gynecology and obstetrics
Menopause
Symptoms and Signs of Menopause
Changes in the menstrual cycle usually begin during a woman’s 40s, with variation in cycle length. A persistent difference in consecutive menstrual cycle length of ≥ 7 days defines early menopausal transition. Skipping ≥ 2 cycles defines late menopausal transition. The marked fluctuations inestrogenlevels may contribute to other perimenopausal symptoms and signs such as Breast tenderness Changes in menstrual flow Moodiness Exacerbation of menstrual migraines Symptoms can last from 6 months to > 10 years and range from nonexistent to severe. Hot flushes (hot flashes) and/or night sweats due to vasomotor instability affect 75 to 85% of women and usually begin before menses stop. Vasomotor symptoms last an average of 7.4 years and can persist for > 10 years in some groups of women ( Symptoms and signs references ). Women feel warm or hot and may perspire, sometimes profusely; core temperature increases. The skin, especially of the face, head, and neck, may become red and warm. The episodic flush, which may last from 30 seconds to 5 minutes, may be followed by chills. Flushes may manifest during the night as night sweats. Other etiologies of hot flushes or night sweats should also be considered (eg, Overview of Lymphoma , The mechanism of hot flushes is unknown, but they are thought to result from changes in the thermoregulatory center located in the hypothalamus. The range of core body temperatures that is comfortable to the woman decreases; as a result, a very small increase in core body temperature can trigger heat release as a hot flush. In a survey study from 1996 to 2017 in the United States, women who self-identified as Black had the highest prevalence and longest duration of hot flashes and were most bothered by them, while the prevalence in those who identified as Japanese or Chinese was the lowest and prevalence in self-identified Hispanic and White women was in-between the range ( Symptoms and signs references ). Lower socioeconomic status was associated with an increased incidence of hot flashes, independent of race/ethnicity. Vaginal symptoms include dryness, dyspareunia, and occasionally irritation and itching. Asestrogenproduction decreases, vulvar and vaginal mucosae become thinner, drier, more friable, and less elastic, and vaginal rugae are lost. Genitourinary syndrome of menopauseincludes symptoms and signs due toestrogenand androgen deficiency such as Vulvovaginal atrophy Urinary urgency Dysuria Frequent urinary tract infections and/or vaginitis Neuropsychiatric changes (eg, poor concentration, memory loss, depressive symptoms, anxiety) may transiently accompany menopause. Many women experience these symptoms during perimenopause and assume that menopause is the cause. However, evidence supporting a connection between menopause and these symptoms is mixed ( Symptoms and signs references ). Also, these symptoms are not directly related to the decreases in Recurrent night sweats can contribute to insomnia, fatigue, irritability, and poor concentration by disrupting sleep. However, during menopause, sleep disturbances are common even among women who do not have hot flushes. After menopause, levels of low-density lipoprotein (LDL) cholesterol increase in women. Levels of high-density lipoprotein (HDL) cholesterol remain about the same as before menopause. The change in LDL levels may partly explain why atherosclerosis and thus coronary artery disease become more common among women after menopause. However, whether these changes result from aging or from the decrease inestrogenlevels after menopause is unclear. Until menopause, the highestrogenlevels may protect against coronary artery disease. Up to 20% of bone density loss occurs during the first 5 years after menopause. After this period of rapid bone loss, the age-related rate of bone loss in women is similar to that in men. Menopause is a normal, healthy phase in a woman's life, but each woman has a unique experience. Quality of life may decrease if symptoms are severe or if less common symptoms of menopause, such as joint aches and pains, develop. For some women (eg, those with a history of endometriosis, dysmenorrhea, menorrhagia, premenstrual syndrome, or menstrual migraine), quality of life improves after menopause. Some postmenopausal women experience Burning Mouth Syndrome . 1.Avis NE, Crawford SL, Greendale G, et al: Duration of menopausal vasomotor symptoms over the menopause transition (Study of Women's Health Across the Nation).JAMA Intern Med175 (4):531–539, 2015. doi: 10.1001/jamainternmed.2014.8063 2.El Khoudary SR, Greendale G, Crawford SL, et al: The menopause transition and women's health at midlife: a progress report from the Study of Women's Health Across the Nation (SWAN).Menopause26(10):1213-1227, 2019. doi:10.1097/GME.0000000000001424 3.Gold EB, Sternfeld B, Kelsey JL, et al: Relation of demographic and lifestyle factors to symptoms in a multi-racial/ethnic population of women 40-55 years of age.Am J Epidemiol152(5):463-473, 2000. doi:10.1093/aje/152.5.463 