6 Side Effects of Menopause—Besides Hot Flashes

As your body makes less estrogen, you may notice changes to your bones, heart, and mental health.

Hot flashes, weight gain, and irregular menstrual bleeding – these are some of the commonly discussed symptoms of menopause. However, the journey through menopause entails much more than these well-known changes. As you approach the end of your reproductive years, a host of other transformations, often overlooked in everyday conversations, take place.

Menopause is defined as occurring 12 months after your last menstrual period, typically around the age of 51. During the transition to menopause, also known as perimenopause, significant hormonal changes unfold. Notably, your body gradually reduces its production of estrogen, a key hormone that regulates various bodily functions. These hormonal shifts can spark concerns related to your heart, bones, and mental health, among others.

In this comprehensive exploration, we’ll delve into some of the less discussed but vital health changes that may occur during perimenopause and menopause, providing valuable insights into understanding, managing, and optimizing your well-being during this transformative stage of life.

When Does Menopause Start, and How Long Does it Last?

Menopause, as defined by a full year without menstruation, typically occurs around the age of 51. However, it’s crucial to understand that the journey to menopause starts much earlier. Perimenopause, the transitional phase leading up to menopause, is characterized by hormonal fluctuations and can last for several years. During this phase, estrogen levels decline, leading to various physical and emotional changes.

Bone Loss: Safeguarding Your Skeletal Health

One significant concern during menopause is bone health. Estrogen plays a pivotal role in inhibiting bone resorption, a process in which bone tissue is broken down. As estrogen levels decline, bone loss accelerates, potentially increasing the risk of osteoporosis, a condition characterized by fragile, easily fractured bones.

According to Dr. JoAnn Pinkerton, an OB-GYN and executive director of the North American Menopause Society (NAMS), women can lose up to 20% of their bone density after menopause. Fortunately, there are proactive measures you can take to preserve your skeletal health. Adequate intake of bone-supporting nutrients like vitamin D and calcium is essential. Dr. Pinkerton recommends aiming for 1,200 milligrams of calcium daily, which can be obtained through diet or supplements. In addition, weight-bearing exercises, balance training, and maintaining good posture contribute to maintaining strong bones. In cases of high fracture risk, healthcare providers may recommend specific medications to prevent further bone loss and reduce fracture risk.

Cognitive Changes: Separating Fact from Fiction

Perimenopause often brings about cognitive changes, including memory lapses and difficulties finding the right words—a phenomenon colloquially referred to as “brain fog.” While these changes are commonly reported, the evidence linking cognitive shifts to hormonal fluctuations remains somewhat tenuous.

Dr. Karen Carlson, an OB-GYN and assistant professor of obstetrics and gynecology, notes that cognitive function and dementia are not definitively linked to natural menopause. Instead, cognitive impairment may be attributed to other menopausal symptoms, such as sleep disturbances. However, studies have suggested that early menopause, occurring at age 40 or younger, may increase the risk of decreased cognitive function over time. Understanding these nuances is crucial for a comprehensive perspective on cognitive health during menopause.

Heart Disease: Understanding the Risk Factors

Declining estrogen levels during menopause can influence heart health. Estrogen typically contributes to maintaining flexible blood vessels, promoting healthy circulation. However, it’s essential to clarify that menopause itself does not cause heart disease. Instead, aging introduces various risk factors to watch for, including high LDL cholesterol, high blood pressure, low HDL cholesterol, a high-fat diet, smoking, and a sedentary lifestyle.

To mitigate the risk of heart disease during and after menopause, adopting a heart-healthy lifestyle is paramount. This includes maintaining a balanced diet, regular exercise, not smoking, and managing cholesterol and blood pressure levels. Dr. Pinkerton emphasizes the importance of maintaining a healthy weight as part of this equation.

Mood Swings: Navigating Emotional Rollercoasters

Mood swings, characterized by emotional fluctuations from happiness to sadness and anger, are a common experience during perimenopause. These mood changes are closely tied to hormonal fluctuations, particularly in estrogen levels. However, it’s essential to recognize that a history of depression and a lack of sleep due to night sweats can exacerbate these mood swings.

Activities that reduce stress, such as exercise and relaxation techniques, can serve as effective remedies for mood swings. Hormone therapy is also an option for managing mood changes, but consulting a healthcare provider is advisable if mood disturbances persist or become severe.

Poor Sleep: Tackling Sleep Disturbances

Sleep disturbances are prevalent during perimenopause and menopause, often stemming from hot flashes and night sweats triggered by declining estrogen levels. Additionally, changes in progesterone levels, another sex hormone, may contribute to sleep disruptions. Frequent nighttime awakenings to urinate further compound sleep problems.

To improve sleep quality, consider lifestyle adjustments, including maintaining a cooler bedroom temperature, using fans for air circulation, avoiding large meals, alcohol, cigarettes, and caffeine before bedtime, engaging in regular exercise (avoiding vigorous activity close to bedtime), refraining from afternoon naps, and limiting screen time before sleep. Additionally, relaxing bedtime rituals, such as enjoying herbal tea or warm milk, may promote restful sleep. If sleep problems persist, consulting a healthcare provider is advisable. Treatments, including hormone therapy, can help restore estrogen levels, alleviating hot flashes and night sweats.

Urinary Problems: Navigating Genitourinary Changes

In addition to more widely recognized symptoms like vulvar atrophy and vaginal dryness, some individuals notice changes in bladder function during menopause. These changes collectively fall under the umbrella of genitourinary syndrome of menopause (GSM), encompassing various bladder and genital alterations.

Estrogen receptors present on the bladder and urethra play a crucial role in maintaining proper bladder function. With declining estrogen levels, many women experience shifts in bladder function, including stress incontinence, which involves unintentional bladder leakage during activities like coughing or sneezing. Notably, stress incontinence may be more common among individuals who have had multiple vaginal childbirths.

Strengthening exercises and hormonal treatments represent viable options for addressing bladder problems. Consulting a healthcare provider is essential to determine the most suitable approach for individual circumstances.

Potential Complications of Menopause: Safeguarding Your Health

Research has unveiled the protective effects of estrogen on the heart, bones, and mental well-being. As estrogen production decreases during menopause, the risk of several chronic conditions may rise. These potential complications include:

1. Osteoporosis: The accelerated bone loss associated with menopause heightens the risk of osteoporosis, a condition characterized by brittle, easily fractured bones. It’s essential to recognize that menopause does not guarantee the development of osteoporosis; rather, it increases the risk.

2. Alzheimer’s Disease: Some evidence suggests a link between declining estrogen levels during menopause and an elevated risk of Alzheimer’s disease. While research is ongoing, understanding this potential connection is essential.

3. Mental Health Conditions: Perimenopause and menopause may be associated with a higher risk of depression and anxiety. Recognizing these risks is crucial for comprehensive mental health care.

Treatment Options and Potential Risks

Healthcare providers may recommend hormone therapy to alleviate menopause symptoms and mitigate the risk of certain health complications. However, it’s essential to acknowledge potential risks associated with hormone therapy, including:

1. Stroke: Estrogen interacts with the nervous and circulatory systems, impacting stroke risk. Some evidence suggests that hormone therapy may increase stroke risk, although the relationship is complex. Early implementation of hormone therapy may mitigate this risk.

2. Venous Thromboembolism (VTE): Combined estrogen-progesterone hormone therapy may carry a higher risk of VTE than estrogen-only therapy. Local therapies like Vagifem may have lower VTE risks than oral therapies.

3. Breast Cancer: Research has identified an increased risk of breast cancer among individuals using hormone therapies containing progestin. Progestin is a synthetic form of progesterone.

In conclusion, menopause is a transformative phase in a woman’s life marked by a range of physical, emotional, and health changes. Understanding the complexities of menopause empowers individuals to make informed decisions about their well-being. By adopting a holistic approach to health, including lifestyle modifications and, if necessary, medical interventions, you can navigate menopause with confidence and grace. Consultation with a healthcare provider is paramount to tailor the most suitable strategies to your unique needs, ensuring a smoother transition through this significant life stage.