The symptoms of menopause can be divided into early and late onset symptoms. Early symptoms include abnormal vaginal bleeding, hot flashes, and mood changes. Late symptoms include vaginal dryness and irritation, osteoporosis, and heart disease. These symptoms are discussed in detail below:
Early Onset Symptoms (Perimenopause)
Abnormal Vaginal Bleeding
Abnormal vaginal bleeding may occur during menopause. Some women have minimal problems with abnormal bleeding during perimenopause whereas others have unpredictable, excessive bleeding. In general, menstrual periods (menses) at first occur more frequently (meaning the cycle shortens in duration), and subsequently get farther and farther apart (meaning the cycle lengthens in duration) until they stop. It is also common for women in perimenopause to get a period after going for several months without one. There is also no set length of time it takes for a woman to complete her menopausal transition, as all women are different. It is important to remember that all women who develop irregular menses should be evaluated by her doctor to confirm that the irregular menses are due to menopause and not as a sign of another medical illness.
Hot flashes are common among women undergoing menopause. A hot flash is a feeling of warmth that spreads over the body. A hot flash is sometimes associated with flushing and is sometimes followed by perspiration. The cause of hot flashes is not completely understood; they may be due to fluctuations in hormone levels. There is currently no method to predict when hot flashes will begin and how long they will last in a given woman. Hot flashes can occur in menstruating women in their forty’s. Hot flashes in some women can last decade(s). There is no way to predict when hot flashes will cease in a given woman, though they tend to decrease in frequency over time. Hot flashes on average last about 5 years. For more, please read the Alternative Treatments for Hot Flashes article.
There is considerable controversy about exactly which behavior symptoms are due directly to menopause. Moodiness and irritability seem to be linked with menopause, but other symptoms are less clear. The research has been difficult for many reasons. First, mood symptoms are so common to begin with that it is sometimes difficult in a given woman to know if they are due to menopause. Also, to further complicate matters, women can suffer from significant fatigue that may aggravate moodiness. Many other symptoms that women associate with menopause, such as mood swings, could actually be linked with the sleep disturbance itself. Research is now trying to determine what factors can influence mood symptoms during menopause. Factors that have been suspected and are being analyzed for their impact on menopausal mood symptoms include education level, exercise level, familial support system, and history of depression.
Late Onset Symptoms (Postmenopause)
Vaginal symptoms tend to begin some years after the cessation of menses. Postmenopausal women (the term for women who have completed their menopausal transition) may experience vaginal dryness, itching, or irritation due to the lack of estrogen. Dyspareunia, or pain with intercourse, can also result from the loss of estrogen.
Osteoporosis is the deterioration of the quality of bone that causes an increased risk of fracture. Osteoporosis depletes both the calcium and the protein from the bone, resulting in either abnormal bone quality or decreased bone density, or both. Estrogen loss over many years, such as after menopause, is the most firmly established and common cause of osteoporosis.
The osteoporosis process can operate silently for decades. Some osteoporosis fractures may escape detection until years later. Patients may not thus be aware of their osteoporosis until suffering a painful fracture. The symptoms are then related to the location of the fractures.
For an extensive review of osteoporosis, its treatment and prevention, please read the Osteoporosis article.
Heart disease is the number one killer of women after menopause. One out of two postmenopausal women will develop heart disease, and one out of three will die from it. Although the onset of heart disease in women lags behind the onset in men by about a decade, the occurrence of heart disease increases after menopause. Furthermore, there are actually more women than men who eventually die of heart disease. Being a female over the age of 55 is one of the many risk factors for heart disease.
Revision date: July 6, 2011
Last revised: by Sebastian Scheller, MD, ScD