Around the time of the menopause the most common symptom is hot flushes. A typical flush starts suddenly and often for no apparent reason, though many women recognize that some flushes follow triggers such as hot drinks, alcohol, spicy or hot foods, getting flustered or anxious, rushing, or getting too hot in bed. A feeling of heat develops in the face, accompanied by flushing and often a tingling skin sensation. The hot feeling and flushing spread to the neck, trunk and upper arms -sometimes the whole body. The flush starts to subside within a few minutes; then you break out in a cold sweat, which is often profuse.
Flushes classically occur at night but can also be frequent during the day. They may be mild and infrequent or can happen several times each hour and be very distressing. They disturb sleep (many women need to change nightgowns – and sometimes sheets! – drenched with sweat) and daytime activities; I’ve known women who had to carry one or more spare shirts to work. Other physical symptoms dependent on loss of oestrogen include headaches, palpitations, skin eruptions, prickling skin sensations, genital and vaginal dryness, loss of libido, painful sex and worsening of bladder control.
Psychological symptoms include insomnia, lack of energy, irritability, tearfulness, anxiety, depression, lack of concentration, poor short-term memory, confusion and loss of confidence. Many of the psychological symptoms are linked with physical effects of a lack of oestrogen.
Without treatment, menopausal symptoms may last from a few months to many years after the last period. Most diminish with time but some, such as those due to the effect of lack of oestrogen on bones and in the genital and vaginal epithelium, progress as you get further beyond the menopause.
Do all women have menopausal symptoms?
No. About 15 per cent have no health disturbance around the time menstruation stops. These women are usually the more plump amongst us who have more body fat in which to convert adrenal hormones to oestrogen. The majority of women have some mild symptoms that are not too distressing. Twenty-five per cent of women have symptoms that really disturb their lives and health. In general, thin women suffer more. However, body
shape is not necessarily a good predictor of severity of symptoms.