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.
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]
Physiological
Biochemical
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]
[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