Symptoms of Menopause

What are the most common symptoms of menopause?

Every woman is different, but menopause symptoms can include:

  • hot flashes
  • mood and memory changes
  • changes to skin texture and appearance, including thinning and wrinkling
  • sleep disturbances
  • loss of vaginal lubrication
  • reduced sexual desire and interest in sexual relations
  • bladder control difficulties
  • fatigue
  • joint pain

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What can I do about my symptoms?

There is a lot of information available about menopause, and treatments for menopause symptoms.  Some of that information is available on this web site.  But for worrisome symptoms, and health issues that are affecting a woman’s quality of life, a discussion with a health professional is always recommended.

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What is hormone therapy?

Hormone therapy (HT) is sometimes prescribed after a woman’s ovaries stop doing their job of producing a natural balance of female hormones.

An HT program may involve using estrogen alone (ET), or an estrogen-progestin (EPT) combination, depending on what is happening in a woman’s life and health.  Women who have undergone a hysterectomy, for example, and have no uterus, are usually given estrogen alone.  Others who still have their uterus are more likely to be prescribed  an estrogen-progestin combination.  Progestin has the advantage of providing protection to the lining of the uterus from endometrial cancers.

Hormone therapies can involve a medication taken by mouth, or a skin patch or gel for symptoms such as hot flashes.  Other hormone therapies are applied right where there is a problem – for example, a vaginal cream, tablet or ring, can restores estrogen in the vaginal area and is used when vaginal symptoms are a problem.

HT is usually prescribed for women with moderate to severe menopause symptoms or for women who go through a surgical or unexpected menopause.

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Is it true that menopause may affect my mood?

Clinical studies do suggest that women may notice some changes in their emotions and moods during perimenopause (the time leading up to menopause) or when they have reached menopause.  Irritability, tearfulness, anxiety, depression, lack of motivation and poor concentration are in the range of symptoms that some, but not all, women may experience.  In some cases, these symptoms are linked to other, more physical changes.  Sleep disturbance over a prolonged period, for example, can lead to mood changes.  Serious mood disorders may be treated with anti-depressants, sometimes in combination with estrogen therapy.  Women can also find support and help from trained mental health professionals who offer “cognitive” therapy, also known as “talk” therapy, which can address current or longstanding problems and concerns.

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Is it true that anti-depressants help with other menopause symptoms?

In some cases, physicians recommend a certain type of anti-depressant to provide relief from symptoms such as hot flashes.  As well, even if a woman is not actually depressed this treatment approach may be helpful for women who can’t or don’t want to use hormone therapy.

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Is estrogen therapy used to help women with memory loss, forgetfulness, Alzheimer’s disease or other dementias?

There is no doubt that a person’s estrogen levels have an impact on the functions of the brain.  There is lots of research underway, and much of it is promising.

Some of that research has been about the impact of hormone therapy (HT) on women who have been diagnosed with Alzheimer’s Disease.  But it is still early days to make any hard and fast conclusions.  Estrogen therapy is not currently recommended for reducing the risk of dementia in postmenopausal women or for slowing the progress of Alzheimer’s disease.

There is much more to be learned about this important connection.

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Will hormone therapy deal with all of these symptoms?

Hormone therapy (HT) is prescribed to address a number of menopause symptoms, and is based on a careful assessment of a women’s health status and the seriousness of her symptoms. We do know that:

  • Some menopause problems (such as hot flashes and vaginal dryness) are almost entirely caused by the drop in hormones, so they can be greatly relieved by hormone therapy.
  • Sexual changes, fatigue or sleep disturbance and memory changes are often the result of multiple factors and therefore the impact of hormone therapies varies between women.
  • Estrogen protects skin from thinning and wrinkling, but physicians do not recommend HT for this purpose alone.

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How severe do my symptoms need to be before I consult a physician?

If you are having symptoms that are bothersome and have not been helped by some of the lifestyle changes that you have tried, you should talk to a physician. Your doctor will have a number of strategies to discuss with you, and will help you to find one that is right for you.

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What are the risks associated with hormone therapy?

The risks associated with hormone therapy (HT) depend very much on a woman’s personal health status. Your overall health, your family history and your age can have an impact on the risks you need to think about.  As well, ongoing health research is providing new insights all of the time. So assessing risk needs to be done with the support and guidance of a health professional.  Still, research and experience does tell us that women who take hormone therapy may face:

  • A small increase in the risk of deep vein thrombosis, or blood clots in the veins.
  • A risk of stroke for some older women, especially those with high blood pressure.
  • A greater potential incidence of heart disease for women who start HT after age 60.
  • A small increased risk of breast cancer for women who use HT for a long time.

The good news is that the risk of breast cancer returns to normal in long term users soon after they discontinue HT.

When considering hormone therapy and the risks, it is important to remember that while hormone therapy is usually offered to women to give them better quality of life, in some areas (e.g. endometrial cancers), HT actually reduces risks and offers protection.

Recent research shows that women who started hormone therapy around the time of menopause can reduce their risk of heart disease by about 40 per cent, but doctors don’t currently recommend HT as a means to address that issue alone.

Risk Factors for Breast Cancer

Risk Factors for Breast Cancer
Factor Baseline breast cancers* per 1,000 women Additional cancers per 1,000 women Total cancers per 1,000 women
No HT use (baseline) 45 0 45
5 years of HT use 45 2 47
10 years of HT use 45 6 51
15 years of HT use 45 12 57
Alcohol consumption
(2 drinks per day)
45 27 72
Lack of regular exercise
(<4 hours/week)
45 27 72
Late menopause
(10-year delay)
45 13 58
Body mass index
(10 kg/m2 increase)
45 14 59
Weight gain after menopause
(>=20 kg)
45 45 90

*Baseline or basic risk applies to all women and is due to factors that cannot be controlled (e.g., aging, gender)

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How long can I use hormone therapy and how will I know when to stop?

Health care professionals in Canada, armed with new research, can help women decide whether some type of hormone therapy (HT) would help them manage their menopause symptoms.  The kind of HT, and the length of time you take HT, are both things you need to talk over with your doctor. They will also have information about alternative therapies, and the impact of lifestyle issues such as diet, exercise, alcohol, smoking and caffeine, and what course of treatment will work best for you.

The Society of Obstetricians and Gynaecologists of Canada (SOGC) supports the recommendations of the 2006 Menopause Consensus Report, that hormone therapy be prescribed for the duration necessary to address menopause-related problems.

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I have heard that some women take The Pill (oral contraceptive medication) during menopause.  Is that a form of hormone therapy?

Low dose oral contraceptives are commonly prescribed to help women with perimenopausal symptoms.

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What is the Society of Obstetricians and Gynaecologists' position on hormone therapy use?

After carefully reviewing scientific research on hormone therapy from Canada and around the world, Canadian obstetricians and gynaecologists recommend hormone therapy as a safe option for most women who are experiencing a reduction in their quality of life due to the symptoms of menopause.

The Society of Obstetricians and Gynaecologists of Canada (SOCG) published a report in 2006, The Menopause Consensus Report, which says that hormone therapy may safely be prescribed in the dose and for the duration necessary to achieve treatment objectives, unless a woman has a specific risk factor for a specific disease or health condition.  The Society recommends that health care providers regularly review the risks and benefits of hormone therapy with their patients. Emerging advice is suggesting that for women under age 60 HT is a safe and reasonable choice.

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I have read a lot about the use of natural products to treat menopausal symptoms. Do they work?

A range of non-hormonal therapies (some that require prescriptions, others that do not) are available in the marketplace, and research continues in the search for additional menopause therapies that will give women more choices.  For example, complementary and alternative medicines, including black cohosh and red clover, are often suggested as a way to ease hot flashes and night sweats.

Unfortunately, there is very little scientific data about the long term effectiveness and safety of these products and therapies so it is a good idea to talk to a health care professional you trust to get some advice before you try them. 

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Where can I get more information about these alternative treatments?

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What else can I do to deal with troublesome symptoms?

All serious menopause symptoms should be discussed with a health professional, but common sense tells us that anything that helps reduce the body’s core temperature, for example, using a fan or wearing loose fitting clothing, drinking cold drinks, and installing ceiling fans, will help women suffering from hot flashes.  And since women in menopause often experience dramatic temperature changes in a short time frame, it’s a good idea to keep a shawl or sweater handy to deal with a sudden chill.

Equally, lifestyle changes such as exercising regularly and, quitting smoking, and relaxation techniques, may also be helpful when dealing with sleep disruptions, night sweats and hot flashes.  Some people try acupuncture or reflexology to help menopause symptoms, but there is no evidence-based research to prove that these treatments are going to work.

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SOGC

"I thought my mood swings would get better as I got older - no PMS- but I am still going through it. I didn’t know that this could be part of menopause."