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October 13, 2021

Menopause Part 4: Identifying Menopause Signs and Symptoms

Welcome to part 4 of the ODX Menopause Series. In this post, the ODX Research team reviews the signs and symptoms of menopause that are common to so many women.

The ODX Menopause Series

  1. Menopause Part 1: A Quick Overview of a Slow Process
  2. Menopause Part 2: Biology and Physiology of Menopause
  3. Menopause Part 3: Increased Risk of Disease Associated with Menopause
  4. Menopause Part 4: Identifying Menopause: Signs and Symptoms
  5. Menopause Part 5: Laboratory Evaluation of Menopause
  6. Menopause Part 6: Cardiovascular Risk in Menopause
  7. Menopause Part 7: Beyond Hormone Testing in Menopause
  8. Menopause Part 8: Natural Approaches to Menopause
  9. Menopause Part 9: Diet and Nutrition Intervention in Menopause
  10. Menopause Part 10: Characteristic of Herbal Derivatives used to Alleviate Menopause Symptoms
  11. Menopause Part 11: Lifestyle Approaches to Menopause
  12. Menopause Part 12: The National Institute on Aging Addresses Hot Flashes
  13. Menopause Part 13: Hormone Replacement Therapy (HRT) in Menopause
  14. Menopause Part 14: North American and European Guidelines for Hormonal Management of Menopause
  15. Menopause Part 15: Bioidentical Hormone Therapy
  16. Menopause Part 16: Optimal Takeaways for Menopause
  17. Optimal The Podcast - Episode 10

Some women glide through menopause without disruptive symptoms while some experience unbearable discomfort that needs to be addressed.

For many women, changes in mood and sleep patterns characterize the perimenopausal period and can extend throughout menopause. The transition from pre-to postmenopause can take up to four years.[1]

Approximately 80% of women transitioning into menopause will have symptoms though not all will seek intervention. The most disruptive appear to be vasomotor symptoms such as night sweats, hot flashes, and sleep disruption.[2] Researchers suggest that menopausal vasomotor symptoms may reflect adverse vascular changes. Therefore, risk of endothelial dysfunction should be assessed as well.[3]

Signs and Symptoms of Perimenopause and Menopause [4] [5] [6] [7] [8] [9] [10] [11] [12] [13] [14]

Physiological

  • Back pain
  • Bone density loss, bone pain
  • Cognitive decline
  • Decreased libido, decreased sexual function
  • Dental caries
  • Depression
  • Difficulty concentrating
  • Dry mouth/ xerostomia, burning mouth
  • Elevated heart rate
  • Emotional distress
  • Genitourinary syndrome of menopause (GSM)
  • Headaches
  • Gingival atrophy
  • Jawbone osteoporosis
  • Joint pain, aches, or stiffness
  • Loss of lean body mass
  • Mood changes, mood swings
  • Osteopenia, osteoporosis
  • Palpitations
  • Periodontitis
  • Psychological distress
  • Sarcopenia
  • Sexual dysfunction
  • Skin lesions
  • Sleep disruption, insomnia
  • Taste changes
  • Vaginal dryness, discharge, itchiness or irritation
  • Vasomotor (hot flashes/flushes, night sweats)
  • Visceral and abdominal adiposity
  • Weight gain, obesity

Biochemical

  • Dyslipidemia
  • Glucose intolerance
  • Hyperinsulinemia, insulin resistance
  • Inflammation
  • Decreased estradiol, progesterone, AMH, adiponectin, HDL-C
  • Increased triglycerides, total cholesterol, LDL, VLDL, FSH, leptin, proinflammatory markers

The Menopause Rating Scales (MRS) is a validated tool for assessing menopause-related symptoms categorized as:[15]

Somatic

Psychological

Urogenital, sexual

Cardiac discomfort

Hot flashes

Joint issues

Muscle issues

Sleep issues

 Anxiety

Depressed mood

Exhaustion, physical & mental

Irritability

Bladder issues

Vaginal dryness

Vasomotor Symptoms

Vasomotor symptoms occur in 80% of perimenopausal women and are the most common complaints that drive a woman to seek intervention and relief.[16] Although hormone replacement therapy may be the most effective at relieving these symptoms, it may be contraindicated in some women (e.g., breast cancer survivors), or rejected by others due to potential adverse health effects. A trial period of 2-4 weeks of non-hormonal intervention will indicate if a non-hormonal approach is efficacious.[17]

Hot flashes/flushes appear to occur due to an abrupt decrease in serum estrogen, fluctuations in neurotransmitters such as serotonin and norepinephrine, and peptides neurokinin-B and calcitonin gene-related peptide.[18]

Headache

The hormonal changes associated with menopause may trigger headaches or even migraines in some individuals. Unfortunately, for individuals with a history of headaches or migraine, menopause may make symptoms worse.

A 2018 review notes that for individuals with aura-associated migraines, hormone replacement therapy may increase ischemic stroke risk and may be contraindicated. Other non-hormonal therapies may provide some relief, including black cohosh, vitamin E, acupuncture, yoga, and aerobic exercise.[19] If estrogen therapy is used for migraine without aura, transdermal delivery is recommended.[20]

References

[1] Honour, John W. “Biochemistry of the menopause.” Annals of clinical biochemistry vol. 55,1 (2018): 18-33. doi:10.1177/0004563217739930

[2] Hickey, Martha, Rebecca A. Szabo, and Myra S. Hunter. "Non-hormonal treatments for menopausal symptoms." bmj 359 (2017).

[3] Hale, Georgina E et al. “The perimenopausal woman: endocrinology and management.” The Journal of steroid biochemistry and molecular biology vol. 142 (2014): 121-31. doi:10.1016/j.jsbmb.2013.08.015

[4] Honour, John W. “Biochemistry of the menopause.” Annals of clinical biochemistry vol. 55,1 (2018): 18-33. doi:10.1177/0004563217739930

[5] Kaya, Cihan et al. “The relation among steroid hormone levels, lipid profile and menopausal symptom severity.” Journal of psychosomatic obstetrics and gynaecology vol. 38,4 (2017): 284-291. doi:10.1080/0167482X.2017.1321633

[6] Neves-E-Castro, Manuel et al. “EMAS position statement: The ten point guide to the integral management of menopausal health.” Maturitas vol. 81,1 (2015): 88-92. doi:10.1016/j.maturitas.2015.02.003

[7] Johnson, Alisa et al. “Complementary and Alternative Medicine for Menopause.” Journal of evidence-based integrative medicine vol. 24 (2019): 2515690X19829380. doi:10.1177/2515690X19829380

[8] Hale, Georgina E et al. “The perimenopausal woman: endocrinology and management.” The Journal of steroid biochemistry and molecular biology vol. 142 (2014): 121-31. doi:10.1016/j.jsbmb.2013.08.015

[9] Lab Tests Online Menopause Testing. Last reviewed April 30, 2021. Accessed July 18, 2021.

[10] Agha-Hosseini, Farzaneh, and Iraj Mirzaii-Dizgah. "Serum progesterone level in menopausal women with oral dryness." Majallah i Dandanpizishki (Journal of Islamic Dental Association of Iran) 22.1 (2010).

[11] Zovari, Fatemeh et al. “Evaluation of Salivary and Serum Total Antioxidant Capacity and Lipid Peroxidation in Postmenopausal Women.” International journal of dentistry vol. 2020 8860467. 17 Nov. 2020, doi:10.1155/2020/8860467

[12] Ko, Seong-Hee, and Hyun-Sook Kim. “Menopause-Associated Lipid Metabolic Disorders and Foods Beneficial for Postmenopausal Women.” Nutrients vol. 12,1 202. 13 Jan. 2020, doi:10.3390/nu12010202

[13] Chen, Li-Ru, and Kuo-Hu Chen. “Utilization of Isoflavones in Soybeans for Women with Menopausal Syndrome: An Overview.” International journal of molecular sciences vol. 22,6 3212. 22 Mar. 2021, doi:10.3390/ijms22063212 This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license ().

[14] Stute, Petra et al. “Management of depressive symptoms in peri- and postmenopausal women: EMAS position statement.” Maturitas vol. 131 (2020): 91-101. doi:10.1016/j.maturitas.2019.11.002

[15] Kaya, Cihan et al. “The relation among steroid hormone levels, lipid profile and menopausal symptom severity.” Journal of psychosomatic obstetrics and gynaecology vol. 38,4 (2017): 284-291. doi:10.1080/0167482X.2017.1321633

[16] McCormick, C A et al. “Managing vasomotor symptoms effectively without hormones.” Climacteric : the journal of the International Menopause Society vol. 23,6 (2020): 532-538. doi:10.1080/13697137.2020.1789093

[17] Hickey, Martha, Rebecca A. Szabo, and Myra S. Hunter. "Non-hormonal treatments for menopausal symptoms." bmj 359 (2017).

[18] Li, Mingdi et al. “Chinese herbal formulae for the treatment of menopausal hot flushes: A systematic review and meta-analysis.” PloS one vol. 14,9 e0222383. 19 Sep. 2019, doi:10.1371/journal.pone.0222383

[19] Lauritsen, Clinton G et al. “Current Treatment Options: Headache Related to Menopause-Diagnosis and Management.” Current treatment options in neurology vol. 20,4 7. 6 Mar. 2018, doi:10.1007/s11940-018-0492-7

[20] Shuster, Lynne T et al. “Hormonal manipulation strategies in the management of menstrual migraine and other hormonally related headaches.” Current neurology and neuroscience reports vol. 11,2 (2011): 131-8. doi:10.1007/s11910-010-0174-7

 

 

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