Photo Credit: by Sam, flickr.com
Menopause marks a significant transition in a woman’s life, a natural phase that brings not only the end of menstrual cycles but also a host of other health concerns. For years, it was a topic rarely discussed in detail, but things have changed and women everywhere are becoming more educated about it. While menopause is often discussed in hushed tones, understanding its most common symptoms is vital for women trying to navigate this period.
Beneath the physiological changes lies a fascinating story about estrogen, a hormone that has quietly protected the heart, joints, and even mood for decades. As estrogen levels decline, its protective shield begins to wane, revealing vulnerabilities to specific health conditions.
This article explores five common symptoms associated with menopause, delves into the vital roles estrogen plays in safeguarding women’s health, and highlights both natural and medical strategies for managing this transformative stage.
1. Fatigue
Fatigue is one of the most frequently reported symptoms of menopause. Unlike ordinary fatigue, menopausal fatigue can be persistent, overwhelming, and sometimes unpredictable, affecting both physical stamina and mental clarity. Many women describe it as a deep, unrelenting exhaustion that doesn’t improve with rest and can often interfere with work, relationships, and daily activities.
Why Does Fatigue Occur During Menopause?
The primary driver behind menopausal fatigue is the decline in estrogen levels. Estrogen plays a crucial role in regulating energy by supporting healthy sleep patterns, maintaining stable blood sugar, and influencing neurotransmitters in the brain that regulate alertness and mood. As estrogen levels diminish, these systems become disrupted, leading to poor sleep quality, lower energy reserves, and increased feelings of tiredness.
https://www.webmd.com/healthy-aging/what-to-know-about-menopause-fatigue?utm
2. Hot Flashes
Hot flashes are among the most recognizable and disruptive symptoms of menopause, affecting up to 85% of women during the transition. They are commonly characterized by sudden, unpredictable, and intense feelings of warmth–often accompanied by sweating, flushing, and sometimes even anxiety or chills. Hot flashes typically last between one and five minutes and can occur multiple times daily or at night. Nighttime episodes, known as night sweats, often disrupt sleep and contribute to daytime fatigue.
What Triggers Hot Flashes?
Estrogen plays a role in the regulation of body temperature by the hypothalamus. The reduction in estrogen disrupts this temperature balance causing the body to become more sensitive to slight changes in core temperature, triggering a rapid dilation of blood vessels and a sensation of overwhelming heat. Other factors, such as genetics, lifestyle, and certain medical conditions, can influence the frequency and severity of hot flashes.
3. Insomnia/Sleep Problems
Problems sleeping is a hallmark of menopause, with more than half of menopausal women reporting trouble falling or staying asleep. Insomnia can manifest as difficulty drifting off, tossing and turning, and frequent nighttime awakenings. They can also wake up too early and be unable to return to sleep. These disturbances not only leave women feeling unrested, but also contribute to daytime fatigue, irritability, and difficulty concentrating.
Why Does Sleep Suffer?
The decline in the hormones estrogen and progesterone during menopause plays a key role in sleep problems. Estrogen helps regulate the sleep-wake cycle and promotes deep, restorative sleep. Progesterone, on the other hand, has natural sedative effects that support relaxation. As these hormone levels drop, women become more susceptible to insomnia.
https://pmc.ncbi.nlm.nih.gov/articles/PMC8034540/?utm
4. Joint and Bone Issues
Joint pain and stiffness are surprisingly common symptoms during menopause, affecting more than half of women as they transition through this stage of life. Many women report aching, swelling, or a sense of stiffness in their knees, hands, hips, and other joints, sometimes mistaking these symptoms for signs of aging or overuse. Frozen shoulder is also quite common. The discomfort can range from mild and occasional to persistent and severe, often impacting daily activities and overall quality of life.
Why Do So Many Women Experience Joint Pain During Menopause?
Again, the primary culprit behind menopausal joint pain is the decline in estrogen. Estrogen has anti-inflammatory properties and helps maintain the health of cartilage, ligaments, and the synovial fluid that lubricates joints. As estrogen levels fall, the body becomes more prone to inflammation, with less lubrication and protective cushioning within joints. This can lead to increased friction, pain, and stiffness.
Menopausal joint pain
Estrogen and joints
5. Mood Changes
Mood changes can be a signature of the menopausal transition, with many women experiencing increased irritability, anxiety, sadness, or mood swings. While these emotional shifts can be subtle for some, others may find them intense and disruptive, affecting relationships, work, and overall well-being. It’s essential to recognize that these changes are not a sign of personal weakness, but can be closely linked to the body’s shifting hormonal landscape.
Imagine a woman who is typically calm, cheerful, and easygoing suddenly snapping at loved ones over minor frustrations or feeling unexpectedly tearful at work. These reactions may feel completely out of character for her and for those close to her. Yet, they are a common part of the menopausal experience and reflect the powerful influence of hormonal changes on mood.
What Brings on The Emotional Changes?
Estrogen plays a pivotal role in regulating neurotransmitters such as serotonin and dopamine in the brain. These neurotransmitters directly influence mood, motivation, and emotional stability. Serotonin is closely linked to feelings of happiness and calmness. It also helps with sleep initiation. Dopamine is associated with the brain’s reward system, driving feelings of accomplishment and productivity. Both neurotransmitters play key roles in maintaining balanced mood and emotional responses and imbalances in their levels are linked to mood disturbances. They can lead to symptoms of depression and anxiety. As estrogen levels fluctuate and then fall, the delicate balance of these neurotransmitters is disrupted, making women more susceptible to mood changes.
Mood and Menopause
Estrogen’s Protective Effects
As we’ve seen with these common associated symptoms, estrogen plays a significant role in many aspects of women’s health. Here’s a brief recap of some of its most important roles and other protective effects it offers:
* It helps maintain cardiovascular health by improving cholesterol profiles, promoting blood vessel dilation, and supporting endothelial repair, which together lower the risk of heart disease.
* Estrogen also preserves bone density by reducing bone resorption. It also supports bone formation, helping to prevent osteoporosis and fractures.
* In the brain, estrogen regulates neurotransmitters like serotonin and dopamine, which support mood stability, cognitive function, and emotional well-being.
* Estrogen helps regulate body temperature and reduces inflammation, contributing to joint health and minimizing hot flashes and night sweats.
Menopause does not have to be a death sentence and can be a transformative time in a woman’s life. Some natural approaches can be beneficial and are summarized below:
• Lifestyle Changes:
Exercise: Engage in regular physical activity such as walking, swimming, or yoga to reduce joint pain, improve mood, and support heart health. Building muscle is crucial during this time since women lose muscle mass at a much faster rate after menopause. Adding weights is a great way to prevent muscle loss.
Balanced Diet: Focus on vegetables, legumes, lean proteins, fruits, and healthy fats to maintain energy, stabilize blood sugar, and reduce inflammation.
Sleep: Maintain a consistent sleep schedule by creating a restful environment, and avoiding caffeine or blue light from our cell phone and computer screens before bed to promote better sleep.
Mindfulness and Meditation: Can improve emotional resilience and reduce anxiety.
Food to Naturally Increase Serotonin and Dopamine Production: Did you know that food can affect your mood? For example, serotonin production is derived from an important amino acid called tryptophan which our body cannot make and needs to be obtained from food. Tryptophan-rich foods can help drive more serotonin production. Foods like walnuts, edamame, bananas, and eggs are rich in tryptophan. Similarly, Dopamine is made from an amino acid called Tyrosine which is present in foods such as hard cheeses, dark chocolate, nuts and beans.
• Herbal Remedies:
Black Cohosh: Has been shown to help alleviate hot flashes and night sweats.
Red Clover and Flaxseed: Contain phytoestrogens that may offer mild symptom relief for some women.
Ginseng: It is sometimes used to improve mood and energy, but consult a healthcare provider before use.
https://www.sciencedirect.com/science/article/abs/pii/S1043661808000996?utm
https://pmc.ncbi.nlm.nih.gov/articles/PMC5044908/?utm
• Medications
Hormone Replacement Therapy (HRT):
Hormone replacement therapy received a bad reputation for many years because of a study that came out in the early 2000s citing an increased risk of breast cancer. Many women who were on HRT were taken off and unfortunately many doctors (including myself) were misinformed and afraid to prescribe HRT, BUT… The HRT of yesteryear is very different from the HRT of today. The HRT noted in the studies was a synthetic type of hormone derived from horse urine. Still, the risk of breast cancer was pretty low even in these studies.
We now know that the type of HRT makes a significant difference and Bio-Identical HRT (BHRT) is much safer than the synthetic type because it more resembles the natural estrogen a woman’s body makes. Many women can receive BHRT in topical or patch form instead of the oral form. Even oral form for some women has numerous benefits and may be an option.
Every woman should at the very least have a conversation about BHRT with their doctor to assess risks and benefits. Ideally, the conversation should start during perimenopause, which for many women starts in their early 40s.
Some possible options include:
* Estrogen-only therapy: For women who have had a hysterectomy.
* Combined estrogen and progestogen therapy: For women with a uterus, to reduce the risk of endometrial cancer.
* Testosterone: Sometimes offered for low sex drive if other treatments are ineffective.
Non-Hormonal Prescription Medications
For Bone protection:
Calcium/vitamin D are important protective supplements that can help preserve bone function. Calcium/Vitamin D
Bisphosphonates are medications that can help preserve and improve bone density in women with osteopenia/osteoporosis Bisphosphonates
SSRIs/SNRIs can also be helpful for women who have persistent mood changes including medications such as
Paroxetine: https://www.canadapharmacyonline.com/DrugInfo.aspx?name=Paxil1828
Venlafaxine: https://www.canadapharmacyonline.com/DrugInfo.aspx?name=Effexor0415
Citalopram: https://www.canadapharmacyonline.com/DrugInfo.aspx?name=Celexa0228
Escitalopram: https://www.canadapharmacyonline.com/DrugInfo.aspx?name=Lexapro2489
Desvenlafaxine: https://www.canadapharmacyonline.com/DrugInfo.aspx?name=Pristiq6637
Gabapentin: Can help with vasomotor symptoms (hot flashes).
Clonidine: https://www.canadapharmacyonline.com/DrugInfo.aspx?name=Catapres0219
Wrap up
Managing menopause is not a one-size-fits-all process. If you’re suffering from menopause symptoms, or think you might be entering this stage, but feel unsure about what to expect, consulting with your OBGYN is essential to assess risks, discuss benefits, and develop an individualized plan that addresses both current symptoms and long-term health.
This article is meant for information purposes only and should not be construed as medical advice. Always speak to your physician prior to starting any therapy.
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