Some women don't have any symptoms during menopause or only have a few symptoms. Others develop disturbing and even severe, disabling symptoms. Studies of women around the world suggest that differences in lifestyle, diet and activity may play a role in the severity and type of symptoms women have during menopause. Symptoms can be noticed for several months to years before the last menstrual period and can continue for several years after.
Symptoms of menopause or perimenopause include:
Hot flashes — A hot flash is a feeling described as suddenly being hot, flushed and uncomfortable, especially in the face and neck. Hot flashes come in bursts or flushes that usually last a few seconds to a few minutes. They are caused by changes in the way blood vessels relax and contract and are thought to be related to the changes in a woman's estrogen levels.
Irregular periods — A woman can have irregular periods for several months to years before her periods finally stop. Any vaginal bleeding that develops after a year of no periods is abnormal and should be evaluated by a doctor. Heavy or prolonged bleeding during the perimenopause should also be evaluated.
Vaginal drying — As estrogen levels fall, the vagina's natural lubricants decrease. The lining of the vagina gradually becomes thinner and less elastic (less able to stretch). These changes can cause sex to be uncomfortable or painful. They can also lead to inflammation in the vagina known as atrophic vaginitis. These changes can make a woman more likely to develop vaginal infections from yeast or bacterial overgrowth and urinary tract infections.
Sleep disorders — Sleep often is disturbed by nighttime hot flashes. A long-term lack of sleep can lead to changes in moods and emotions.
Depression — The chemical changes that happen during menopause do not increase the risk of depression. However, many women experience major life changes during their middle age including menopause and sleep disturbances, which can increase the risk of developing depression.
Irritability — Some women report irritability or other mood changes. Irritability is commonly caused by poor sleep resulting from nighttime hot flashes. A number of women, however, do not feel irritable.
Osteoporosis — This condition is a thinning of the bones that increases the risk of fracturing a bone, especially in the hips or spine. As estrogen levels drop and remain low during menopause, the risk of developing osteoporosis increases. The risk is greatest for slender, white or light-skinned women. You can help prevent osteoporosis by getting enough vitamin D through sunlight or a daily multivitamin, eating a diet rich in calcium and performing regular exercise. Women should start taking these actions well before menopause begins. This is because women begin to lose bone mass as early as age 30 but fractures resulting from osteoporosis don't occur until 10 to 15 years after menopause.
Cardiovascular disease — Before menopause, women have lower rates of heart attack and stroke than men. After menopause, however, the rate of heart disease in women continues to rise and equals that of men after age 65.