Share

Symptoms of perimenopause and menopause

During pre-/perimenopause there is a gradual decline in ovarian function and oestrogen production as the body begins to change in preparation for menopause. The decline and sudden absence of oestrogen has a huge impact on your body and emotions.

In the beginning hot flushes, night sweats (nocturnal hot flushes), sleep disturbances, mood swings and joint pains are the most common symptoms. Forgetfulness is quite common. These are followed by thinning of the vaginal wall which can lead to vaginal dryness and result in sexual discomfort. Your skin and hair gradually thin and you have a greater chance of developing a belly. There is also a greater risk of heart disease and osteoporosis. Other symptoms include bladder incontinence and diminished libido.

Some women live through the whole menopausal period without suffering any of the classic symptoms, but they’re a small minority.

1. Hot flushes
One of the first things to become seriously mixed up is the temperature-control centre in your brain, and that’s the reason for hot flushes.

Experiencing hot flushes (also called flashes) is the feature that has made the menopause famous because it’s the most common symptom: 75-80% of women suffer these feelings of intense heat over the trunk and face with an accompanying flushing of the skin.

A hot flush generally lasts less than five minutes, and the sweating that accompanies this “attack” usually starts a minute after the feeling of palpitations.

The frequency of flushing may range from one or two per day to one every 15-30 minutes. Flushing is more pronounced late in the day, in hot weather, after ingestion of hot foods or drinks, or during periods of stress and tension.

Hot flushes can begin during perimenopause before menstruation stops. Most women have hot flushes for more than a year while 25-50% will suffer for up to five years if they’re not treated. New studies indicate that hot flushes often last 10-12 years.

2. Night sweats
Hot flushes at night are called night sweats.

3. Sleep disturbances
Insomnia (sleeplessness) can be caused by hot flushes at night which may be accompanied by night sweats as a result of fluctuating hormone levels. Insomnia may already be experienced some years before menopause, and it is a problem mainly because it can cause daytime tiredness.

4. Erratic periods
Very few women simply suddenly stop menstruating. Before ovulation stops altogether, the menstrual cycle generally becomes more irregular in length.Changes in the flow may be experienced – blood flow may be heavier or lighter. This can start anything from two to eight years before menopause.

Finally, the intervals between menstruations become longer, with missed periods or episodes of spotting only. The irregularity may last two or three years before menstruation finally ceases. When no bleeding has occurred for one year, the menopausal transition is said to have occurred.

Bleeding after this time can be a sign of a serious underlying problem and should be seen to as soon as possible.

Problems to look out for:

Although it is completely normal to have irregular periods and a change in flow, one should see a doctor if any of the following symptoms are noticed, as they could signal other problems:

- Spotting between menstrual periods
- Periods that last more than seven days (or two days longer than usual)
- Very heavy or gushing flow
- Bleeding from the vagina during intercourse

5. Mood swings, forgetfulness and other psychological symptoms
Psychological symptoms such as moodiness, irritability, anxiety, depression, tearfulness, forgetfulness and difficulty in concentrating are often the focus of jokes about the menopause, but there is no objective evidence that cessation of ovarian function is associated with severe emotional disturbance or personality changes.

Mood swings can be a problem particularly for women with a history of premenstrual syndrome or post-natal depression. During the perimenopausal time span, some women notice worsening PMS or experience it for the first time. Menopause ends PMS.

The symptoms of menopause can precipitate an underlying psychological problem, but it cannot cause it.

6. Joint pain
Many women suffer joint pain as one of their earliest symptoms. Often starting during perimenopause, it may suddenly become painful to get out of bed, walk upright to the bathroom or get dressed. Quite often the joints of the back, fingers, knees and ankles are affected. The severity of the joint pain may decrease after a few months.

7. Vaginal dryness and sexual discomfort
Sexual discomfort due to vaginal dryness is a common symptom. Decreased oestrogen can lead to thinning of the epithelial lining and the underlying tissues of the vaginal wall may become thinner and less elastic, a condition known as atrophy.

This causes decreased lubrication, which in turn may lead to substantial pain during and after intercourse. As painful intercourse is seldom a turn-on, it might lead to a decline in the desire for making love.

Vaginal dryness and thinning may continue after menopause. Some doctors estimate that at least half of all women over 60 have some degree of vaginal dryness.

Vaginal changes may also increase the risk of infections due to reduced local protection against micro-organisms which may enter the vagina due to self-contamination or sexual intercourse.

8. Middle-age spread and weight gain
Oestrogen is responsible for the female pear-type fat distribution and a lack of oestrogen will cause the fat distribution to change to the male apple-type fat distribution.

Appetite may decrease, but the stress associated with this menopause often leads to an increase in appetite.

Other gastro-intestinal symptoms associated with menopause include nausea, flatulence, constipation or diarrhoea.

9. Decreased libido
Beginning in perimenopause, some women may experience a gradual decline in sexual desire (libido). However, 60% of women experience no change in libido, 20% experience a decrease and in 20% of cases libido improves.

Although no correlation has been found between oestrogen levels and libido, it appears that testosterone may also affect libido.

Other factors which could lead to changes in sexual function include:

- Painful intercourse due to vaginal dryness (atrophy)
- A woman’s perception of her changing body
- Incontinence which could lead to sexual avoidance
- Sleep disturbances due to night sweats
- Depression, stress and anxiety
- Many medications, including some anti-depressants
- Reduced libido and impotence in the male sexual partner

10. Urinary incontinence (leaking bladder)
Decreasing oestrogen levels can weaken the pelvic floor muscles controlling the bladder and urethra (tube through which urine is passed from the bladder).

The tissue of your urinary tract also becomes less elastic. These changes can lead to painful urination (called dysuria), urination at night (called nocturia) and the need to urinate urgently (called urge incontinence). Another symptom which may be associated with these changes is stress incontinence, which is involuntary urine leakage, occurring with coughing, laughing, sneezing, exercising or sudden exertion.

However, stress incontinence can have organic causes and is not alleviated by hormone therapy (HT). HT will only have a positive effect on symptoms stemming from bladder irritability. Other problems that may arise are frequent bladder and vaginal infections.

We live in a world where facts and fiction get blurred
Who we choose to trust can have a profound impact on our lives. Join thousands of devoted South Africans who look to News24 to bring them news they can trust every day. As we celebrate 25 years, become a News24 subscriber as we strive to keep you informed, inspired and empowered.
Join News24 today
heading
description
username
Show Comments ()
Editorial feedback and complaints

Contact the public editor with feedback for our journalists, complaints, queries or suggestions about articles on News24.

LEARN MORE