Hot flashes, flushes, or night sweats are the most common characteristics of menopause. Some women experience a simple warming sensation throughout the body. Others feel acute flushes that begin with a sensation of pressure in the head similar to a headache, which then leads to a feeling of heat or burning in the face, neck, and chest, followed immediately by an outbreak of sweating. In most cases, hot flashes are mild and disappear after a year or two. But the frequency can vary from 1 or 2 a week to 1 or 2 per hour, and a few women experience them acutely for as long as 2 or 3 years.
The exact physiological cause of this upset in body temperature control is not yet known. Low estrogen levels alone are not responsible; it appears that estrogen must be present, and then withdrawn, for hot flashes to occur. The feeling may be precipitated by a hormonally induced imbalance in the body's temperature- control center, resulting in a drop in core body temperature and a subsequent attempt by the body to activate heat centers to re-adjust the body's "thermostat." (See "Five Common Problems and Their Remedies" for potential treatments.)
Short term memory loss has been cited as a problem by women in midlife, although this phenomenon has not been carefully documented and memory lapses have not as yet been linked to changing hormone levels during menopause. Forgetfulness may be related to stress or lack of sleep. Anecdotal reports suggest that memory problems in the perimenopausal period tend to disappear after menopause. If the problem persists, you should see your doctor.
Emotional issues loom large for many women during menopause, but contrary to previous conventional wisdom, studies now show that there is no increase in serious psychiatric disorders in women experiencing menopause. Minor emotional distress, however, may be a natural response to the changes a woman faces during this period.
Two changes in physical function that occur around the time of menopause may take a particularly heavy toll on a woman's psychological state. Hot flashes may keep you up at night, leading to chronic sleep deprivation which can reduce your mental and coping abilities. Vaginal changes that result in painful intercourse may interfere with your sexual pleasure and psychological health. There may also be other factors, currently unknown, that create coping challenges for women in the years immediately surrounding menopause.
Weight gain, while a common occurrence around menopause, has not been shown to be directly related to hormonal changes. There is a natural redistribution of fat over the abdomen and hips. That may be due in part to changes in the endocrine system; but weight gain most likely results from reduced muscle tone, reduced physical activity, increased appetite and calorie intake, and other effects of the aging process. Increased physical activity and a nutritious, balanced diet, can minimize weight gain.
Heart Health
Women rarely die of heart disease before menopause because estrogen provides protection against it—partially by helping to keep cholesterol levels in check. For reasons not completely understood, there is a relationship between hormone levels and the development of the plaque-like substances inside the blood vessels that can cause blockage and lead to heart disease.
A women's risk of cardiovascular disease rises dramatically after menopause. Surgical menopause likewise increases the risk for heart disease, even in young women. In fact, the younger a woman is when her ovaries stop functioning, the greater her risk for heart attack and although women tend to worry more about breast cancer, heart disease is considerably more lethal—it is the number one killer of American women. One in seven women, ages 45 to 64, has some form of heart disease. This number increases to one in three over the age of 65.
Thus menopause itself is a risk factor for cardiovascular disease, along with high blood pressure, smoking, family history, poor diet, high blood cholesterol, diabetes, and obesity. Hormone replacement therapy (HRT) may help to promote cardiovascular health; but reducing the risk factors that are within your control can be equally important. Proper nutrition, regular exercise, maintaining your proper weight, and quitting smoking are key strategies for ensuring your cardiovascular health during midlife and beyond.
Bladder Control
Women in peri- and postmenopause may experience mild stress incontinence, defined as the loss of a little urine in response to sudden muscular stress, such as jogging, sneezing, coughing, laughing, or emotional distress. Many women also experience urge incontinence, the sensation that they need to urinate with great urgency, even though the bladder may be empty. These problems occur when declining estrogen levels cause cell deterioration and diminished muscle control in the urethra, bladder, and vagina.
Severe incontinence problems are rare and are not related to menopause. If incontinence goes beyond the mild form usually associated with menopause, you should see your doctor for proper diagnosis and treatment. (See "Five Common Problems and Their Remedies" for exercises that help prevent or treat incontinence.)
Repeated urinary tract infections (UTIs), are also common in menopausal women. The deterioration of cells in the urinary tract produces an easily torn and bruised surface, creating a hospitable environment for the bacteria that cause UTI.
