How Menopause Affects The Body
How Hormone Fluctuations Cause Physical Effects In Menopausal Women

Feeling a little flushed?

The Effects Of Menopause On The Body

Contents

• Menopause Terminology
• What's Going On Inside My Body?
• The Perimenopause Phase
• Menopause And Postmenopause Phase
• Who Is Most Likely To Have A Hard Time Of Menopause?
• Who Is Likely To Start Menopause Early?
• How Long Will It Take For Me To Feel Normal Again?

Terminology

Menopause: Menopause technically means the end of menstrual periods. During the years leading up to menopause (called perimenopause) your periods become erratic until finally they stop coming. When you have not had a period for 12 months you are officially menopausal. The average age a woman hits menopause in the United States is 51. If you reach menopause before the age of 45 it is considered 'early' and before the age of 40 it is considered premature menopause.

Perimenopause: Perimenopause refers to the years leading up to menopause when you still have periods but estrogen production is slowing down. A lot of the symptoms associated with menopause like hot flashes and depression actually take place in the perimenopausal years. Any woman over the age of 35 is a candidate for perimenopause although typically it kicks in around the age of 45.

Postmenopause: Technically when you have your last period you immediately enter postmenopause - this phase lasts for the rest of your life. In postmenopause, hormone production levels off at a lower level and the worst of the menopause symptoms subside (although new ones like vaginal dryness may start). The term postmenopause has not really caught on, and so when most people refer to menopausal women - they are referring to women whose periods have stopped, be they 55 or 85. I will use the terms interchangeably in this article.

What's Going On Inside My Body?

Firstly it is worth pointing out that menopause is not a disease, nor is it necessarily going to cause problems for you. Every woman experiences the transition in a different way. It is a natural process, one we should feel privileged to experience because in the past, life expectancy was so low, most women died at the end of their reproductive years. Today it is considered just another stage of life, and many women go on to live another 30 or 40 years after menopause (see latest health statistics). Your postmenopause years can be just as fruitful and happy as any other stage of your life. Of course, as with any change, the more we know about it, the easier it is to deal with what's happening. So let's start by taking a look at what is going on inside your body.

Crazy Hormone Swings

Some doctors tell women who are still having periods but experiencing menopause symptoms not to worry and just ignore it. Yet we now know that some of the worst symptoms associated with the change of life are often most intensively felt during the perimenopause years when we are still having periods. And the perimenopause phase can start 10 years before periods stop completely. So what's happening to cause these symptoms? Hormones. Over the course of a lifetime the female body goes through many changes. Primarily those changes occur during puberty, pregnancy and menopause and they are controlled by hormone fluctuations. Hormones are little chemical messengers that travel through the bloodstream and issue orders to cells and organs throughout the body. The main hormone that is responsible for menopause changes is estrogen, but there are others involved in the process. Together they are known as the sex hormones and they are controlled by the endocrine system.

The Hormones That Cause Menopause

Hormone	Produced By	Function
Estrogen	Ovaries	Promote breast growth, cause menstrual cycles, ovulation and pregnancy. Before menopause the ovaries make estrogen, after it, your body fat takes over the job. This is why fatter women are sometimes cushioned from the initial side effects of menopause (although being overweight exposes them to a host of other health problems). See, effects of estrogen on the body.
Follicle-stimulating-hormone (FSH)	Pituitary Gland	Produced in the brain this hormone stimulates the ovaries to cause eggs to ripen and mature. It kicks off the ovulation cycle.
Luteinizing Hormone (LH)	Pituitary Gland	LH triggers follicles in the ovaries to release the egg once it has matured. It also helps in the production of estrogen and progesterone.
Progesterone	Ovaries	Prepares the womb for pregnancy and sustains pregnancy. Where estrogen is dominant in the first half of the menstrual cycle, progesterone takes over in the second half. Side effects of progesterone are a bloated stomach due to water retention, cravings for sweet things and tiredness. The synthetic (man-made) version of progesterone (used in some contraceptive pills) is called progestin.
Testosterone	Ovaries	Although it is considered a male hormone, testosterone is produced in smaller quantities in women. It helps to maintain libido, strong bones and muscle growth. During menopause levels start to drop.
Androgens	Ovaries and adrenal glands	Typically seen as male hormones, androgens are produced in small amounts in women. Women produce a host of different types of androgens but the ones that affect menopause are DHEA and testosterone. Typically levels of both hormones decrease as estrogen levels decrease. However estrogen can decrease faster leading to an imbalance and a greater presence of DHEA and testosterone. This imbalance causes fat to start collecting around the waist; hair to grow on the chin, hands and feet; and blood pressure and cholesterol to rise.

The Perimenopause Phase

The symptoms of menopause are tied up with fluctuating hormone levels. Symptoms are worse during perimenopause than in menopause itself because this is when the levels fluctuate the most. Sometimes levels rise to normal levels other times they come crashing down. When you reach menopause your hormone levels are consistently low so they don't trigger symptoms in the same way, although some symptoms (often different ones) can still occur. In perimenopause the most obvious effects come from fluctuating levels of estrogen. Here's how it works:
1. Your ovaries produce less estrogen (specifically estradiol, one of the three types of estrogen). As a result less estrogen reaches your brain.
2. Less estrogen in the brain causes a decrease in endorphin levels. Endorphins are the so called happy hormones that keep our moods regular and act as natural painkillers which make us less sensitive to pain.
3. The brain panics because there are lower levels of endorphins hanging around so it thinks something is wrong. It reacts by sending out bursts of adrenaline to kick-start your system. Specifically it sends out norepinephrine (the hormone that triggers fight-or-flight, see dangers of stress for a more detailed explanation).
4. The burst of norepinephrine raises our heart rate (causing palpitations) so that we are ready for action. It raises blood pressure, causing our blood vessels to dilate, leading to hot flashes and sweating. If you're sleeping you may suddenly wake up, or you might get a bout of diarrhea or flutters in your stomach.

Common Perimenopause Symptoms

Irregular Periods
Hormone fluctuations interrupt the ovulation cycle, some months you release an egg from your ovary, some you don't (hence declining fertility, see what age does fertility decline?). If you don't ovulate you don't produce enough progesterone to have a period. This results in irregular periods.

Headaches
Women already prone to bad headaches or migraines in the days before or after their periods may suffer more headaches during perimenopause. This is because you are likely to be particularly sensitive to low levels of estrogen. Women who experience their first migraine during perimenopause however usually find they disappear again after menopause.

Mood Swings
Mood swings are common feature in most women's lives. Mood can fluctuate around period-time, and during or after pregnancy - so it's hardly any surprise that mood swings feature again in our perimenopausal years. Although scientists don't completely understand why - it appears that low levels of estrogen (common to all these occasions) is linked to lower serotonin levels. Serotonin is another one of those 'happy' hormones related to moods. Low levels make us irritable, prone to feeling pain and less able to sleep soundly. Other related articles, see menopause and depression as well as the effects of depression.

Memory Failure
You may find you lose your train of thought half way through a sentence or you go to the store and forget what it is you went for. Memory problems are very common in perimenopausal women, this is because estrogen is necessary for facilitating communication in brain cell neurons. Fortunately as estrogen levels stabilize postmenopause, memory returns to normal.

Skin Changes
One day you look down at your hands and notice that the texture has changed. Suddenly you notice your skin is dryer, you may also have noticed a few extra crow lines around your eyes and patches of dry scalp on your head. Whether this is a natural part of the ageing process or if declining levels of estrogen speed up the process is still open to debate. See, menopause skin changes.

More Hair And Less Hair
Hormone imbalances can be responsible for hairs that start to appear on the chin or on the backs of your fingers. It can also cause loss of hair or thinning hair on your head. Although both estrogen and androgen levels are declining, the rate of estrogen loss is faster, meaning the androgen suddenly has more prominence. One side effect of this is hair loss. Read about menopause hair loss.

Fibroids
Nearly one third of women have fibroids by the time they are 50. Fibroids tend to get bigger as you approach menopause but don’t usually change or grow afterwards. Fibroids only require treatment if they become symptomatic - see symptoms of fibroids. Women with endometriosis may also find that it flares up in the years approaching menopause but then subsides and even disappears afterwards.

Breast Soreness
Breast soreness is a common feature of menstruation, pregnancy, breastfeeding and perimenopause. It is a symptom of hormone fluctuations. However, always consult a doctor if there is any nipple discharge or lumps (symptoms of breast cancer). Also, read how to carry out a breast self-examination, which is particularly important as we get older.

The Menopause And Postmenopause Phase

After you reach menopause (periods have stopped for 12 months) things start to calm down a bit. Hormone levels settle at a lower level, mood swings stabilize and hot flashes subside. Your body begins to accept its new level of estrogen production, although a small percentage of women continue to suffer menopausal symptoms for another few years. In the longer term, consistent lower levels of estrogen cause some new physical changes to your body. These include:

Menopause Symptoms

Vaginal dryness: Medically called vaginal atrophy, low levels of estrogen can cause the vaginal tissue to shrink and dry out. It is most noticeable when sexual intercourse becomes painful without lubrication. Vaginal dryness is the most common cause of painful intercourse in women.

Vulva itchiness: The skin of the vulva dries and can become itchy. However always ask a doctor to check any changes in your vulva, as there are many other causes. See reproductive system disorders.

Urinary incontinence: The muscles and tissues in the urinary tract become weaker, so you might have leakages of urine when you laugh or sneeze.

Urinary frequency: The need to urinate more often than you used to.

Weight changes: Body fat shifts to the center of your body, away from the arms and legs to settle in the waist. This means you take on a more apple body shape appearance. This doesn't necessarily mean you gain weight, but a larger tummy may mean you still need to go up a dress size. See weight gain and menopause.

Low libido: Decreased sex drive is a common problem in menopause and it can usually be traced back to testosterone levels being too low. See low libido in menopause.

Depression: If you have been taking estrogen replacement therapy (ERT) to cope with the side effects of menopause (rather than going through the natural weaning process), you may find you are suddenly hit with a wall of depression when you quit.

Extra Problems
Estrogen is a miraculous hormone (as no doubt you are beginning to notice) - as well as all the wonderful functions it controls in our body, it also acts as a protector. It helps protect against bone disease (osteoporosis), heart disease and a host of other medical conditions. Once we hit menopause, we are no longer protected in the same way, which is why the risk of heart attacks, coronary heart disease and osteoporosis suddenly increase. For this reason, regular health screenings become even more important, as well as taking regular exercise, maintaining a healthy body weight and eating a balanced diet.

Who Is Most Likely To Have A Hard Time Of Menopause?

The simple answer is, doctors don’t know. Just because your mother or sister suffered badly, doesn’t mean you necessarily will. What we do know is that your attitude to the change of life can have a significant impact on your experience. Studies show that educated women are more likely to view the menopausal transition with a positive attitude and appear to have an easier time as a result. Additionally, women who exercise regularly and have a healthy body weight are less likely to suffer hot flushes, depression and joint pain compared to obese women. Also, higher cholesterol levels are associated with more sweating, depression and skin dryness. Ultimately however, the only way to find out how you will react to menopause, is to experience it. In the meantime, take a look at our list of books on menopause, it contains some useful guides.

Who Is Likely To Start Menopause Early?

Researchers have found some links as follows:

Genetics: Women tend to experience perimenopause around the same time as their mother or sisters, so look to your family history as an indication of what to expect.
Smoking: Studies show that menopause occurs 2 years earlier in women who smoke compared to those who do not.
Giving Birth: A woman who has never given birth may be more likely to start menopause earlier.
Hysterectomy: A hysterectomy which removes the uterus but not the ovaries does not normally induce menopause earlier (as estrogen is still produced). Where the ovaries are removed, premature menopause is induced. Read about the side effects of hysterectomy.

How Long Will It Take For Me To Feel Normal Again?

From start (when you first notice obvious menopause symptoms) to finish (when you don’t notice them anymore) the process can take anywhere between 1 and 15 years. But before you have a heart attack - statistically research shows that it usually lasts on average 4 years. Typically symptoms tend to peak one year after the woman's last menstrual period but continue for up to 4 years in 50 percent of women. But who knows - you may be one of the lucky ones that sails through with only the odd hot flash to contend with. For more see other menopause questions, as well as our general section on womens health questions.

Other Useful Guides

Head And Face Disorders: From headaches to depression, skin and eye conditions.
Main Causes Of Death In Women: What are you likely to die of?
Development of the female body: From puberty to menopause.
Hospital Departments Explained: Diseases and conditions treated by each department.
Back Problems: Symptoms of upper and lower back pain and neck problems.
Bones and Joint Problems: Symptom checker for hands, feet, arms and leg pain.
Skin Care Questions: Dry skin? Discover the best treatments, plus lots more.

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