SYMPTOMS AND SIGNS OF THE MENOPAUSE: PHYSICAL SYMPTOMS
Altered menstrual flow
During the peri-menopause menstrual flow may alter in both volume and duration, which signals changes taking place in the control mechanism between the hypothalamus and the pituitary gland. While irregular periods are quite normal, irregular bleeding is not; any bleeding that occurs between periods, after intercourse or after the menopause needs medical investigation.
Dysfunctional uterine bleeding erratic and irregular menstrual bleeding is often heavy and also requires medical attention to bring it under control. Simple medication is usually sufficient, but possible causes other than the menopause have first to be ruled out, perhaps by exploratory procedures such as endometrial biopsy or dilatation and curettage, as well as by blood tests.
Painful periods
Pain associated with normal or abnormal menstrual bleeding is known as dysmenorrhoea. It may be caused by infection, fibroids, endometriosis or prostaglandin imbalance.
Genital changes
The vagina, uterus and cervix are areas where oestrogen is readily taken up and which consequently suffer when deficiency occurs: their lining, or surface tissue, then tends to atrophy. The vagina shortens, the skin surface weakens and thins and blood supply diminishes. Vaginal acidity lessens and dryness occurs as a result of a reduction in mucus glands, giving rise to painful intercourse, the risk of bleeding, and infection. Shrinkage of the uterus and cervix, together with shortening of the cervical canal, also takes place.
The bladder and urethra (the tube leading from the bladder to the outside of the body) are also affected, for they originally developed in the embryo in tandem with the genital tract. The lining walls shrink and become thinner and drier, hence more likely to crack and split and more vulnerable to infection. The trigone bladder (doorkeeper to the urethra) also atrophies, causing a pressing need to pass urine, and to pass it frequently, and sometimes incontinence after sneezing or coughing. Urge incontinence an involuntary loss of urine which may occur with the sudden urge to urinate responds well to exercises which can improve the surrounding muscles, while stress incontinence involuntary loss of a little urine on coughing, sneezing or laughing may require surgical correction.
Skin and hair changes
'There is no magician's mantle to compare with the skin in its diverse roles of waterpoof, overcoat, sunshade, suit of armour, and refrigeration, sensitive to the touch of a feather, and executing its own running repairs,' observes Professor R. D. Lockhart, anatomist, of Aberdeen University.
The skin constitutes the largest organ of the body. It is restless, constantly shedding its surface and repairing itself. It contains sweat glands, oil glands and hair follicles. Collagen and elastic fibres define its quality and support it.
At the peri-menopause an increasing dryness and thinning of the skin, brittle nails and changes to the hair may be noticed. Thirty per cent of skin collagen, which forms a large part of the connective support tissue of the skin, is lost in the first 10 years after the menopause; this causes further thinning of the skin, which increases the incidence of bruising and gives a transparent, waxy appearance.
Oestrogen replacement has been shown to restore lost collagen to pre-menopausal levels within six months, due in part to the fact that there are oestrogen receptors in the fibroblast cells from which skin connective tissue is developed. It increases the water content of the skin as well as improving its blood flow. A dry throat, burning mouth and problems in swallowing are common complaints. These are due to a lack of water content in the tissue concerned, combined with reduced blood supply. Again, oestrogen can help.
Hair roots originate from the deep layers of skin connective tissue and are therefore affected by lack of oestrogen. Thicker, healthier hair is another benefit to be gained from oestrogen.
Vasomotor symptoms (flushes, sweats and palpitations)
Vasomotor symptoms are those caused by the changing size of blood vessels, triggered by fluctuating oestrogen levels before the menopause. The commonest menopausal symptoms, experienced to some degree by 80 per cent of women, are vasomotor ones hot flushes ('flashes' in North America), night sweats, palpitations and headaches (usually caused by lack of sleep resulting from the flushes and sweating, but not a primary menopausal symptom in themselves).
The exact cause of a hot flush is unknown, but there is a probable link with breakdown in the temperature control by the hypothalamus as oestrogen production declines during the peri-menopause. This in turn influences the sympathetic nervous system which dilates the blood vessels and gives rise to an increased heart rate (palpitations), and sometimes headaches.
Oestrogen therapy helps to control the hormone level fluctuations, which usually eases vasomotor symptoms within 10 days of treatment, although it may be two or three months before the full benefits are felt. Non-hormonal approaches which may help are reviewed in Chapter 5. Vasomotor symptoms are most noticeable just before and at the menopause, but then disappear as hormone levels stabilise.
Breast changes
The breasts develop at puberty under the influence of oestrogen. Around the menopause some gradual change may be apparent due to the reduction of both oestrogen and progesterone. The breasts may become smaller, with the nipples also reducing and becoming flatter and the areola darkening slightly; there may also be some roughness and thinning of the skin.
Bone and cardiovascular changes
Both bone and blood vessels undergo change at and after the menopause. Bone mass reduces more rapidly than during the peri-menopause and heart disease, in particular, is more likely to develop.
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Womens health