Menopausal Symptoms

Last Updated: October 20, 2021

Menopause is the stage of life when menses permanently cease, and the reproductive system no longer performs functions related to fertility. A woman is considered to have entered menopause after menses have stopped for 12 months.

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Overview

Natural menopause generally occurs between the ages of 40 to 58 and has no obvious pathological or physiological cause, but early menopause can result from surgery, chemotherapy, radiotherapy, or primary ovarian insufficiency. Perimenopause is the transitional phase into menopause and may last between 4 to 8 years. During this phase, menstrual periods become irregular due to fluctuating hormone levels.

For this page, we use the generic term 'woman', but this information can apply to anyone with ovaries and/or who might be undergoing a hormonal shift associated with the symptoms of menopause.

Causes

Menopause is a natural condition that occurs as women age. Over time, a woman’s ovarian follicles and granulosa cells diminish. Given these cells are the main producers of estradiol and inhibin[7](a hormone that tells the pituitary gland to make less follicle stimulating hormone), the body’s hormonal balance shifts toward lower estrogen levels and increased follicle-stimulating hormone and luteinizing hormone levels. This hormonal profile results in irregular menstrual cycles, which ultimately stop altogether. One clinical indicator that a woman is postmenopausal is a follicle-stimulating hormone level greater than 30 mIU/mL and an estradiol level under 30 pg/m.[1]

Hormonal variations across a woman's lifetime

image

Primary ovarian insufficiency (POI) is a condition often characterized by entering menopause at a young age (i.e. prior to 40 years). There are a variety of causes that underlie POI, but the main one is estrogen deficiency.[8] Other factors that play a role in POI are genetic disorders, autoimmune disease, chemotherapy, radiotherapy, and metabolic disorders. Smoking has also been associated with early menopause.[9]

Symptoms

Hot flashes, night sweats, vaginal dryness, insomnia, trouble focusing, and mood swings are the primary symptoms women experience during the transition into and sometimes throughout menopause. Women can also experience changes in body composition. The majority of these symptoms are a result of hormonal fluctuations accompanying the decline to infertility, with hot flashes among the most commonly reported.

In fact, as many as half of all women report experiencing hot flashes even before they cease menstruating. Hot flashes peak during the later phases of the menopausal transition, tapering off in late menopause. Women tend to experience these symptoms for roughly five years.[10][11]

Changes in vaginal tissue resulting from decreased estrogen account for a number of other commonly reported symptoms, including an increase in urinary tract infections, vaginal atrophy, burning, urinary incontinence, and discomfort during intercourse.[12] Moreover, these changes in hormone levels after menopause affect metabolic processes that can increase the risk of cardiovascular disease, osteoporosis, and stroke.[13]

Regarding changes in body composition, the transition into menopause marks a time when women are particularly prone to gaining fat and losing lean mass. Later onset of menopause seems to temper this increase in weight and body fat.[14] Hormonal changes also tend to shift body fat distribution from a gynoid pattern (body fat around the hips and buttocks) to a more android pattern (body fat around the midsection).[15]

Diagnosis

Menopause is clinically diagnosed after 12 months of amenorrhea without other causes, such as surgical removal of the ovaries, chemotherapy or radiotherapy, or POI. It usually occurs after 45 years of age (median age of 51.4 years) and is considered abnormal if it occurs prior to 40 years of age.[16] The diagnosis does not require hormone testing.

In cases where an alternative diagnosis is suspected, such as in women below the age of 45 or in women with thyroid disorders, the following hormone tests can be performed to predict or diagnose the onset of menopause:
-Anti-Müllerian Hormone
-Estrogen
-Follicle-Stimulating Hormone

Examine Database: Menopausal Symptoms
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References
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Examine Database References
  1. Red Clover Extract - Atkinson C, Warren RM, Sala E, Dowsett M, Dunning AM, Healey CS, Runswick S, Day NE, Bingham SARed-clover-derived isoflavones and mammographic breast density: a double-blind, randomized, placebo-controlled trial ISRCTN42940165Breast Cancer Res.(2004)
  2. Black Cohosh - Wen-pei Bai, Shu-yu Wang, Jian-li Liu, Li Geng, Li-na Hu, Zhong-lan Zhang, Shu-ling Chen, Shu-rong Zheng[Efficacy and safety of remifemin compared to tibolone for controlling of perimenopausal symptoms]Zhonghua Fu Chan Ke Za Zhi.(2009 Aug)
  3. Red Clover Extract - Baber RJ, Templeman C, Morton T, Kelly GE, West LRandomized placebo-controlled trial of an isoflavone supplement and menopausal symptoms in womenClimacteric.(1999 Jun)
  4. Black Cohosh - Geller SE, Shulman LP, van Breemen RB, Banuvar S, Zhou Y, Epstein G, Hedayat S, Nikolic D, Krause EC, Piersen CE, Bolton JL, Pauli GF, Farnsworth NRSafety and efficacy of black cohosh and red clover for the management of vasomotor symptoms: a randomized controlled trialMenopause.(2009 Nov-Dec)
  5. Panax Ginseng - Kim SY, Seo SK, Choi YM, Jeon YE, Lim KJ, Cho S, Choi YS, Lee BSEffects of red ginseng supplementation on menopausal symptoms and cardiovascular risk factors in postmenopausal women: a double-blind randomized controlled trialMenopause.(2012 Apr)
  6. Black Cohosh - Jacobson JS, Troxel AB, Evans J, Klaus L, Vahdat L, Kinne D, Lo KM, Moore A, Rosenman PJ, Kaufman EL, Neugut AI, Grann VRRandomized trial of black cohosh for the treatment of hot flashes among women with a history of breast cancerJ Clin Oncol.(2001 May 15)
  7. Black Cohosh - Matthias Rostock, Julia Fischer, Andreas Mumm, Ute Stammwitz, Reinhard Saller, Hans Helge BartschBlack cohosh (Cimicifuga racemosa) in tamoxifen-treated breast cancer patients with climacteric complaints - a prospective observational studyGynecol Endocrinol.(2011 Oct)
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  13. Maca - Meissner HO, Kapczynski W, Mscisz A, Lutomski JUse of gelatinized maca (lepidium peruvianum) in early postmenopausal womenInt J Biomed Sci.(2005 Jun)
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  15. Maca - Tsuyoshi Takewaka, Kiyoshi HaraClinical Effect of Oral Administration of Maca (Lepidium meyenii) Extract on Japanese Peri-Menopausal Women Subjects: A Randomized, Double-Blind, Placebo-Controlled StudyInt J Biomed Sci.()
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  36. Red Clover Extract - Ehsanpour S, Salehi K, Zolfaghari B, Bakhtiari SThe effects of red clover on quality of life in post-menopausal womenIran J Nurs Midwifery Res.(2012 Jan)
  37. Pueraria Mirifica - Chandeying V, Sangthawan MEfficacy comparison of Pueraria mirifica (PM) against conjugated equine estrogen (CEE) with/without medroxyprogesterone acetate (MPA) in the treatment of climacteric symptoms in perimenopausal women: phase III studyJ Med Assoc Thai.(2007 Sep)
  38. Black Cohosh - Pockaj BA, Gallagher JG, Loprinzi CL, Stella PJ, Barton DL, Sloan JA, Lavasseur BI, Rao RM, Fitch TR, Rowland KM, Novotny PJ, Flynn PJ, Richelson E, Fauq AHPhase III double-blind, randomized, placebo-controlled crossover trial of black cohosh in the management of hot flashes: NCCTG Trial N01CC1J Clin Oncol.(2006 Jun 20)
  39. Fish Oil - Cohen LS, Joffe H, Guthrie KA, Ensrud KE, Freeman M, Carpenter JS, Learman LA, Newton KM, Reed SD, Manson JE, Sternfeld B, Caan B, Freeman EW, LaCroix AZ, Tinker LF, Booth-Laforce C, Larson JC, Anderson GLEfficacy of omega-3 for vasomotor symptoms treatment: a randomized controlled trialMenopause.(2014 Apr)
  40. Maca - Meissner HO, Mscisz A, Reich-Bilinska H, Kapczynski W, Mrozikiewicz P, Bobkiewicz-Kozlowska T, Kedzia B, Lowicka A, Barchia IHormone-Balancing Effect of Pre-Gelatinized Organic Maca (Lepidium peruvianum Chacon): (II) Physiological and Symptomatic Responses of Early-Postmenopausal Women to Standardized doses of Maca in Double Blind, Randomized, Placebo-Controlled, Multi-Centre Clinical StudyInt J Biomed Sci.(2006 Dec)
  41. Pueraria Mirifica - Surachai Lamlertkittikul, Verapol ChandeyingEfficacy and safety of Pueraria mirifica (Kwao Kruea Khao) for the treatment of vasomotor symptoms in perimenopausal women: Phase II StudyJ Med Assoc Thai.(2004 Jan)
  42. Black Cohosh - Maki PM, Rubin LH, Fornelli D, Drogos L, Banuvar S, Shulman LP, Geller SEEffects of botanicals and combined hormone therapy on cognition in postmenopausal womenMenopause.(2009 Nov-Dec)
  43. Pueraria Mirifica - Chandeying V, Lamlertkittikul SChallenges in the conduct of Thai herbal scientific study: efficacy and safety of phytoestrogen, pueraria mirifica (Kwao Keur Kao), phase I, in the alleviation of climacteric symptoms in perimenopausal womenJ Med Assoc Thai.(2007 Jul)
  44. Valerian - Taavoni S, Ekbatani N, Kashaniyan M, Haghani HEffect of valerian on sleep quality in postmenopausal women: a randomized placebo-controlled clinical trialMenopause.(2011 Sep)
  45. Black Cohosh - Castelo-Branco C, Gambacciani M, Cano A, Minkin MJ, Rachoń D, Ruan X, Beer AM, Schnitker J, Henneicke-von Zepelin HH, Pickartz SReview & meta-analysis: isopropanolic black cohosh extract iCR for menopausal symptoms - an update on the evidence.Climacteric.(2021-Apr)