Menopause: Signs, Symptoms & Diagnosis

The first sign of oncoming menopause is usually a fluctuation in the menstrual cycle. This period of transition is known as perimenopause. Menopause does not occur until a woman has not had a menstrual period for 12 consecutive months (and no other biological or physiological cause for this phenomenon can be identified).

During perimenopause and menopause, a woman may experience several symptoms typically associated with the changes taking place in the body. These symptoms often include:

• Hot flashes. These cause a feeling of warmth in the face, neck or chest. The intensity of a hot flash can range from mild to severe. According to the U.S. Food and Drug Administration (FDA), about 85 percent of women approaching or going through menopause have hot flashes.
  
  
• Night sweats and difficulty sleeping. A lack of sleep can make other symptoms worse and make a woman feel tired, stressed or tense.
  
  
• Changes in vaginal tissue. These changes may include thinning, dryness, itchiness or a burning sensation. In some cases, sex may become painful (dyspareunia).
  
  
• Thinning of bones (osteoporosis). Some women may lose as much as 20 percent of their bone mass. There is an increased risk of fractures of the hip, spine, wrist and other bones. In some cases, fractures of the spine can result in slumped-over posture and a loss of height.
  
  
• Abnormal vaginal bleeding or spotting. While this is a common sign of menopause, you should see a physician if you experience it and you have not had a period for 12 consecutive months. It can sometimes be a side effect of birth control pills or hormone replacement therapy or a sign of other conditions including cancer, hormonal imbalance or noncancerous growths in the lining of the uterus (fibroids).
  
  
• Mood changes including mood swings, depression and irritability. Some researchers believe these emotions are caused by changes in the brain due to the decrease in estrogen production. Others think menopausal symptoms such as sleep problems, hot flashes and fatigue are responsible.
  
  
• Urinary problems. You may have urinary problems during menopause, such as leaking (sometimes after a cough or sneeze), burning or pain when urinating (dysuria). The thinning of the urethra that happens at this time may result in an increase in urinary tract infections (UTIs).
  
  
• Increased risk of heart problems. Estrogen helps raise levels of HDL cholesterol ("good" cholesterol). This in turn helps remove LDL cholesterol ("bad" cholesterol), which can contribute to plaque buildup in the arteries. As estrogen levels drop, there is increased risk of this buildup, which can lead to coronary artery disease (narrowing or blocking of the veins and arteries to the heart).
  
  
• Heart palpitations. You may experience episodes of a sudden pounding in the chest. Though heart palpitations can be harmless, they can also be a sign of a major health disorder. For this reason, you should seek medical care if you experience them.
  
  
• Memory or concentration problems. The source of these symptoms is not clearly understood. It is thought that they may be related to factors such as stress or lack of sleep.
  
  
• Lack of interest in sex or changes in sexual response. [Qy: Please provide more detail like all other items in list.] Decreasing estrogen levels cause various changes in the vaginal tissue (e.g., vaginal dryness, reduced blood flow to the genital area, reduced vaginal sensitivity), which can in turn affect a woman's sexual desire and ability to orgasm. As a result, the sexual response cycle often takes longer or may be less intense in postmenopausal women.
  
  Changing hormone levels also can produce emotional changes (e.g., mood swings) that can make some women feel less interested in sex. Insomnia, weight gain and other side effects of menopause can also contribute to a lack of sexual desire.
  
  
• Changes in physical appearance. After menopause, weight that previously was settled in a woman's hips and thighs may shift to her waist. The breasts may lose their fullness, wrinkles may form and hair on the head may thin. As estrogen levels drop, the small amount of testosterone that a woman produces may have a more pronounced effect on her body and she may develop coarse hair on the chin, upper lip, chest and abdomen.

The severity of these symptoms will almost certainly vary. Some fortunate women experience few symptoms. For most women, many symptoms fade over time, whether or not they receive treatment for them.

Diagnosing menopause

To determine whether the absence of menstrual periods is caused by menopause, a physician will perform a physical examination and compile your medical history. The physician may also perform a number of tests that may help reveal whether or not menopause has occurred.

For example, a blood test that reveals the level of follicle-stimulating hormone (FSH) is frequently used. FSH is made in the pituitary gland in the brain and circulates in the blood to stimulate the ovaries to make estrogen and progesterone. Once the ovaries stop making these hormones, the pituitary gland compensates by making more FSH. FSH levels greater than 25 to 40 mIU/ml (milli-international units per milliliter) are a sign of menopause. The U.S. Food and Drug Administration (FDA) has approved a home urine test kit that measures follicle-stimulating hormone in a urine sample.

A physician may also test you for levels of estradiol, a type of estrogen whose levels fall in the body once the ovaries fail. You may also be tested for luteinizing hormone (LH), the hormone that triggers ovulation. Higher levels may indicate that menopause has occurred.

Once you have entered menopause, it becomes even more important to monitor aspects of your health that may be affected by the associated hormonal changes. Tests that can help a physician monitor your postmenopausal health include:

• Pap smear. The surface of the cervix is scraped and analyzed for signs of cancer or other disorders of the cervix, uterus or other pelvic organs.
  
  
• Mammography (or mammogram). This annual X-ray of the breast area can reveal signs of breast cancer.
  
  
• Bone density screening. This can be used to help detect signs of osteoporosis, a thinning of the bones that can be accelerated by low levels of estrogen. Women with osteoporosis are at greater risk for fractures of the wrist, hip and spine due to a decrease in bone density.