Menopause: A complete guide to hot flashes and more

Ever been somewhere and all of a sudden feel a flash of hot air going through your body? The sudden sweat and need to take everything off makes it difficulty to concentrate. Well every woman has to undergo menopause eventually, but what is it and what are its symptoms, causes, and treatments? How does it affect the body, mind, and hormones? What are some tips to help those dealing with it?

What is menopause

Menopause is the time in a woman’s life when she no longer experiences periods. Typically diagnosed as the absence of menstrual periods for 12 months. The process of menopause is gradual and happens when the ovaries cease to function. The loss of active ovarian follicles is one of the trademark changes and occurrences that happen during menopause. Ovarian follicles are structures that produce and release eggs from the ovary wall which allow fertility and menstruation.

On average, the age women start menopause is 51 years old. However, it can occur as late as the 60s or as early as the 30s. In the U.S. most women have undergone menopause at 52. There is a myth that the age at which a woman begins to have periods predicts when she will begin menopause, but it’s just a false myth. Sadly, there is no test reliable enough to accurately predict when a woman will start menopause. That said, genetics and ovary health are useful indicators.

Symptoms of menopause

During perimenopause (the months that lead up to menopause), there are many emotional, physical and cognitive symptoms. Sometimes, the cognitive and emotional symptoms are so common that it can be difficult to know if they are due to perimenopause. The night sweats that can happen can cause fatigue which has an effect on mood and cognitive performance, both other symptoms of perimenopause.

Some common early and perimenopausal symptoms are:

• Chills
• Breasts feel less full
• Vaginal dryness
• Memory problems, issues with cognitive performance
• Stiff joints or it’s painful to move
• Night Sweats
• Rapid mood changes
• Fatigue
• Reduced bone mass
• Irritability
• Hot flashes
• Reduced muscle mass
• Irregular periods. First beginning with inconsistent periods and then the flow becomes longer and heavier.

After perimenopause, the real menopause begins. Each woman experiences her own symptoms at different rates and some may not experience certain symptoms. A small number of women experience menopausal symptoms up to a decade before menopause actually begins. 1 in 10 women experience menopausal symptoms for 12 years after her last period. However, common symptoms of menopause include:

• Increased urination. This is due to the decreased estrogen levels and increased dryness, thinness, and elasticity of the vagina and urethra (the tube that allows the bladder to urinate). This combination of hormones and dryness leads to the feeling to pee more often, an increased risk for a urinary tract infection, and urinary incontinence (urinary leakage).
• Vasomotor symptoms. Roughly 75% of menopausal women experience some form of vasomotor (blood pressure regulation) problems.
• Changes in mood
• Felling of less full breasts
• Sleeping issues

On average, roughly 80% of women, hot flashes will occur for five years and then stop. Some common triggers for hot flashes include alcohol, stress, hot weather, caffeine, and spicy food.

Causes of menopause

Menopause is caused by a reduction in a female’s reproductive hormones. The body begins to physical, emotional, and cognitive changes in response to a lower level of:

• Testosterone. The hormone found in males.
• Progesterone. The female sex hormone used to regulate periods and get the body ready for pregnancy.
• Estrogen. The hormone is found in both men and women, but women produce higher levels of it. It’s responsible for sexual development and regulates the body’s glucose metabolism as well as the insulin sensitivity.
• Luteinizing hormone (LH). Produced by both men and women, LH plays a vital role in puberty and fertility.
• Follicle-stimulating hormone (FSH) is the hormone responsible for the growth of ovarian follicles which produce estrogen and progesterone.

In her late 30s, a woman’s ovaries begin to make less estrogen and progesterone- the hormones that help regulate menstruation. Due to this change, fertility declines. Which is why it’s harder to get pregnant the older a woman is. In her 40s, her periods become shorter or longer, lighter or heavier, less frequent or more frequent, until eventually, the ovaries stop producing eggs and periods stop altogether.

There also exists the possibility of induced menopause due to injury or surgical removal of the ovaries/pelvic structures. Some common causes of induced menopause include:

• Bilateral oophorectomy which is the surgical ovarian removal.
• Ovarian ablation which is a complete shutdown of ovary function due to radiotherapy, surgery, or hormone therapy. It typically occurs in women who have estrogen-related tumors.
• Chemotherapy and radiation therapy are cancer therapies that can induce menopause as well as cause menopausal symptoms like hot flashes.
• Pelvic injuries that damage the ovaries
• Pelvic radiation
• Hysterectomy is a surgery that removes the uterus but not the ovaries. While it doesn’t cause immediate menopause, a woman who has a hysterectomy won’t have periods. Her ovaries still will produce eggs, progesterone, and estrogen.
• Total hysterectomy, also known as a bilateral oophorectomy, causes immediate menopause because it removes both ovaries and uterus. Menopausal symptoms are immediate and typically more severe.

Early menopause

Early menopause, also known as premature menopause and primary ovarian insufficiency, is the time when a woman begins menopause under the age of 45. 5% of women begin menopause between ages 40 and 45. 1% of women begin menopause before age 40. Primary ovarian insufficiency happens when the ovaries fail to produce normal levels of reproductive hormones (progesterone and estrogen). It’s believed that it comes from an autoimmune disease or genetic factors.

What is perimenopause?

Perimenopause is a term used to define the period before menopause, or the time surrounding menopause. It’s not an official medical term, but it helps to explain certain aspects during the transitional period between regular menstruation and menopause. Many women begin to experience perimenopausal symptoms in their 40s. Others skip perimenopause completely and jump straight into menopause itself.

Tests that diagnose menopause

For most women, the signs and symptoms are enough to tell them that they’ve begun menopause. The only reliable way to diagnose menopause is to notice a lack of menstrual periods for 12 months in a woman within the expected age range of menopause.

Diagnosing menopause based on hormone levels isn’t reliable considering that hormone levels fluctuate greatly between women and change on a daily basis. There currently is no blood test that is reliable enough to test for menopause. The only thing a blood test can do is rule out medical causes of erratic menstruation. However, a doctor may also require a blood test to look for levels of estrogen, the thyroid-stimulating hormone, and the follicle-stimulating hormone. An underactive thyroid shows many symptoms that coincide with menopause.

How does menopause affect the body?

There are many physical changes that happen to a woman when she undergoes menopause. For example, wrinkles, weight gain, and thinning hair.

There is also a HUGE physical change going on inside the body in the ovaries- the reproductive glands in a woman. Each ovary is roughly the shape and size of an almond and there is one located on each side of the uterus. The job of the ovaries is to produce hormones (like estrogen and progesterone), and eggs (ova). Considering that the ovaries are the main source of female hormones and these hormones control physical appearances such as body hair, shape, and breast when these hormones decrease, so do the appearances of many physical features. The hormone estrogen also helps protect bone. Osteoporosis, the thinning of the bone, is common after menopause because there is not enough production of estrogen.

How does menopause affect the brain?

During menopause, many women notice cognitive changes in the brain that affect them in many ways- especially negatively. While it’s true that when everybody ages, our cognition changes. However, there are some aspects of menopause that really do affect the woman experiencing them. The most common are menopause brain, the brain structure changes, and declining memory, specifically with words.

Menopause brain, also known as a brain fog, is essentially having difficulty with concentration. One study shows that 60% of middle-aged women said they have issues with concentration. Many women also struggle with memory problems during the stages of menopause, and this struggle can lead to anxiety, which simply exacerbates the menopause brain symptoms.

It’s crazy to think that the brain structure can change, but it isn’t changed by much. As we age, our brain’s structure changes in tiny ways that aren’t always clinically observable. Mainly, the changes involve changes in white matter. White matter contains myelin which improves our processing speed in our cognitive thinking. One study showed that women who suffer from more hot flashes have more white matter changes in the brain (ischemic changes) than those who didn’t suffer from hot flashes or who had fewer hot flashes. This study simply shows that when menopausal symptoms accumulate, it really can affect thinking and cognitive ability.

Almost every symptom of menopause goes hand-in-hand with another symptom. For example, night sweats lead to tiredness and changes in the white matter due to hot flashes affect memory and concentration. In terms of memory, menopause affects, more than any other type of memory, the memory for words. For example, trying to remember items on a grocery list or trying to remember the title of that book you just read.

One study followed 2,300 women for four years while testing them on processing speed, working memory, and verbal memory. While premenopausal, the women tested well on all tests. While perimenopausal, when their estrogen began to dip, the women couldn’t learn as well. However, some women supplemented estrogen before their last period. Those who did had higher scores. Postmenopausal, once the body was used to the new level of estrogen, the scores all rose again.

How does menopause affect hormones?

Menopause brain is thought to be caused by a change in hormones in the brain. Somewhere between the varying and changing levels of progesterone, estrogen, luteinizing hormone (LH), and follicle stimulating hormone (FSH), all of which are responsible for cognition, something goes weird and a female’s cognition changes. However, this change is temporary- on average about four years. Menopause brain stops once the hormone levels stop varying and start to become more predictable.

Low estrogen levels are what really make menopause unbearable, or at least a little harder, for many women. Estrogen is a hormone that works directly with cognitive function, insulin regulation, cholesterol levels, the metabolism, and serotonin– the brain chemical that regulates mood, appetite, sleep, memory, and sexual desire. This is why when women start to have lower levels of estrogen, they have issues with sleep, night sweats, vaginal dryness, and hot flashes.

Treatment for menopause

• Hormone replacement therapy (HRT), also known as hormone therapy (HT) and postmenopausal hormone therapy (PHT) are therapies that consist of using estrogen, or a combination of estrogen and progesterone (progestin), to control the symptoms of menopause that have to do with a decline in estrogen levels. For example, vaginal dryness and hot flashes. While these types of therapies are considered to be the best and most effective, long-term studies done by the Women’s Health Initiative found that women who received a combined therapy of both estrogen and progesterone and halted the treatment had an increased risk for breast cancer, stroke, and heart attack compared to those who didn’t receive treatment. Studies of estrogen as a treatment alone showed an increased risk of stroke and endometrial cancer (cancer of the lining of the uterus), but not breast cancer or heart attack.
• Oral contraceptive pills are a form of hormone therapy that are used to treat irregular vaginal bleeding, relieve hot flashes, and provide a form of contraception in both perimenopausal and menopausal women.
• Bioidentical hormone therapy is a type of therapy that is becoming more and more popular. It’s mainly used for perimenopausal women with medications that contain hormones that have the same chemical formula as the hormones made naturally in the body. The hormones in the pill, however, are made in a lab by altering compounds derived naturally from plants. Essentially, it’s a plant, put into the form of medication, that is altered to mimic a hormone.
• Local hormone treatments are applied directly to the vagina and used to symptoms of vaginal estrogen deficiency. The most common local treatments include vaginal estrogen creams (K-Y Silk-E Vaginal Moisturizer), vaginal estrogen tablets, or the vaginal estrogen ring (Estring).
• Non-hormone treatments include using lubricants during intercourse to prevent vaginal dryness and soaking in a tub of warm water to relieve vaginal itchiness and irritation.
• Antidepressant medications have been shown to control hot flashes in up to 60% of women. The antidepressants shown to be most effective include paroxetine (Paxil), desvenlafaxine (Pristiq), venlafaxine, (Effexor), fluoxetine (Prozac), citalopram (Celexa), and sertraline (Zoloft).
• Other medications have been proven to relieve hot flashes but should only be used with doctor approval. Of those include the anti-seizure medications gabapentin (Neurontin) and clonidine (Catapres). As well as some drugs used to treat high blood pressure.

Tips for dealing with menopause

• Decrease vaginal comfort by using over-the-counter, water-based vaginal lubricants (K-Y jelly and Astroglide), as well as silicone-based moisturizers such as Replens. Make sure to choose products that don’t contain glycerin because it can cause burning and more irritation in some women. Sexual activity also helps vaginal discomfort because it increases blood flow to the vagina.
• Strengthen your pelvic floor by trying Kegel exercises, essentially pelvic floor muscle exercises, in order improve urinary incontinence (unwanted and uncontrollable urination)
• Practice relaxation by using techniques like deep-breathing, guided-imagery, paced-breathing, and massage.
• Cool hot flashes by dressing in layers and always having (a cool glass of) water. Try to find what triggers the hot flashes.
• Eat well by limiting saturated fats, sugars, and oils. Some doctors may suggest an increase in calcium or vitamin D supplements. The Mediterranean diet is linked to better health after menopause.
• Get enough sleep by avoiding caffeine or drinking too much alcohol.
• Exercise regularly in order to protect against common side effects of menopause such as osteoporosis, heart disease, and other conditions that happen with age.
• Hypnosis is theorized by the National Center for Complementary and Integrative Health to help decrease hot flashes in menopausal women. It can also help with improved sleep which is useful when experiencing hot flashes and night sweats- both phenomenon that can prevent a good night’s sleep.
• Yoga, while there isn’t evidence proving so, is thought to reduce menopausal symptoms. In any case, it can increase balance which can help prevent falls and later broken bones due to osteoporosis due to a decrease in estrogen.
• Acupuncture is thought to bring temporary relief in decreasing hot flashes, but there isn’t any solid research done yet on the topic.
• Don’t smoke because smoking not only may increase hot flashes and bring on menopause earlier, but it increases one’s risk for osteoporosis, cancer, stroke, and heart disease.

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Anna Bohren

Anna is a freelance writer who is passionate about translation, psychology, and how the world works.