Strictly speaking, the symptoms of the menopause are those that identify the time leading up to the final bleed and this is usually called the peri-menopause. Symptoms can be physical and psychological in nature. Some of the symptoms are described as “acute” which are those that will occur immediately there is a reduction in the production of oestrogen, these include hot flushes, night sweats, dry vagina, dry hair and skin, insomnia, bladder problems and moodiness. The remainder are described as “chronic” and take place over a longer period of time, these include irregular periods, breast changes and other psychological symptoms.
All women that have a hysterectomy that removes their ovaries will begin to experience acute symptoms, even as early as 24 hours following surgery. Women whose operation has left their ovaries intact have a 50% chance of experiencing acute symptoms within five years of their surgery. If you have had surgery that leaves your ovaries intact and you begin to experience some of the symptoms described below you should make an appointment to see your GP or gynaecologist to have a simple blood test to measures the level of oestrogen in your blood.Physical symptoms may include irregular periods, they may vary in timing, they may be lighter or heavier and they may be a combination of these. Whatever your age heavy bleeding may also be a sign of something more serious and should be checked out with your GP.
Hot and cold flushes (flashes), sweating during the day and at night and palpitations are all known as Vasomotor symptoms. Exact causes of the vasomotor symptoms are unknown but it is thought probable that the hypothalamus, which regulates body temperature, is affected by the decrease in oestrogen production and this in turn dilates the blood vessels when it affects the sympathetic nervous system. It is thought that up to 80% of women will experience vasomotor symptoms.
Insomnia and headaches are secondary vasomotor symptoms and can occur as a result of night sweats which result in loss of sleep.
Changes in the vagina include a shortening, weakening of the skin, diminishing blood supply, changes in the acidity levels and dryness due to the reduction in secretions from the mucous glands. All of these can lead to pain on sex and increase the risk of bleeding and infection.
The bladder and urethra are also affected as the linings become thin and weak and stress incontinence can occur as they atrophy. This increases the risk of infection and bleeding.
Breast changes are as a direct result of the reduction in production of oestrogen. The breasts may become smaller and less elastic and the skin will become thinner and dryer.
The skin and hair become dryer and the elasticity of the skin reduces which increases the appearance of wrinkles. The changes in the skin are due to damaging effects on the connective tissue, collagen, when oestrogen production reduces.
Psychological symptoms are similar to those experienced with Pre-Menstrual Syndrome and may include: mood swings, irritability, anxiety, poor concentration, poor memory, loss of energy and depression.
Altogether it’s thought there are 33 different symptoms that may indicate you are menopausal and you can find a list of them here.
It cannot be confirmed at present whether these symptoms are caused by oestrogen deprivation or whether they are as a result of other physical symptoms, such as lack of sleep. However, some sleep disorders are helped by hormone replacement therapy, so there appears to be a link with oestrogen deficiency and some of the psychological symptoms.
Other sources of information about menopausal symptoms can be found at the following sites:
The Pocket Guide to Hysterectomy – £5.50 from The Hysterectomy Association. This is essential reading and tell you everything you need to know about the menopause after a hysterectomy.