The menopause can be a difficult time for both women and their partners/families. The mood swings and uncomfortable range of feelings experienced during this time can be surprisingly debilitating, causing distress and anxiety which can put pressure on relationships.
A combination of altered hormone levels due to a variety of factors can lead to short term symptoms and long term health problems. These symptoms are explained in more detail below:
These are commonly known as hot flushes and night sweats as the blood vessels dilate, but also the heart rate increases (palpitations) and body temperature control becomes erratic. Palpitations may be associated with panic feelings due to the increased adrenaline drive. If these occur whilst asleep then deep sleep will be interrupted and the individual will sleep lightly or badly all night waking feeling unrefreshed and exhausted and may report vivid dreams due to remaining in a state of semi-wakeful, restless dreaming sleep or REM sleep (rapid eye movement sleep REM) rather than going through the normal cycle of light (REM) sleep and deep (non-REM) non-dreaming sleep.
These include persistent tiredness, often worst in the morning due to absence of normal cyclical sleep but especially due to reduced non-dreaming sleep. A tell-tale sign is an increased difficulty in ‘getting going’ feeling depressed or low first thing in the morning. This then recurs mid to late afternoon as cortisol levels gradually and naturally decline. This is also associated with profound lack of energy, motivation and drive. Tasks which previously seemed straightforward now become monumentally difficult. Short term memory and especially ‘word-blindness’ occur with an increasing inability to concentrate.
Negative feelings occur with loss of self worth and self-esteem and occasionally agoraphobia and claustrophobia. Sudden changes in mood can occur as tolerance levels are very low. This ‘flying off the handle’ may be out of character or an exacerbation of previously existing characteristics with control of the situation being minimal.
Clumsiness, reduced reaction time and lack of ability to judge distance can occur with a woolly ‘out of body’ feeling. Many of these so called psychological symptoms have been attributed to the known reduction of blood flow to the brain during oestrogen deprivation as the blood vessels constrict, however, there is increasing evidence that chronic sleep disturbance may be responsible even if it is not obvious that sleep quality is impaired.
Persistently high levels of insulin lead to fluctuating glucose levels with feelings of nausea, shakiness or giddiness, hunger, carbohydrate craving and loss of a feeling of fullness after a meal. This interferes with the usual signals of satiety or ability to tell whether a person is hungry or not which can lead to eating disorders of any type due to confused messages. Fasting or random glucose levels are often in the normal range as it is the insulin response that is disordered although a glucose tolerance test may be abnormal.
In females, these symptoms are in the short-term worst pre-menstrually and they may occur in most women in this phase of the menstrual cycle but with poor quality ovulation may occur constantly with an exaggerated response premenstrually and make attempts to lose or control weight virtually impossible. Abnormal insulin responses lead to symptoms suggestive of low glucose levels but eating or drinking more carbohydrate or glucose simply worsens the insulin response perpetuating the problem. High levels of insulin increase fat deposition in the body generally but especially in the central abdomen (male distribution) and also around the body organs (liver, heart). This is nearly always associated with abnormal levels and ratio of cholesterol with an increased risk of cardiovascular disease.
The base of the bladder, where the nerve endings arise, are sensitive to changes in hormones becoming more irritable and less able to hold large volumes of urine than previously. The symptoms include urgency, frequency and getting up at night to pass urine, the so-called urethral syndrome. Stress incontinence has also been observed to worsen at times of low sex hormone production in men and women. In women especially the symptoms worsen premenstrually and as connective tissue becomes weak at that time prolapse worsens due to weakening of the pelvic floor muscles. In females, therefore, local oestrogen treatment (creams, pessaries, rings) can be used to improve the strength and health of the area even if the individual is already being treated with hormone replacement therapy.
In men and women the addition of bladder relaxants such as Oxybutynin and Detrusitol may reduce the bladder irritability on their own or in addition to hormonal treatments.
The muscular layer of the bowel wall is sensitive to sex hormones and lack of oestrogen in females stops the muscular contractions of the gut so preventing the bowel from moving matter forward. The bowel, therefore, distends and becomes bloated and full of gas and this can be excruciatingly painful. Eventually the bowel will contract in reaction to the increased diameter and this will cause spasm and further pain.
As faecal matter is not moving forward, it remains in the bowel and water is absorbed from it so that it becomes harder and therefore even more difficult to move forward. Early morning or, indeed, constant nausea may occur along with a metallic taste in the mouth and constipation and occasional diarrhoea (IBS – Irritable Bowel Syndrome).
Many individuals experience a marked increase in bowel related symptoms after carbohydrate or sugar load which may be perceived as being due to allergy to a particular food product. Instigating changes such as reduction in some carbohydrates especially wheat, can affect the hormone profile leading to improved bowel symptoms.
Connective tissues (skin, joints, hair)
Oestrogen and testosterone both impact on connective tissue and when their levels decline, symptoms may occur including joint pains after resting, dry mucous membranes (eyes, mouth, nose, ears, vagina) and this may also have an impact on connective tissue throughout the body (loss of hair, dry skin, itchy skin, brittle nails). Reduced connective tissue (collagen) in the pelvic floor also increases the risk of prolapse even in young women. In women who have undergone vaginal repair recurrence of prolapse will occur if the strength of the vaginal skin and muscle is not maintained.
Whilst many of these symptoms can be improved with use of hormone replacement, dietary changes are as important.
The blood vessel muscular wall is also very sensitive to hormone levels which if reduced can lead to spasm of the vessel and this, in turn, can result in deprivation of oxygen and nutrients to the tissue normally supplied by that blood vessel. Headaches and migraines, will therefore often worsen at times of relative low hormone production. In females this is most common pre-menstrually and during the menstrual cycle and often occurs more commonly during reduced ovulation such as with PCOS and during the peri-menopause and after the menopause.
Cramp-like chest pains may occur (males and females) even when the blood vessels are otherwise healthy due to constriction of the vessel supplying the heart muscle and leg cramps or restless legs can also occur for the same reason and often at the same time. Often a hot flush or panic feeling will be accompanied by a profound headache indicating hormonal dysfunction at the time.
You may find it useful to complete our Symptoms Questionnaire
We will arrange an individual consultation during which a detailed history will be taken and possibly an examination made. Further investigation including ultrasound scans and blood tests may be advised in order to confirm your diagnosis.
Individual hormone tailoring for hormonal imbalance will also benefit:
Treatments are tailored to your individual needs and may include specialist dietary advice, sensitive and sympathetic explanation with a targeted treatment plan of hormone replacement can provide great relief.
Some products such as testosterone cream (for tiredness, joint problems, low sex drive) are not licensed for use in this country although they are in Europe and the U.S.A . These products are imported and dispensed on a named patient basis with excellent results.
Helping you to manage the menopause
We treat each individual patient with care and consideration. We listen to your worries and concerns and offer expert advice and guidance so that you can make informed decisions about your treatment options.
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