What Is Menopause & What Drives Menopause Symptoms?
Do you know much about menopause? Do you know exactly what it is, when it starts or how to manage its symptoms?
In this blog you will learn:
- What exactly is menopause and when does it start?
- What are the typical symptoms of menopause?
- What are the drivers causing menopause symptoms and how can they be addressed?
What is Menopause?
Menopause is a natural stage in a woman’s life. It is the biological process that marks the end of the reproductive years when menstrual cycles stop.
Menopause is technically defined as 12 months without a menstrual period. The diagnosis is made retrospectively after 12 months of no periods.
Menopause is three distinct stages:
- Peri-menopause: This is a primary time where symptoms appear. The menstrual cycle starts to become irregular due to hormonal changes. There will be months without ovulation. The production of the hormones estrogen, progesterone and testosterone fluctuate greatly, leading to a wide variety of symptoms which affect different organ systems.
- Menopause: This is one point in time, defined as a 12-month period without menstruation. It can be confirmed by an FSH test.
- Post-menopause: This is the phase after menopause, when menstrual periods have ceased for at least one year. Symptoms of menopause may persist after menstruation stops and into post-menopause.
All women go through menopause but not all women experience symptoms. In women who do have symptoms, up to 25% have ‘debilitating’ symptoms (Gatenby C, 2024). Menopause symptoms can greatly affect physical and mental well-being, relationships, work life and overall quality of life.
What happens during Menopause?
In menopause, the ovaries gradually begin to make less reproductive hormones and then eventually stop producing hormones. Estrogen and progesterone levels fluctuate and trend down. Most of the symptoms of menopause are due to low estrogen.
Some women have severe menopause symptoms and some have absolutely no symptoms. The majority of women fall somewhere in the middle. It is an extremely individual experience for each woman.
During menopause, the risk of several chronic diseases increases due to the decrease in estrogen levels. Cardiovascular diseases, tumors (especially hormone-sensitive breast cancer), insulin resistance, type 2 diabetes and osteoporosis can become more common.
When does Menopause Start?
Most women go into menopause between the ages of 49 and 52 with the average age being 51 years old (Koothirezhi R, 2023). Perimenopause, the process leading up to menopause, can start several years before the final menstrual period.
Genes, family history of menopause timing, lifestyle habits and medical conditions influence the timing of menopause. Women who smoke, have had certain surgeries like a hysterectomy or have had cancer treatment/chemotherapy may have earlier menopause. Menopause before the age of 40 years is defined as premature menopause. Women spend 1/3 of their life in post-menopause.
What are the Symptoms of Menopause?
Hormonal changes during perimenopause and menopause cause several characteristic symptoms. The strength, frequency and tolerability of the symptoms vary and are influenced by lifestyle.
What are the Most Common Symptoms of Menopause?
- Vasomotor symptoms: Hot flashes/night sweats
- Weight gain
- Bloating and other digestive changes
- Sleep disruption (often due to night sweats)
- Sexual issues (lower libido, loss of libido, vaginal dryness)
- Brain fog, less ability to concentrate & cognitive issues
- Mood changes, anxiety, low mood, irritability, more emotional
- Fatigue as a result of sleep issues
- Loss of skin elasticity, wrinkles, hair loss
75-80% of women experience menopause symptoms (Erdélyi A, 2024). 20–30% of women have symptoms that are severe (Erdélyi A, 2024). A change in lifestyle may not fully eliminate symptoms and associated risk of disease, but it can make symptoms more bearable and delay their onset.
Symptoms of menopause vary across races. Asian women are typically less affected by vasomotor symptoms (hot flashes), whilst Caucasian women frequently cite these as the most common and debilitating symptoms (Gatenby C, 2024).
Symptoms start 1–2 years before the last menstrual period, in peri-menopause. Menopausal symptoms can last for between 2-10 years (Gatenby C, 2024). Symptoms can last longer with 20% of women still having vasomotor symptoms (hot flashes and night sweats) for up to 15 years after menopause (Gatenby C, 2024).
What does Low Estrogen do?
Menopausal symptoms are primarily caused by the drop in estrogen. Progesterone plays a role as well. We will also touch on other aspects of health that contribute to the symptom picture, but it is mainly down to estrogen changes.
Vasomotor Symptoms
Vasomotor symptoms are hot flashes and night sweats and are the most frequently reported symptoms of menopause. Vasomotor symptoms typically start before other hormonal changes and can last up to 15 years after menopause (Gatenby C, 2024). They happen in about 70% of women going through menopause (Hachul H, 2023). They are due fluctuating estrogen levels. Changes in estrogen and progesterone cause changes in body temperature that can lead to hot flashes and night sweats.
The physiological mechanism of hot flashes is still not fully known. Fluctuating levels of estrogen cause blood vessels to constrict or dilate. The fluctuation interferes with the body’s ability to maintain a steady blood flow. As estrogen levels jump around, it creates an inconsistent change of pace between the constricting and dilating of these vessels. This can cause surges of blood which causes the feeling of heat.
Hot flashes are triggered by this small rise in core body temperature. This activates the sympathetic nervous system by vasodilation, causing an increase in blood flow and increased activity of sweat glands (Forma E, 2024). Estrogen is also involved in regulating body temperature so the combined effect is hot flashes.
Sleep Disruptions
Insomnia occurs in almost 60% of postmenopausal women (Hachul H, 2023). Poor sleep is often due to night sweats, resulting in increased fatigue.
Sleep symptoms can range from difficulty falling asleep to frequently waking up or waking up very early in the morning. The reason for sleep disturbances is not fully clear. It is related to the decline in hormones. But there are other factors that contribute to poor sleep.
Regulation of body temperature – Estrogen helps keep core body temperature low during the night. Decreasing estrogen can lead to hot flashes, sudden feelings of warmth and excessive sweating, called night sweats, during the night. This can be disruptive to sleeping through the night.
Lower melatonin production – Melatonin is the hormone which promotes sleep. Its production decreases naturally with age. Melatonin maintains the body’s natural circadian rhythm. Less melatonin can lead to earlier sleep and wake times and worse sleep quality.
The link between mood disorders and sleep – Progesterone is involved in sleep regulation and mood disorders. Anxiety and depression are connected to sleep disturbances. Difficulty falling asleep can lead to anxiety and vice versa. Hot flashes can contribute to depression, which can negatively affect sleep.
Osteoporosis
Estrogen keeps bones strong. Osteoporosis and bone density changes happen in menopause. Low estrogen is linked to significant bone loss, increased fragility and risk of fracture. Women lose about 50% of their trabecular bone (i.e. the vertebrae) and 30% of their cortical bone (the long bones, such as the femur) during the course of their lifetime (Villiers, 2024). Half of this loss happens during the first 10 years after menopause (Villiers, 2024).
Vaginal Dryness
Vulvovaginal atrophy, due to lower levels of estrogens and estrogen deficiency, can cause vaginal and bladder problems. Women often report symptoms such as vaginal dryness and itch, dysuria (pain or burning when urinating), polyuria (more frequent urinating) and incontinence (Gatenby C, 2024).
Libido & Testosterone
Low or no libido is very common in menopausal women. Many women in both perimenopause and menopause have sexual issues, from lack of interest in sex to difficulty reaching orgasm. The main issue is lower estrogen which can decrease the desire to have sex and make arousal more difficult.
Testosterone is also a factor. Testosterone levels decline with age and menopause. One key symptom of low testosterone is decreased libido. Testosterone is also important for bone density, muscle mass, cognitive function, mood, sexual function and energy (Scott A, 2020).
Joint Pain
Over 50% of perimenopausal women have joint pain, which is a sign of inflammation (Wright VJ, 2024). Estrogen regulates inflammation. It inhibits pro-inflammatory cytokines which can degrade muscle proteins. When estrogen declines during perimenopause and menopause, inflammation may occur. Women may have more inflammation, osteoarthritis, pain and decreased cartilage volume (Wright VJ, 2024).
Muscle Loss
Sarcopenia is age-related muscle loss, which is accompanied by increased adipose or fat tissue. Estrogen has an important role in muscle function and strength. Decreasing estrogen levels are associated with declining mitochondrial function (cellular energy production), reduced insulin sensitivity and declining levels of antioxidant proteins. Just 24 weeks of estrogen deficiency can lead to a 10% decrease in strength (Wright VJ, 2024).
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Weight
The decrease in estrogen and progesterone, along with aging in general, triggers metabolic changes in the body. Muscle mass decreases, burning fewer calories. With the decline in muscle tissue, fat tends to accumulate. In post-menopause, there is a clear trend to increasing fat mass and decreasing lean muscle mass (Palacios S, 2024). This can lead to weight gain. Lifestyle habits like lack of sleep, poor diet and a sedentary lifestyle make this process worse. It can be a vicious cycle which can continue if nothing is done to stop it.
Being overweight can make menopause worse. Obese women are more likely to experience frequent and severe hot flashes compared to women of normal weight. It is harder for the body to dissipate heat due to the excess adipose tissue in obese women. It acts as an extra layer of insulation which prevents heat dissipation.
Obesity is also associated with other menopause symptoms; poor sleep, inflammation and joint pain. Weight loss can help. For overweight/ obese women, losing just 5 kg of weight improves hot flashes by 30% (Erdélyi A, 2024).
Cognitive Function
Estrogen and progesterone affect cognition. The lower hormone levels seen in menopause can influence cognitive and mental health. Brain fog, difficulty finding words, difficulty concentrating or processing information and memory lapses /forgetfulness are possible cognitive symptoms.
The exact pathophysiology of cognitive deficits in menopause is not fully understood but is due to lower estrogen levels (Gatenby C, 2024).
Estrogen has a neuroprotective role on cognitive function (Conde DM, 2021). It helps protect neurons from damage and reduces oxidative stress (Mosconi L, 2021). It promotes neuroplasticity, learning and memory by forming new neuronal connections in the hippocampus, where the brain holds memories. Estrogen influences attention, focus and how memories are stored and retrieved. Estrogen regulates neurotransmitters which are important for mood regulation, memory and motivation (Mosconi L, 2021).
Estrogen has anti-anxiety and antidepressant effects. Lower estrogen during menopause can impact mental health and is linked to depressive symptoms, irritability, fatigue, anxiety, sleep problems, low mood and mood swings.
Progesterone is neuroprotective and helps reduce inflammation in the brain, protecting neurons from injury. It is essential for myelin formation, to allow efficient communication between brain cells which impacts cognitive function. It affects working memory, multitasking and planning. It is related to emotional control. Progesterone regulates mood and has a calming effect on the brain.
Cardiovascular Disease (CVD)
Menopause is a risk factor for CVD (Uddenberg ER, 2024). Menopause brings on cardiometabolic changes. Body composition and body fat distribution changes, blood pressure increases and there are changes in lipoproteins levels, endothelial markers and insulin resistance. The increased abdominal and visceral fat seen in menopause increases cardiometabolic risk and mortality (Palacios S, 2024).
The timing and symptoms of menopause affect CVD risk. Early or surgical menopause increase CVD risk. Menopause symptoms such as vasomotor symptoms, sleep disturbances and mood changes may all impact CVD risk and are linked to adverse cardiac outcomes (Uddenberg ER, 2024).
Beyond Hormones: Are there Other Root Causes of Menopause Symptoms?
Menopausal symptoms are not just due to hormones. There are other factors that contribute. In functional medicine, we look at the whole picture to get to the root causes. We address other areas of health, apart from hormones, to best manage menopause symptoms and maximize overall heath. Areas that can potentially be optimized include:
Gut Health – The gut is important for estrogen metabolism. Specific gut bacteria can help to regulate estrogen, break it down and excrete it from the body. Dysbiosis can impair this process of estrogen regulation and contribute to digestive symptoms. For example, bloating, gas, slowed digestion and water retention are common symptoms during menopause.
Blood Sugar Regulation – Blood glucose levels should remain relatively stable. Insulin is produced to help manage glucose levels. Big increases or decreases in blood sugar can lead to brain fog, fatigue, irritability, sleep issues and more, which are common menopause symptoms. Blood sugar imbalances can cause insulin resistance. Insulin resistance affects weight, cognitive function and overall health.
Liver Health – The liver is responsible for detoxification processes, detoxifying toxins and waste products. A sluggish liver can allow for the buildup of toxins which can cross the blood-brain barrier. This leads to neuroinflammation and possibly worse symptoms such as brain fog or memory issues. Well-functioning detoxification is essential for estrogen clearance. If the detox pathways are not functioning optimally then estrogen can be reabsorbed by the body rather than excreted. This potentially leads to impaired estrogen metabolism, which will affect menopause symptoms.
Chronic Stress – Chronic stress increases the production of the stress hormone cortisol. In excess, cortisol can damage the hippocampus and impair hippocampus-dependent learning and memory (Sroykham W, 2019). It can affect memory, learning, brain fog and concentration (Sroykham W, 2019). Imbalanced cortisol levels can lead to feeling exhausted, wired and anxious, or both. It can cause daytime fatigue and anxiety or sleeplessness at night.
Nutrient Deficiencies – Nutrient deficiencies can have a profound impact on health. Low levels of Omega 3 fatty acids, magnesium or vitamin D, for example, can affect nervous system function, neurotransmitters, inflammation, synaptic plasticity and brain health. Deficiencies can contribute to symptoms such as anxiety, depression, cognitive impairment, low mood, low energy and poor memory.
Sedentary Lifestyle – Lack of exercise can lead to cognitive issues during menopause. Exercise is neuroprotective and increases blood flow, oxygen and essential nutrients to the brain. Exercise improves insulin sensitivity, regulates blood sugar levels, improves brain fog and memory and decreases inflammation. It is important for sleep quality and duration. Regular exercise improves metabolic health and reduces the number and intensity of hot flashes (Erdélyi A, 2024).
How can Menopause Symptoms be Improved?
Menopause symptoms can be a challenge. But they can be managed with diet and lifestyle habits. Ways to manage menopause symptoms include:
- Optimize overall health including gut, liver, thyroid etc.
- Follow a hormone-balancing diet
- Lifestyle changes: exercise, sleep optimization and stress management
- Use menopause- targeted herbs & supplements
- Try bioidentical hormone replacement therapy or BHRT.
We will continue to blog on menopause and how to manage symptoms. Look out for the next blog on the best diet to support menopause.
If you are suffering from menopause symptoms, then get in touch with us at the Medicine with Heart clinic. We can help to manage symptoms, optimize your menopause experience and get your health back on track!
SUMMARY
- Menopause marks the end of the reproductive years when menstrual cycles stop and the ovaries make less reproductive hormones and then eventually stop producing hormones.
- Most women go into menopause between the ages of 49 and 52 with the average age being 51 years old.
- The most common symptoms of menopause include hot flashes/night sweats, weight gain, bloating and other digestive changes, sleep disruption, sexual issues, brain fog & cognitive issues and others.
- 75-80% of women experience menopause symptoms (Erdélyi A, 2024). 20–30% of women have symptoms that are severe (Erdélyi A, 2024).
- Beyond hormones, other root causes of menopause symptoms include gut health, blood sugar issues, liver health, stress, nutrient deficiencies and lack of exercise.
- Lifestyle habits like sleep, stress and exercise, as well as diet, supplements and herbs, can all help to manage menopause symptoms. Hormone replacement therapy can also be very helpful.
