Around three-and-a-half million women aged 45 to 54 are employed in the UK, working full or part time while trying to deal with the menopause. It’s thought that nearly one million women have been forced out of the labour market due to their menopausal symptoms.

This article was included in issue 96 (spring 2023) of The Menopause Exchange newsletter.

So what are the common menopausal symptoms and when might these occur? The average age of the menopause in Europe is 51. Symptoms can start a few years before the last natural period and continue for about seven years, although 20% of women may experience troublesome problems for 15 years or more. Around 20% of women experience no problems and welcome the menopause with the disappearance of their periods. Five percent of women experience an early menopause (aged 40 to 45) and in 1% of women the menopause occurs before the age of 40 (the symptoms come as a complete surprise).

Hot flushes and night sweats

Although it’s seen as a part of their life course, 70% to 80% of women complain of flushes and sweats (vasomotor symptoms). These are thought to be caused by fluctuating and finally decreasing levels of oestrogen affecting the body’s thermostat in the brain’s hypothalamus, which becomes more sensitive to slight changes in body temperature. When the hypothalamus thinks the body is too warm, it starts a chain of events that cause a hot flush and sweating to try to cool down.

Hot flushes and sweats seem to be worse in women who smoke, are overweight, drink large amounts of alcohol, have underlying mental health issues or who have gone through a rapid transition, such as having a medical or surgical menopause caused by chemo/drug therapy or the removal of both ovaries. Vasomotor symptoms reach their peak about 18 months after a woman’s last natural period and around 20% of women with menopausal symptoms report severe flushes and sweats. Fortunately, the frequency and severity of flushes and sweats tend to decrease with time.

Vaginal and bladder symptoms

As women approach the menopause, one in four have vaginal dryness. After the menopause, 50% of women suffer from urogenital symptoms, such as vaginal dryness, irritation, burning, pain with sex, urinary frequency/urgency and recurrent urinary tract infections. These hidden symptoms can have a major impact on quality of life and relationships. They are caused by low levels of oestrogen, resulting in a loss of fat around the genitals and the vaginal tissue becoming paler, thinner and less well lubricated. The changes also affect the urethra and bladder, taking months or sometimes years to trigger symptoms.

Sex drive

Sex drive decreases gradually with age in both men and women, but women are more likely to be affected, reporting a decrease in desire in their late 40s and early 50s before urogenital atrophy symptoms begin. Sexual arousal may take longer and orgasms become less intense. Many other factors influence sexual desire, including stress, anxiety, self-esteem, relationship problems, some medicines, partner’s sexual problems and some long-term conditions such as heart disease and diabetes.

Aches and pains

Many menopausal women experience ‘menopausal arthralgia’, with joint pain, muscle aches and back pain affecting more than 50% of women. These symptoms can be due to hormonal changes but may be exacerbated by dehydration, stress, weight gain, diet and poor posture. Osteoarthritis and other rheumatological inflammatory conditions become more common around this time so if severe pain persists, seek help from a healthcare professional. Similar symptoms occur when women stop HRT or are treated for breast cancer with aromatase inhibitors (these lower oestrogen levels). This pain appears to be caused by an interaction between the decline in reproductive hormones, stimulation of the pain processing pathways, and changes to the immune cells and cartilage cells.

Brain and mood

Menopausal women may notice increasing anxiety and mood changes, such as irritability, sadness, lack of motivation, aggressiveness and difficulty concentrating. They get more forgetful, experience brain fog and find it hard to stay focused. Women may experience wordfinding difficulties, lose their train of thought and get confused easily. These symptoms improve with time but can last for up to 10 years.

Sleep problems

Up to 60% of menopausal women experience insomnia or other sleep problems. Many have no difficulty getting to sleep but staying asleep is the issue and early morning wakening increases significantly. This can have detrimental effects on the risk of cardiovascular disease, diabetes, dementia and obesity and may even reduce the body’s immunity and cancer-fighting ability. Changes in oestrogen and progesterone levels directly affect the sleep cycle. Vasomotor symptoms can interrupt sleep and falling levels of melatonin alter the circadian system that regulates sleep.

Obstructive sleep apnoea is more common after the menopause, especially if weight gain has been an issue. Not only are sleep patterns worsened but associated symptoms include headaches, insomnia, depression, anxiety and daytime fatigue.

Other symptoms

Menopausal weight gain affects other menopausal symptoms. Self esteem can be adversely affected and quality of life diminished. HRT is often blamed but aging (a slower metabolism, decreased lean body mass, becoming more insulin resistant and increased accumulation of body fat) and lifestyle factors are the primary culprits.

About the author

Dr Diana Mansour is a consultant in community gynaecology and reproductive healthcare in Newcastle upon Tyne. She has been an associate clinical lecturer at Newcastle University since 1997 and was senior vice president at the Faculty of Sexual and Reproductive Healthcare until October 2021.

Created Spring 2023
Copyright © The Menopause Exchange 2023

Tags: aches and pains, brain and mood, hot flushes, HRT, menopause, night sweats, sex drive, sleep problems, symptoms, vaginal and bladder symptoms, weight gain