The Menopause Exchange Blog


In the months or years leading up to the menopause, women can experience common symptoms including hot flushes, night sweats and insomnia, especially before a period. Fortunately, many recognise these symptoms and ask for advice. But women with less common symptoms may not ask for help, delaying the diagnosis. Less common symptoms include joint aches and pain, ‘brain fog,’ feeling forgetful, skin changes, low mood or mood swings, a loss of interest in sex, vaginal dryness and bladder problems.

This article was included in issue 85 (summer 2020) of The Menopause Exchange newsletter.

For healthcare professionals, reaching a diagnosis often requires ‘detective work’ which may involve considering or excluding other causes, especially in younger women. When women are finally diagnosed they are often relieved as this empowers them to seek tailored advice, support and/or treatment.

Why do these symptoms happen?
Falling levels or a loss of oestrogen can affect a number of different organs, as you have oestrogen receptors in your vagina, pelvic floor muscles, bladder and urethra, mouth and salivary glands, joints, brain, skin and soft tissues.

Vagina, mouth, eyes
A loss of oestrogen causes your skin and mucous membranes to get thinner and less elastic. Fewer vaginal secretions can make your vagina dry, itchy or burn. Some women may get pain with sex and/or weakening of their pelvic floor muscles causing bulging of their pelvic organs (prolapse.) Sexual problems can become more common, with reasons including worries about self-image and a loss of confidence as well as local changes in your vagina and loss of interest in sex.

You may have a dry mouth or dry eyes. Studies suggest that hormonal changes at the menopause can cause a ‘burning’ or painful tongue/or mouth, a change in taste (commonly metallic) or a ‘crawling’ sensation in your mouth (also called burning mouth syndrome).

Bladder problems
Oestrogen receptors in your urethra and bladder play an important role in bladder control. When your oestrogen levels fall, you often get urinary symptoms. These may include urgency (dashing to the toilet), frequency, pain passing urine, urine infections and urinary incontinence (leakage). At the time of the menopause, around one in three women experience urinary leakage.

Vaginal oestrogen can help to treat and prevent recurrent urinary tract infections at the menopause and reduce any urgency. Women with pelvic organ prolapse may find vaginal oestrogen helps but may also need a gynaecological assessment about treatment options if their symptoms are affecting their life.

Mood changes
Mood changes around the menopause include feeling low, anxious, mood swings and feeling very tired (fatigue) or low in energy. These may be associated with fluctuations in hormone levels.

For many women, these symptoms are ‘out of character’ and can have a detrimental effect on their lives. There may be other causes, but recognising these symptoms may be hormonal helps women get tailored treatment when it’s appropriate. Evidence suggests that short-term HRT may improve low mood or depression that’s associated with the menopause. Some women also use antidepressants to help relieve some of these symptoms with the additional benefit of reducing hot flushes.

Poor concentration or feeling forgetful can be related to a lack of oestrogen but there are likely to be other reasons as well, such as a lack of sleep, low mood and some medicines. Many women find using HRT helps; if not, they may need to look at other underlying causes. Limited evidence suggests that there’s an improvement in thought processing and a lower risk of Alzheimer’s disease in women who are prescribed HRT for a premature or early menopause, but HRT isn’t advised as a preventative treatment.

Many women find they have more headaches or migraines around the menopause and this is likely due to the fluctuations in oestrogen and progesterone. Transdermal HRT may help.

Why joint pain and stiffness occurs at the menopause is poorly understood. Underlying arthritis or being overweight may make the symptoms worse. There’s some evidence that oestrogen replacement may help and may also reduce the risk of getting osteoarthritis after the menopause.

A loss of oestrogen can affect the production of collagen (a protein in skin, hair and nails), which explains why some women notice their skin is thinner, drier, itchy or bruises more easily. Itchy skin can also be linked to an abnormal skin sensation called formication (the feeling of insects crawling under your skin.)

Some women report hair thinning. Although this may be partly related to loss of oestrogen, it’s also affected by age and genetics, as well as some medical causes such as iron deficiency or thyroid disease. The role of HRT isn’t clear.

Heart palpitations
Palpitations at the perimenopause may be related to hormone fluctuations and may occur before or during a hot flush/sweat. Anxiety may make them worse. They’re usually harmless and HRT may help to ease them. If they get more common or last for longer, see your GP.

Each woman’s experience of the menopause is unique. It’s important to seek advice if you suspect you’re experiencing menopausal symptoms and would like further support.

About the authors
Dr Katherine Gilmore is a specialist registrar in Community Sexual and Reproductive Health at the New Croft Centre integrated sexual health service in Newcastle upon Tyne. Dr Diana Mansour is a consultant in community gynaecology and reproductive healthcare in Newcastle upon Tyne. Her areas of expertise include menopause management and the prescribing of HRT to women with complex medical needs.

Created Summer 2020 

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