Most of the time, when we speak of “menopausal symptoms,” we mean the hot flashes and night sweats that have traditionally been associated with the menopausal transition. These are collectively known in the medical literature as “vasomotor symptoms” and they are experienced by about 75% of women. However, the warning signs of menopause are often much more subtle and diverse than that.
Without realizing it, many women have already experienced some symptoms of menopause long before they reach the point of having hot flashes and night sweats. The earliest change is the onset of irregular menstrual periods. The variation in menstrual cycle length by more than seven days from their usual length marks the beginning of the early menopausal transition. By the time a woman has had more than two missed periods or has not had bleeding for more than 60 days, she has begun the late menopausal transition phase. Somewhere during this time, she is likely to experience the onset of hot flashes, night sweats, or both. She may also begin to experience vaginal dryness with intercourse. The vagina is the most estrogen-sensitive part of the body, and the effects of a declining estrogen level are often felt there first.
Hot flashes are recurrent episodes of flushing associated with a feeling of heat that can be mild or intense, and they chiefly involve the upper body and face. During these episodes, the body suddenly releases heat. This can result in a lowering of the body’s core temperature, which means that the release of heat is often followed by a chill. The same phenomenon can occur at night; with the combination of nightclothes, sheets, and blankets, women can experience intense sweating with these episodes. They often throw the covers back, only to become very cold from a combination of the usual post-flash chilliness and the evaporation of sweat. They then pull the covers up again, and the cycle can repeat itself numerous times during the night. This leads to poor sleep and a feeling of fatigue upon awakening. Inadequate sleep can interfere with forming new memories, hence many women complain of memory problems. Poor sleep can also cause some women to have headaches and to be irritable.
So here we have a symptom complex of hot flashes, night sweats, vaginal dryness, poor-quality sleep or insomnia, fatigue, memory issues, headaches, and irritability. It’s a lot more complex than commonly thought! The good news is that there are many different ways of treating these symptoms. Women today have many options, including nonhormonal as well as hormonal (including bioidentical hormones) management. There are many herbs and supplements that may be helpful, and often prescription medication is not needed. The most important thing that a woman can do at this time of life is to seek reliable information, and to discuss any questions that she cannot answer for herself with a healthcare provider who has an interest in menopausal issues.