• 9 Signs You're Approaching Menopause

    by Renee Cotter, MD
    on Nov 4th, 2015

This week we’ll discuss 9 signs that indicate that - yes finally - you may be approaching menopause. All women are different in the age that they go through menopause and it is actually already determined by the time you are still a growing fetus in your mother’s womb.

 

About Menopause

Even before you’re born, your eggs already begin to slowly die off. By the time you’re born, 70 to 80% of your eggs are already gone, leaving you with 1 to 2 million eggs for the entirety of your life. Each month, beginning around age 12, this number decreases by one - sometimes by two or three (hello twins and triplets). This process (ovulation) combined with natural egg degradation occurs continually until you slowly begin to run out. Studies have shown that by age 30, 90% of your eggs are already gone.

As you approach the last of your eggs, your body begins to go through changes. Your Estrogen levels gradually fall while the levels of another hormone, follicle stimulating hormone (FSH), begin to increase. Basically FSH is trying to tell your ovaries to keep producing eggs while Estrogen is saying “we’re all out, I’m not needed here”. Sometimes your body will suddenly find another egg causing this balance in hormones to shift briefly before reverting back to the low Estrogen, high FSH levels. It is this change in hormones that causes all the sign and symptoms of menopause that so many women dread getting or have come to loath. Once you’ve gone 12 months without a period, you will be considered to be in menopause.


9 Signs of Nearing Menopause

Since you can’t measure your hormone levels at home, there are several signs that indicate that you may be approaching menopause. Not every woman experiences these signs, and every woman experiences a different mix of these. In the few years approaching menopause, women will typically experience many symptoms which worsen as true menopause approaches.

1. Irregular Periods

Your periods seem to be all over the place. They seem to be shorter in length, but then sometimes missing altogether. You’ve definitely gone a month or two without a period. This is a telltale sign of approaching menopause. For most women, length of your menstrual cycle shortens to around 21 to 26 days and missed periods are very common. It becomes nearly impossible to track your period. Changes in flow are also common. A period that gradually lightens in flow is normal, however some women will experience a heavier flow. An increase in flow often represents a uterine issue which also typically arises at this time. Change in flow depends on your body and any other uterine issues that may be present. If your periods are becoming seriously irregular: cycles shorter than 21 days, bleeding for longer than 10 days, or soaking through a pad or tampon in an hour or less, there may be other more serious issues causing these irregular periods.

2. Difficulty Sleeping

Lying in bed, ticking away the minutes until the minutes turn into hours. Sound familiar? Difficulty sleeping is a common symptom of menopause. Some women will have difficulty falling asleep, while others will wake up during the middle of the night and be unable to fall asleep for hours. This is typically caused by the change in your hormones. Oftentimes, for women with this sign, a low dose Hormone Replacement Therapy (HRT) will help to improve their symptoms. Progesterone, one of the hormones in HRT naturally makes you drowsy and is good to take before bed. Other people have found that natural treatments like melatonin have helped them fall asleep more easily.

3. Irritability and Mood Problems

Suddenly, everyone is rude to you, all the drivers on the road are idiots, and your dog is barking way louder than usual; everything is just wrong somehow. Perhaps, your changing hormones are the true culprit. Actually, studies have shown that the irritability and mood problems may be stemming from several causes including the lack of sleep mentioned above, kids moving away from home, aging parents, falling serotonin levels, and other issues that arise in your late 40s and early 50s.

4. Decreased Libido

It seems like lately you just have no desire to engage in sex. It doesn’t seem appealing, you’re not in the mood, you try but it’s not exactly working or improving the mood. Whatever the feeling, decreased libido is another sign that you may be approaching menopause. Like other signs, there may be several reasons for this decreased libido and really requires you to look carefully into your life to discover the other contributors to this issue. Possible contributors are stress in the relationship, increased demands at work, children moving away, problems with other family members, perhaps even poor weather may contribute. Hormonally, a decrease in libido may be caused by the fall in Estrogen and/or the fall in Testosterone.

5. Weight Gain

You’re eating the same amount. You’re exercising the same, maybe even more. Nothing has changed! But your weight has gone up and your waistline has seemed to disappear. Steady but uncontrolled weight gain around the belly is a sign of approaching menopause. As estrogen drops, women begin to gain weight around the midsection. Studies have shown that estrogen protects against weight gain around the belly. Gaining weight in this area is particularly risky because it severely increases the risk of heart disease. Another contributor to weight gain at this time is that as you age, your metabolism naturally slows. This requires you to reduce the amount of calories you consume as well as increasing the intensity of your physical activity.

6. Brain Fog

As women near menopause, oftentimes they describe being more forgetful and unable to concentrate. Where are the keys? Who was I supposed to call back? What did I need for that casserole? It really does feel as though your brain is just not functioning! This brain fog is due to a drop in estrogen.Some speculate that this may contribute to Alzheimer's Disease and thus, HRT may offer protection against Alzheimer’s.

7. Hot Flashes and Night Sweats

Perhaps the most popular signs of menopause are hot flashes and night sweats, beginning up to 10 years before true menopause sets in. In the early stages of menopause, hot flashes and night sweats begin a few days before menstruation and then finish after menstruation ends. They are described as a feeling of heat bubbling up from your core and engrossing your whole body, causing you to flush red and to sweat uncontrollably. At night, you may wake up during the middle of the night, sweating and hot, as though you had a high fever. These two symptoms are a very common sign of menopause, affecting 85% of women, and may last anywhere from a few seconds to several minutes. Some women may get many in just one hour, while others will only get them a few times a month. Again, these hot flashes and night sweats are caused by your changing hormones, however stress is known as a large contributor to this symptom. Therefore, reducing stress may help with hot flashes. HRT, however, is one of the best methods to reduce hot flashes and night sweats for most women. For those unable to use hormones or those with a fear of hormones, non-hormonal options are also available.

8. Painful Intercourse

Another sign of approaching menopause is increasing pain with intercourse at the vaginal opening. When Estrogen falls, moisture and elasticity drops in the vaginal area. A lack of moisture in the area causes dryness and tighter tissues. Thus, intercourse can be painful. This symptom is most common once menopause has already begun, but some women will experience it as it nears. Some women may even split from intercourse. Fortunately, this is able to be treated, most easily, with Estrogen applied to the vagina. There are some non-hormonal options that are also available, but are typically less effective. You should also be encouraged to continue sexual activity to help blood flow to the tissue, though it may be difficult to engage at the time.

9. Increased UTIs

If it seems as though the frequency of Urinary Tract Infections (UTIs) has been increasing unexplainably, you may be nearing menopause. This sign, like painful intercourse, is another side effect of vaginal dryness, so it is less common in the approaching time to menopause and more common once actual menopause has hit. Loss of Estrogen causes vaginal dryness and also thins the skin of those tissues. This thinning of the tissues creates the potential for more E. coli to be pushed from your rectum/anus towards your urethra. These E. coli will then start to live and grow in the urethra, causing an infection, and symptoms such as increased frequency of urination, burning at the end of urination, and more. Like painful intercourse, this may also be treated with a topical vaginal estrogen.


Conclusion

Overall, as you near menopause, your body is going through a series of hormonal changes, all related to your body running out of eggs. Simultaneously, around that time of your life, you may be experiencing other changes and stresses that contribute to your symptoms. Though your Estrogen and Testosterone drop and FSH rises, more responsibility at work, children moving away from home, the sickness of a parent, and more may be adding to the signs you are feeling. 9 common signs of menopause are irregular cycles, difficulty sleeping, irritability and mood problems, decreased libido, weight gain, brain fog, hot flashes and night sweats, painful intercourse, and increased UTIS. All women are different with the signs they are experiencing, however any one or combination of these signs may be a way that your body is hinting to you that it may be that time in your life. But don’t fret! Many women experience a lift and an increase in happiness and freedom around this time too. It’s simply a new era in your life and you and either embrace it with a smile, or bear through it. ​

Author Renee Cotter, MD

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San Fernando Valley

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Renee Cotter, MD
7320 Woodlake Ave
Suite 160
West Hills, CA 91307