[What is Menopause?]

[Symptoms]

[Healthy Menopause]

[Treatment]

[Support]

[Resources]

Symptoms of Menopause

The drop in your estrogen levels that occurs during menopause may cause you to have symptoms and long-term health effects. Here are some of the changes you can expect:

Hot Flashes

Hot flashes are the most common symptom of menopause. Up to 75% of women have them. Hot flashes are caused by changing hormone levels. They tend to be more of a problem in thin women. You may have hot flashes for a few years after menopause, but they rarely go on for more that 5 years.

With a hot flash you have a sudden warm feeling or flush. Your face may or may not be flushed and you may be sweating. Hot flashes may disrupt your sleep. If you have hot flashes, dress in layers of washable clothing and remove layers of clothes when you get warm. If you have a disability, this may be hard to do. If you have a partner, talk to him or her about this problem and ask for help to make you more comfortable. A fan at work or in your bedroom may be helpful.

Hot flashes may be triggered by alcohol, spicy foods, hot foods or drinks, and caffeine. Keeping a hot-flash journal may help you to find out what triggers hot flashes.

   You may be able to decrease hot flashes at night with a regular exercise routine. Deep breathing also helps some women to reduce the intensity of a hot flash.

Hormone therapy (HT), formerly called hormone replacement therapy (HRT), is very effective in relieving hot flashes for most women. However, recent studies call for caution in its use. Talk to your doctor or nurse about the use of hormones. 

Vaginal and urinary problems

As a woman with a disability, you may have urinary and vaginal problems as a result of your disability. These problems may get worse as your hormone levels drop. Estrogen keeps the tissues of your vagina and urinary tract firm and moist. As your level drops, you may have trouble with the tissue of your vagina getting thinner causing burning or itching and pain during sexual intercourse. You can buy lubricants with a water base in the drug store that may help. Hormone creams may help, but you need a prescription for these creams and it is important to talk to your doctor or nurse about the use of hormones.

As your estrogen levels drop, your bladder control muscles may get weaker. You may find that you leak urine when you cough or sneeze. This is called stress incontinence. You may also have to go to the bathroom more often with little or no warning. This is called urge incontinence. You may also find you are not able to fully empty your bladder.

These bladder problems may not be new to you as a woman with a disability. However, with changes in your body that occur with menopause, you may now have to modify actions that worked well for you before menopause. 

  Limiting your caffeine may be helpful. Caffeine works as a diuretic and causes your body to get rid of fluid. Therefore you will need to empty your bladder more often. For some, the bladder can be trained to hold more urine, but this may not be as effective for a woman whose disability has already altered her ability to hold urine.

Another strategy that women with muscle control can use is exercise to strengthen the pelvic muscles. These are called Kegel exercises and should be done at least five times in a row several times a day.

• Tighten the pelvic muscles (as when you are stopping your urine stream) and count to five.
• Tighten a little more and count to five.
• Tighten as hard as possible and count to five.
• Relax (reversing the above steps), counting to five at each step until you are completely relaxed.
• Repeat this sequence at least four more times.

You can do this exercise while you are waiting in lines, stopped in your car, watching TV, or lying in bed.

Hormone therapy (HT) may reduce these problems, but recent studies call for caution in its use. Talk to your doctor or nurse about the use of hormones.

If these measures do not work, your doctor or nurse may refer you to a specialist called a urologist, who can recommend other approaches. These include biofeedback, use of a pessary (a device placed in the vagina to prop the bladder in place), or surgery to lift a sagging bladder. It is important to talk to your doctor or nurse about bladder changes since many of these problems are treatable.

Vaginal bleeding

You may see a change in your periods during perimenopause and your periods may occur more often or less often. Your menstrual flow may become thinner and therefore a bit harder to contain with pads and tampons. The menstrual flow may also contain more clots. You may be alarmed by these changes. The heavy bleeding can also affect your quality of life.

Excess bleeding can cause anemia, a decreased amount of red blood cells in your blood. Symptoms of anemia may include fatigue and/or depression. Your yearly exam should include testing for anemia. Be aware of changes in your menstrual period that might cause this problem. The treatment for anemia is to take an iron pill each day. Taking iron can cause constipation. Prunes or prune juice can help with this problem. Adding fiber to your diet, taking fiber caplets, and drinking at least 8 glasses of water each day can help. If you have a bowel program, you may find it needs to be altered if constipation occurs.

The excess bleeding can be managed with hormone therapy in some women. Low-dose birth control pills are effective for many women. This is not an option for women who smoke because of the risk for developing blood clots. In addition, non-steroidal anti-inflammatory drugs such as ibuprofen (Advil, Aleve, etc.) help to reduce heavy menstrual bleeding in some women.

For some women, excess bleeding may be managed through procedures such as a dilatation and curettage (D&C); endometrial ablation, in which the lining of the uterus is scarred with heat or cold; or, as a last choice, hysterectomy, which is the removal of the uterus.

Be sure to contact your doctor or nurse as soon as you notice unusual bleeding or changes in your menstrual period. Unusual bleeding can be an early sign of uterine cancer.

  Sleep problems may occur with menopause. Some women are awakened by night sweats or the need to use the bathroom. You might have trouble getting to sleep, waking early, or getting back to sleep after waking up in the middle of the night.

           Depression and mood changes 

Before "women's liberation" we did not talk about menopause. Now we have many resources-- we can talk openly about it with other women, books and magazines cover the topic, we hear about it on the radio and TV, and we have lots of web sites that offer good information. This all helps to lower our anxiety.

Research shows that women in perimenopause are no more likely to have depression than other women. Even women with a history of depression are no more likely to become depressed during perimenopause than at other times in their lives.

Some women do experience distressing symptoms, especially if sleep is disrupted or excessive vaginal bleeding interferes with daily life. In these situations, the symptoms can be managed effectively. Women may find that their bodies behave in unpredictable ways-- almost as though they were teenagers. It takes some getting used to.

There are other changes that also occur in midlife-- children leave home, parents become ill or die, there may be changes in your partner relationship, retirement seems close at hand, and women must face their own aging in a society that values youth. Some perimenopausal women are caring for young children or teenagers. Women with disabilities are experiencing all the above in addition to the effects of their disability on their lives. These issues can cause major distress. All women can benefit from stress-reduction techniques, including exercise or meditation.

If you are not able to sleep because of hot flashes and treatments do not bring relief after 6 to 8 weeks, talk to your doctor or nurse about a referral to a mental health care provider. About 10 to 15 percent of women have trouble with menopausal changes in combination with life stressors. If you have symptoms of depression, such as trouble sleeping, loss of appetite, feeling flat or "blue" and so on, you should talk to your doctor or nurse about depression. Normal day-to-day anxiety does not mean you are depressed. Talk to your health care provider if you are unsure about your feelings.

Bone loss

As your estrogen levels drop with menopause, you also lose bone density. Up to 20% of your lifetime bone loss will occur in the first 5 to 7 years after menopause. This can result in osteoporosis or thinning of the bones. As your bones become thin and more fragile, you have a higher risk for fractures. Bone fracture can result in more disability and a lower quality of life. Click here to go to our Osteoporosis webpage.

Other symptoms

It is important to let your doctor or nurse know about any changes that you may notice, since they may or may not be related to perimenopause -- and may or may not be related to your disability. Other symptoms that may occur with menopause include weight gain, hair loss and memory loss. You can manage your weight with diet and activity level. There are prescription medications that can help with hair loss.

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12/02/2003 06:21 PM