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Although production of both sex hormones declines during menopause, it is essentially the estrogen deficiency that produces symptoms and can contribute to the development of certain diseases.
An early sign of the hormonal changes is abnormal menstrual bleeding.
As a result of the fluctuating hormone levels during menopause the build-up and shedding of the uterine lining does not take place as regularly as in the preceding years. This leads to bleeding abnormalities. Often the cycle is shorter than before, bleeding may be lighter or heavier and periods may be shorter or longer. Any kind of change is possible until the last period (menopause) occurs. It is important to keep a
menstrual diary in which you record the frequency, intensity and duration of bleeding.
If you have bleeding abnormalities you should always see a doctor as abnormal bleeding can also be a sign of disease.
Endometriosis and
fibroids in particular occur more frequently after the age of 40 and can cause abnormal bleeding.
Pregnancy can also be associated with bleeding. Many women around the age of 40 underestimate the possibility of becoming pregnant. Effective contraception is necessary right up until you have had your last period.
The typical menopausal symptoms such as
hot flashes, sweating, sleep disturbances and palpitations are caused by hormone-related dysregulation of the autonomic nervous system.
The fall in estrogen levels during menopause can lead to discomfort in the genitourinary organs, particularly in the bladder, urethra and vagina.
The vaginal lining becomes thinner and drier. It can become reddened, there is irritation and itching and it is more susceptible to injury. This can make sexual intercourse difficult or even impossible.
As a result of the estrogen deficiency the healthy acid milieu in the vagina is replaced by a more alkaline environment. This makes it easier for viruses and bacteria to become established and is a reason why infections of the vagina and bladder are more common in the menopause.
Menopause is also associated with a number of cosmetic problems which some women find very distressing. Collagen and elastin, the fibers which are responsible for the elasticity and firmness of the skin, are reduced by the estrogen deficiency. The activity of the sebaceous glands and sweat glands also decreases. The skin becomes dry and tends to itch. The photosensitivity of the skin also increases with increasing age. The skin pigment melanin, which is responsible for tanning and protects against sunburn, is produced by the body in smaller amounts than before as the number of pigment-producing cells is reduced.
The hair changes too: the hair on the head becomes thinner and loses its sheen, the pubic hair and axillary hair decreases.
A particular problem of menopause should not go unmentioned: the increased hair growth at unwanted sites. Although only small amounts of male sex hormones are produced by women in menopause the estrogen deficiency can lead to a relative increase in androgen activity.
After menopause there is increased loss of bone mass and osteoporosis can develop. The loss of bone mass can weaken the bones to such an extent that even minor trauma can be sufficient to cause bone fracture. Fractures of the vertebral bodies occur almost imperceptibly and lead to the familiar phenomenon of the dowager's hump. But the hip bones and the wrist are also sites which are particularly prone to osteoporosis-related fractures.
There are a number of
risk factors that increase a person's likelihood of developing osteoporosis. Speak to your doctor about your risk profile.
The performance of the brain also changes with increasing age. Short-term memory deteriorates and the capacity to learn new things decreases. Concentration, drive and mood can also be influenced by the age-related changes in the central nervous system. The estrogen deficiency appears to play a not insignificant role in this aging process.
However, menopause is not a disease but a time when you should pay particular attention to your health. Go for regular cancer screening. Speak to your doctor about your symptoms and the available treatment options.
Hormone replacement therapy is an established treatment for menopausal symptoms and osteoporosis.
But a healthy lifestyle can also do a lot to preserve your physical and mental wellbeing during menopause.
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