What Are The Worst Menopause Symptoms?

Introduction

Menopause is an entirely normal biological stage which marks the end of a woman’s reproductive capacity.¹ To put it more simply, the NHS defines menopause as when women  stop having menstrual periods and are unable to get pregnant due to the physiological changes that occur in female bodies with age. Usually, women between the ages of 45 and 55 experience menopause, with the average being 51 in the United Kingdom. However, menopause occurs before 40 for 1 in 100 women. When this happens, it’s called premature ovarian insufficiency or premature menopause. ² 

Menopause causes hormonal fluctuations as ovaries stop their egg-releasing capacity and thus cause oestrogen and progesterone levels to drop.¹ Oestrogen is the primary hormone responsible for maintaining the female reproductive system and regulating the menstrual cycle. Progesterone plays a crucial role in the early stages of menopause as a decrease in progesterone levels is responsible for irregular periods during the menopausal transitional stage. As a result, fluctuation in both hormones results in a wide variety of symptoms.³ 

Although often viewed negatively due to its association with ageing and uncomfortable symptoms, many women celebrate the change as liberating as they no longer have to experience discomfort from menstruation.¹ 

Perimenopause is the transitional state that precedes menopause. This stage is characterised by irregular menstrual cycles (irregularly long, short, heavy or light flows), hormonal fluctuations, and depletion of oocytes (such as eggs). Oestrogen hormone concentrations start to fluctuate heavily during the first stages of perimenopause. However, oestrogen levels eventually start reducing and then stop entirely, resulting in menopause. ^4,5 

Effect of menopause on the body

Menopause usually begins with the natural decline of reproductive hormones due to various ageing factors. Eventually, both reproductive hormone levels decline drastically, causing an end to menstrual periods, as the body no longer ovulates monthly.²

The cause of premature menopause varies and can also be brought about by chemotherapy, radiotherapy, specific breast cancers, endometriosis treatments, or surgical intervention .⁴ Additionally, conditions such as Down’s syndrome can also be a factor in the development of premature menopause.²

Most perimenopausal and menopausal symptoms result from reduced oestrogen production and declining levels. For example, vaginal dryness is a common symptom of menopause due to the reduction of oestrogen levels and therefore decreased lubrication of the female genital organ. In addition, thinning of the vulvovaginal tissue of the vaginal wall after menopause may affect urination and make the vagina more prone to irritation and inflammation. Such symptoms can undoubtedly cause discomfort and affect someone’s ability to feel pleasure. 

Symptoms of menopause

Many symptoms of menopause result from the decreasing levels of the oestrogen hormone produced by the ovaries. ⁴ This hormonal fluctuation impacts several different biological systems, which is why symptoms are pretty diverse.

The fluctuation of oestrogen and progesterone levels during perimenopause and the eventual drop of these hormones in the menopause stage impacts several biological systems, which causes an array of symptoms. 

Common perimenopausal and menopausal symptoms include:^4-8

1. Central nervous system-related disturbances: Mood swings, memory and concentration problems, low mood and anxiety.
2. Musculoskeletal changes: These are usually characterised by joint aches, stiffness and reduced muscle mass. 
3. Cardiovascular (heart palpitations) and skin alterations (vasomotor changes). 
4. Sexual dysfunction (or reduced libido): experiencing less sexual desire and pleasure. 
5. Urogenital changes - frequent urinary tract infections (UTIs). 
6. Pelvic symptoms - such as vaginal dryness and discomfort.

Worst symptoms of menopause

Disturbance of sleeping patterns:

Hot flushes and night sweats affect most women during perimenopause. They are often referred to as Vasomotor symptoms and are usually caused by decreasing estradiol concentrations, mainly in blood but also in the hypothalamic temperature regulating centre, impacting temperature regulation.⁹  Vasomotor symptoms typically appear as sudden short experiences of intense heat and sweating on body parts like the chest, face and neck.⁸ These symptoms tend to be the hallmarks of perimenopause and disproportionately affect certain women and may severely affect their quality of life.

Research suggests that ethnicity, smoking and higher BMI may increase the chance of developing Vasomotor symptoms by 60%. Women with prior experiences of anxiety or depression typically experience night sweats and hot flushes more severely.¹⁰ These particular symptoms also substantially reduce the quality of life and make everyday activities much more challenging to complete as sleeping patterns usually are affected severely, sometimes leading to insomnia.^7,9

Decrease in bone density:

A decrease in oestrogen levels and its production increases the risk of developing osteoporosis (often referred to as weakened bones).⁸ In fact, over 250,000 women (menopausal and postmenopausal) experience osteoporosis. This is because a decrease in oestrogen leads to an imbalance in healthy bone formation as it promotes osteoclastic activity, therefore contributing to reduced bone density and bone loss.⁵

Pelvic symptoms such as vaginal dryness and discomfort: 

These particular symptoms affect 50% of menopausal women and can significantly decrease the quality of everyday life. These symptoms are listed below; ⁶

1. Frequent vaginal and urinary infections like thrush.
2. Pelvic pain during urination and sex is felt in the pelvis, vagina and vulva.
3. Vaginal dryness causes irritation and soreness in the urethra, vagina and vulva.
4. Urinary incontinence, e.g., not being able to hold in urine or accidentally urinating when sneezing or laughing.
5. Pelvic prolapse creates a heavy feeling in the vagina as if there is a lump caused by the pelvic organs being weighed down by gravity. This is because the pelvic floor muscles are crucial for bladder control.

When do menopause symptoms begin, and how long do they last?

Around 8 in 10 women experience perimenopausal symptoms before their periods stop altogether. Changes in one’s usual menstrual patterns are usually the first sign of perimenopause because periods may become unusually heavier, lighter, less frequent or more frequent.⁸ 

For most women, menopausal symptoms begin months (sometimes years) before their last period and about four years after it. ² However, for some women, these symptoms can last for over ten years.^4,8

For most, symptoms occur gradually. But for women experiencing premature menopause due to cancer treatments, symptom onset may occur suddenly and more severely.⁸

How to deal with the symptoms of menopause

• Hormone replacement therapy- is the main form of menopausal symptom treatment. It is often seen as the most effective therapy because low oestrogen levels are the leading cause of symptoms. ^1,11 Hormone replacement therapy replaces missing hormones like oestrogen and is taken as tablets, skin patches, and implants.² 

It is important to note that although hormone replacement therapy has numerous benefits, such as relieving joint pain, hot flushes, mood swings and vaginal dryness, it can also increase blood clots and the risk of breast cancer.¹¹ 

• Regarding hot flushes and night sweats, straightforward measures can reduce these vasomotor symptoms, such as sleeping with a fan or air conditioning. Moreover, having cold showers, wearing light clothes and avoiding ingesting certain items such as caffeine and spicy food can help.¹¹ 
• Mood changes- cognitive behavioural therapy is a form of talking therapy beneficial to managing anxiety and low mood symptoms. Different medications can be prescribed to if necessary.¹¹ 
• Alleviating pelvic symptoms ⁶ 

In addition to hormone replacement therapies, topical oestrogen cream inserted directly into the vagina and other parts of the vulvovaginal regions may help reduce pain and urinary tract infection frequency by improving the overall health of the tissues.

Pelvic floor exercises can help relieve the vaginal irritation associated with perimenopause and menopause. In addition, they can improve genital region circulation, irritation, urinary incontinence and prevent pelvic organ prolapse symptoms. Taking yoga and pilates classes will also help as they often have similar movements to pelvic floor exercises.

Using silicone or hyaluronic lubricants and vaginal moisturisers (non-perfumed) during sex reduces irritation, dryness and discomfort. Additionally, wearing breathable underwear and fitness wear that are not very tight, refraining from shaving pubic hair and replacing soap with skin cleansers when washing the vulva also reduces irritation.

• Decrease in bone density- Increasing your calcium and vitamin D intake naturally or by supplements may help reduce your risk of osteoporosis. Additionally, drinking less alcohol, not smoking, and exercising more (particularly resistance exercises) would also be beneficial.¹¹ 

When to contact your doctor

Contact your doctor if you experience any symptoms you’re worried about, want relief from, or are experiencing adverse side effects. The following are other reasons it has been suggested to reach out to your doctor.

1. Suppose you are under the age of 45 and believe to be experiencing menopausal symptoms. This can be confirmed through a blood test to measure your hormone levels.²
2. Specific perimenopausal and menopausal symptoms are predictors of health risks and the onset of different diseases. If you experience severe vasomotor symptoms such as extreme hot flashes, night sweats, and sleep disorders, it may be helpful to contact your doctor, as these symptoms can lead to an increased risk of cardiovascular disease.^{5, 7} 
3. Additionally, similar research suggests that depression and severe vasomotor symptoms might affect cognitive function.⁷  Therefore, discussing with your doctor if your symptoms reflect this could be useful, even if just to understand your actual risk and suitable treatment if necessary.
4. If receiving treatment: NHS recommendations suggest that women receiving treatment for their menopausal symptoms should have a follow-up check-up with their GP 3 months following the start of their treatment and annually after that to monitor symptomatic progression. ¹¹

Summary 

Menopause isn’t an illness; it is simply a natural ageing process for women, in which they stop having periods and cannot get pregnant naturally anymore. The average age in the United Kingdom is 51 years, but some women experience premature menopause before 40 due to underlying conditions or medical treatment. The hallmark of menopause is hormonal fluctuations resulting from the ovary’s decreasing the levels of oestrogen (and progesterone) produced. These hormonal fluctuations impact several biological systems, so symptoms are pretty diverse. The worst symptoms reported tend to be difficulty sleeping (due to night sweats, irritability etc.), decrease in bone density (more risk of fractures) and Pelvic symptoms (vaginal irritation and pelvic prolapse). However, there are natural (adding more calcium to your diet, quitting smoking, reducing alcohol intake, wearing lighter clothing and regular exercising) and therapeutic treatments (i.e. hormone replacement therapy and topical oestrogen cream) taken to relieve symptoms. If you experience any symptoms you’re worried about, want relief from, or are experiencing adverse side effects from treatment, it is best to contact your doctor.