Maintaining optimum health is the most important thing a woman can do in menopause and beyond. Your risk of cardiovascular disease, osteoporosis, diabetes and cancer increases with age. You can slow down the aging process by:

  • Exercising most days of the week for at least 30 minutes (including weight-bearing and resistance exercises).
  • Keeping the weight in check
  • Making healthy food choices and watching portion control. The Mediterranean diet has been shown to be good for the brain and heart
  • Incorporating strategies to reduce stress and increase relaxation into your daily routine
  • Maintaining normal blood pressure, blood sugar, cholesterol and triglyceride levels
  • Not smoking
  • Avoiding excessive alcohol
  • Get help for anxiety and depression
  • Maintain good sleep hygiene
  • Obtaining adequate calcium and vitamin D to keep your bones healthy

What are the foods that must be eaten during menopause?

The Mediterranean diet has been associated with reducing cardiovascular risks and the incidence of cancer and dementia.

A Mediterranean diet includes:

  • Plant-based foods: fruits and vegetables
  • Whole grains
  • Legumes
  • Nuts
  • Replace butter with healthy fats such as olive oil and canola oil
  • Eat fish and poultry. Limit red meat to no more than a few times per month.
  • Replace salt with herbs and spices

How long do the symptoms of menopause last?

Studies have shown, for most women hot flashes and night sweats last for approximately 4.5-5 years after the last menstrual cycle; however, symptoms last longer in African-American women.

Vaginal symptoms associated with menopause do not typically improve and may worsen if not treated.

Cognitive changes and mood disturbances tend to be the worst during the years around the menopause transition; however, improve after the transition.

About Monica Christmas, MD: Dr. Christmas is an Assistant Professor of Obstetrics and Gynecology at the University of Chicago. Her area of specialty includes general gynecology with special interests in the management of uterine fibroids, abnormal uterine bleeding, irregular menses, and menopause.

She also has extensive experience in benign gynecologic surgery, including robotic and laparoscopic techniques, hysterectomy, myomectomy, sterilization, and office-based procedures. Dr. Christmas is also the Director of the Menopause Program at UChicago Medicine and a Certified Menopause Practitioner of the North American Menopause Society (NAMS). In addition; she serves as the Chief Menopause Editor for WomanLab.


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