Vasomotor symptoms (hot flushes and night sweats)
Vasomotor symptoms consist of hot flushes, cold flashes, day sweats, night sweats, or any symptom that has to do with your body's temperature regulation. These are commonly described as temporary periods of intense heat in the upper body, arms, or face—which may be followed by skin flushing and sweating. Sometimes hot episodes are followed by chills and can be accompanied by a feeling of anxiousness. Sometimes you may start shivering even in a warm room.
So what’s the deal with vasomotor symptoms occurring around menopause? Changing levels of oestrogen seem to be the culprit. The hypothalamus is the part of the brain responsible for controlling your body’s temperature. With declining levels of oestrogen, the hypothalamus becomes more sensitive to external temperature changes. This can lead to your body overcompensating for temperature variations.
Menstrual bleeding becomes lighter and less frequent, sometimes it becomes heavier or more frequent. All of these changes are normal during perimenopause, but talk to a healthcare provider if they become very heavy and difficult to manage. Menorrhagia is the medical term for heavy periods, which is common during perimenopause, affecting one in four women.
Why do periods change during menopause?
Oestrogen and progesterone work together to regulate the menstrual cycle. A typical cycle has two peaks of oestrogen and a rise in progesterone during the luteal phase (second half of the cycle). Your period arrives as levels of progesterone decline.
This cycle of hormones typically lasts between 21 to 35 days and varies between each woman.
During perimenopause, your ovaries’ ability to produce hormones such as oestrogen, progesterone and testosterone becomes inconsistent. This variability in hormone production leads to irregular periods and changes in bleeding heaviness. Eventually, when your ovaries stop producing sufficient hormones to cause periods.
Vaginal and urinary symptoms
Sexual problems and difficulty with bladder and bowel control are common issues often not openly discussed enough. Research estimates 1 in 2 women experience sexual problems around menopause, and most don’t seek help for these symptoms.
Talking about genital symptoms during menopause helps normalize seeking treatment. There’s no need to suffer or be embarrassed, as it's more than likely half of your friends are also experiencing such symptoms. These symptoms are easily treated with hormone replacement therapy (HRT), pelvic floor exercises, or lubricants.
What causes genital symptoms during menopause?
The vagina, clitoris, urethra, bladder, and pelvic floor muscles are very sensitive to oestrogen and progesterone—they rely on these hormones to stay healthy. Decreased oestrogen around menopause causes the vaginal skin to become thin due to loss of collagen support and elasticity.
There’s also a reduction in vaginal discharge, leading to less lubrication and changes to your vagina’s normal environment. All of these changes can result in genitourinary syndrome of menopause, which include:
- Dryness of the vulva and vagina
- Bleeding from the vulva or vagina
- Decreased libido
- Itching and burning of the vagina and vulva
- Urinary tract infections
- Changes to vaginal discharge and lubrication
- Clitoral shrinking and loss of sensation
Low sex drive (libido)
Libido is another name for your sex drive—which depends on a whole range of factors, one of which is, you guessed it, hormones. Data from the largest US cohort study of women's health (SWAN) showed that 65% of postmenopausal women infrequently or never felt sexual desire, and yet 3 out of 4 women rated their sex lives are moderately to extremely important.
What are solutions for sexual changes around menopause
Remember that mood and stress have a significant impact on your sex drive. Taking care of your mental health and taking time for yourself can help with your lidido and arousal. Local hormone replacement therapy also helps with vaginal dryness and pain. There are also products, like lubricants, made to help with vaginal dryness and pain specifically.