Is it menopause? That is the question that crosses many women’s minds as they reach their 40s and 50s and begin to experience unexplained physical changes. While girls often receive education and preparation as they approach their first menstrual cycles, there isn’t enough conversation about what a woman can expect as she nears her last. And while a good amount of information can be found online about the most common menopause symptoms, like hot flashes, there are lesser-known physical and physiological changes that occur during the menopausal years, and they can start long before a woman’s last period.
Exactly how menopause affects the body will vary from woman to woman. Knowing what changes to look out for during this time and understanding the underlying cause(s) can help you manage them. We spoke to Dr. Aaron Fielden, a DO and OBGYN in San Antonio, TX about some of the ways menopause affects your body, and what to do about it.
What the Heck is Happening?
According to Dr. Fielden, to understand the symptoms and treatment, you must first understand the physiology behind menopause. In the simplest terms, as the natural reproductive life of a woman comes to an end, her ovaries begin to have a decrease in estrogen and progesterone secretion. Why does this matter? Because the decrease of estrogen plays a major role in the multiple physical and physiological symptoms a woman may experience during the menopausal transition.
How the Symptoms Stack Up
There is a wide range of symptoms associated with menopause and, to complicate matters, the symptoms may “stack up,” or play off one another. Let’s take headaches, a recognized menopause symptom, for example. During menopause, the body’s shift in hormone levels makes the natural temperature zone in the brain more sensitive. This is what triggers the body’s “thermostat,” creating the “hot flash,” sensation. That hot flash may then disrupt sleep. Interrupted sleep, in turn, can increase the frequency of headaches. This type of symptom stacking is why it’s imperative to talk about any and all of the symptoms you’re experiencing during menopause with a healthcare professional. They can then help you address the root cause rather than treating just one specific symptom.
The Effects of Poor Sleep
The quality and quantity of sleep we’re able to get plays an important role in our overall health and wellness. This rings even truer during menopause where sleepless nights due to night sweats have the potential to compound other menopause symptoms such as, headaches, decreased sex drive (due to fatigue), or dizziness from dehydration.
While many factors can contribute to an interruption in sleep such as obstructive sleep apnea, or frequently getting up in the middle of the night to urinate, for menopausal women, hot flashes and night sweats are often what Dr. Fielden refers to as a “significant underlying source.” He recommends “conservative management options,” like sleeping in layered clothing that can be easily removed, using thin, cool sheets on the bed, and putting a fan in the bedroom. Good sleep hygiene can make all the difference in the world.
And if all else fails, there are prescription and over-the-counter treatment options that can help reduce hot flashes and night sweats. These can include prescription options such as hormone replacement therapy or hormone-free dietary supplements.
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Metabolism and the Menopause Middle
Weight gain during menopause is common, even among those who haven’t changed their diet or exercise habits. Seems unfair, right? Some women blame metabolism, but although metabolism indeed slows as we age, a recent study published in the Journal of Clinical Investigation Insight found that the rate of fat gained and muscle lost was similar during the years before menopause and after.1 In other words, it’s hard to say whether or not menopause affects metabolism speed. What is known, according to Dr. Fielden, is that poor sleep, thanks to other symptoms like hot flashes, may once again be to blame.
“We know that sleep disturbances caused by menopause symptoms may have metabolic health consequences that could lead to decreased physical activity and increased appetite, thus leading to increased weight gain,” he explains.
What hormonal changes do contribute to is where the weight gain occurs. A report from the Mayo Clinic explains that hormonal changes of menopause might make you more likely to gain weight around your abdomen rather than around your hips and thighs, also known as “the menopause middle”.2 However, similar to Dr. Fielden, the report states hormones alone are not the only culprit. There are other factors including genetics, lifestyle, and the loss of muscle mass and increase in fat that occurs naturally with age. “Losing muscle mass slows the rate at which your body uses calories (metabolism). This can make it more challenging to maintain a healthy weight as we age,” advises Dr. Fielden.
The good news is that there are things that can be done to prevent those unwanted pounds from creeping up. Adding strength training to keep or increase muscle mass, and following a healthy diet are good places to start. The Mayo Clinic advises that a plant-based diet rich in legumes, soy, fish, nuts, and low-fat dairy is a “healthier” option for most people, as well as a diet low in sugar, alcohol, and processed foods.3 The Mediterranean diet, for example, is often considered a great option for women in menopause.
Estrogen’s Impact on Hair and Skin
While our midsections may look fuller during menopause, that isn’t always the case for our hair and skin. Both may become drier and thinner.
“Skin and hair changes can be seen in perimenopause or menopause patients, which may cause significant anxiety or stress,” says Dr. Fielden.
He explains that estrogen is believed to play a role in hair growth regulation, adding that the overall biologic activity of the hair follicle changes after menopause, resulting in a slower growth rate, a smaller diameter, and a lower density that can create a “thinning” effect.
The skin is also affected, with lack of estrogen contributing to decreased collagen, elastin, and oil production. All of this can result in dry skin,4 which can lead to itchiness, another menopause symptom.
Thanks to an entire industry devoted to cosmetic beauty, these hair and skin issues are often the easiest to address. Many companies are recognizing the needs of mature hair and skin and creating formulations with ingredients designed to meet those needs. It’s worthwhile to do some research, continue to moisturize daily, wear sunblock, and consult a dermatologist for products or treatments to target specific problem areas you may be experiencing.
Speaking of Dryness…
Skin and hair aren’t the only things drying out due to the loss of estrogen. Vaginal dryness is one of the biggest complaints among Dr. Fielden’s menopausal patients, right up there with hot flashes, and night sweats.
“The role estrogen plays in the health of the vagina cannot be understated,” Dr. Fielden says firmly, explaining that the vaginal mucosa has some of the most active estrogen receptors in the body. “The decrease in estrogen from menopause causes vaginal atrophy, dryness, discharge, and pain due to thinning of tissue, loss of vaginal elasticity, and shortening of the vagina.”
This can all result in painful intercourse, which may turn a woman off to sex completely. Lubricants, silicone-based gels, or vaginal moisturizers can help mitigate these symptoms. If those are not enough, Dr. Fielden says that topical vaginal estrogen therapy has been shown to be clinically effective in normalizing the vaginal pH and decreasing dryness and pain during intercourse. Of course, before introducing any type of hormone replacement therapy it is important to talk to your healthcare provider first to make sure it is the right choice for you.
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The Big Picture
Bodily changes during menopause can be particularly challenging, but they are no reason for a woman to feel ashamed or embarrassed. In the book, Comprehensive Management of Menopause, Dr. Leon Speroff, MD states that, “Menopause is not a signal of impending decline or madness, but a perfectly natural and salutary event that can signal the start of something positive. As physicians to women, we have the knowledge and obligation to see that it does.”5
Dr. Fielden agrees, adding that talking about menopause in general needs to be normalized, rather than considered “taboo.”
"I think most people are timid to discuss their health issues when it relates to menopause because of a certain stigma that it brings,” he suggests. “A large portion of our female population suffers from menopausal symptoms, and the more we discuss it, the more that women will find comradery in learning ways to navigate it.”
- Lorrain, J., Plouffe, L., Ravnikar, V. A., Speroff , L., & Watts, N. B. (Eds.). (1994). Comprehensive management of menopause (1st ed., Vol. 1). Springer-Verlag.