Mid-Life Women’s Health

Perimenopause is a gradual process in which a woman stops ovulating regularly. Menstrual cycles may become irregular, maybe skipping months or having periods closer or further apart. This phase can last months to years before the final period. The symptoms can range from PMS-like symptoms such as bloating and breast tenderness to symptoms such as hot flashes, vaginal dryness and mood changes.

Menopause typically occurs around age 51 and is the result of the ovaries not making estrogen. Post-menopause is the state after the menstrual cycle stops for 12 months. It can cause a wide range of symptoms and affects all women differently. Symptoms can include hot flashes/night sweats, trouble sleeping, mood swings, vaginal dryness, sexual changes including pain, brain fog/memory changes, weight gain, hair and skin changes, headaches.

The risk for heart disease increases after menopause. Elevated blood pressure, cholesterol and triglycerides, diabetes and smoking are additional risk factors. Reducing risks factors and lifestyle interventions are the first step to improving heart health and decreasing the chance of developing heart disease.

Quality sleep is critical for all bodily functions as well as healing. Poor sleep quality and sleep disturbances during perimenopause and menopause can include trouble falling and staying asleep. There are many causes including hot flashes and night sweats, poor sleep habits or sleep environments as well as the increased risk of obstructive sleep apnea increases during midlife.

Weight gain is common during a woman’s midlife years due to factors such as hormone levels, decreased metabolism and loss in muscle mass, increased stress, decrease in quality sleep, changes in eating habits, decreased physical activity due to pain or mobility issues and genetics. Focusing on a healthy diet such as the Mediterranean diet not only has been associated with weight loss but also improves blood pressure, cholesterol and blood sugar.

Estrogen loss during menopause causes physical changes to the vagina, vulva and bladder which may lead to symptoms such as vaginal dryness, itching, burning, discharge, painful intercourse, urinary frequency, leaking urine, burning sensation with urination and recurrent urinary tract infections. Together, these changes are often referred to as vaginal atrophy or genitourinary syndrome of menopause (GSM). 

In addition to the physical symptoms, women can also experience emotional and mental health-related issues during midlife. Symptoms can include irritability, anxiety, depression, mood swings, fatigue and more.

The menopause transition can be associated with physical, mental, social and emotional stresses. Chronic stress can lead to fatigue, headaches, sleep problems and weight gain, and can also increase the risk of diabetes, stroke and heart attacks.

The decline of estrogen during menopause can also affect brain health, causing issues with memory and concentration (”brain fog”) and increased headaches. Memory changes are often worse in women with menopausal symptoms such as trouble sleeping and mood swings. Keeping your brain active with word games, learning new hobbies and staying connected to friends are ways to improve and maintain brain health.

Changes in a woman’s sexual health are common during menopause. Issues may include painful sex, low desire, decreased arousal and orgasm sensation and vaginal dryness. Sexual health can also be affected by social stressors, relationship issues, dermatological conditions, cancer treatment, medication side effects, chronic illness (diabetes, incontinence and chronic pain conditions) and mental health issues such as anxiety and depression.

Menopause can lead to changes in a woman’s hair and skin. Low estrogen can lead to a loss of collagen and elastin in the skin, which can cause sagging skin and wrinkles. Hair thinning can be the result of nutritional deficiencies, genetics, changes in hormones and age.

The risk of osteoporosis increases after menopause. Osteoporosis is a disease in which bone density and quality are reduced, which can lead to fractures. Women can improve bone health with diet, weight bearing exercise, balance training and maintaining normal levels of vitamin D.

Hormonal shifts during perimenopause and menopause can cause a range of digestive symptoms, including constipation, bloating/gas, indigestion, acid reflux, decreased nutrient absorption, decreased metabolism and diarrhea. It’s also important for women to get regular colonoscopies starting at age 45 to screen for colon cancer.