Menopause symptoms and side effects

Everyone experiences menopause differently. Some of the more common symptoms and side effects of menopause include:

• hot flashes
• vaginal symptoms
• decreased libido or other sexual side effects 
• sleep disturbance
• memory or mood changes
• weight gain
• heart disease
• bone weakening
• urinary incontinence

Some of these effects may improve over time with medication or other medical interventions. It is important to note that treatments may have their own risks and side effects. For some people, hormone therapy may be an option for addressing medical or quality-of-life issues that are not resolved in any other way. For people who are unable, or choose not to take hormone replacement, other options may be available to help ease the effects of menopause. 

Hot flashes

Hot flashes are the most common symptom of menopause. Hot flashes feel like a mild to extreme heat throughout the body, and may be accompanied by sweating, flushing, and a rapid heartbeat. Hot flashes may begin soon after menopause and last for months or even years. 

Hormone replacement is the most effective treatment for hot flashes. Certain antidepressants, called selective serotonin reuptake inhibitors (SSRIs), may relieve hot flashes and other menopausal side effects. Brisdelle is an SSRI with Food and Drug Administration (FDA) approval for treating hot flashes. 

Supplements do not effectively treat hot flashes. Some supplements may even be harmful. Products such as handheld fans and "chillows" that reduce body temperature have been helpful for some women who experience hot flashes. Others have also reported that exercise, hypnosis, yoga, or acupuncture relieves their hot flashes. 

Vaginal symptoms

Menopause can also cause the walls of the vagina to become thin and dry, a medical condition known as genitourinary syndrome of menopause, or GSM. GSM symptoms include vaginal dryness, shrinking of tissues, and itching and burning, which can make intercourse painful. GSM can cause bladder and urinary tract infections as well as incontinence. Experts may use one or a combination of several approaches to treat GSM.

• lubricants
• vaginal creams
• systemic hormones
• vaginal hormones
• vaginal treatment with laser or radio frequency

Normally, doctors recommend lubricants and vaginal creams as the first treatment for people who have medical reasons to avoid hormones. Vaginal lubricants (e.g., K-Y, Astroglide, and others) can help make sex more comfortable while vaginal moisturizers  (e.g., Liquibeads, Replens, Hyalo GYN) are designed to be used on a regular basis (not related to sexual activity). Both lubricants and moisturizers are widely available and do not require a prescription.  

Systemic hormone replacement therapy (e.g., tablets or skin patches) can also improve vaginal dryness. Some doctors prescribe low-dose local vaginal hormonal treatments. Research suggests that vaginal estrogen may be safe for breast cancer survivors who cannot take systemic hormones. 

Ospemifene (Osphena) is a type of drug known as a Selective Estrogen Receptor Modulator (SERM). It has been FDA approved to treat painful intercourse due to menopause. 

Researchers are studying how well Carbon Dioxide (CO2) laser treatment such as MonaLisa Touch and radiofrequency treatment such as ThermiVa may help. These vaginal treatments do not have have FDA approval, and most insurance companies do not cover their costs. 

Libido

“Libido” refers to a person's level of sexual desire. Many people experience decreased libido as a side effect of menopause. Hormones can improve libido after surgical menopause. Some doctors recommend the addition of testosterone replacement for women who have loss of libido with menopause that isn't alleviated by estrogen and progesterone alone. 

Studies looking at the effects of the antidepressant bupropion (Wellbutrin) on libido suggest that the drug may improve sexual arousal, overall sexual satisfaction, and satisfaction with intensity of orgasm. Larger studies are needed to validate these findings.

Sleep disturbance

Some people report disruption in sleep patterns associated with menopause. Sleep disturbances may also cause fatigue and problems thinking. Sleep experts can help develop plans for treating sleep disorders, which may include behavioral therapy, strategies for improving sleep habits and medication. 

Memory and mood

Menopause can affect memory. People in menopause often report memory loss or difficulty focusing on tasks. A number of studies have shown that having bilateral oophorectomy before menopause can lead to an increased risk of memory decline and dementia.   

Hormone replacement may help protect against memory loss from young-onset menopause. More research is needed to better understand the effects of estrogen and progesterone replacement on memory and the best timing for hormone replacement. Some research has shown a benefit from yoga, exercise, mindfulness, meditation and cognitive training. Experts also recommend a healthy diet, avoiding alcohol, and getting adequate sleep. Research has shown some benefit from the medication Modafinil, a drug used to treat sleep disorders.

Heart disease

Heart disease is the leading cause of death in American women. Risk increases after menopause, especially young-onset, surgical menopause. In addition to surgical menopause, risk factors for heart disease include:

• sedentary lifestyle
• waistline of more than 35 inches
• high blood pressure or cholesterol
• certain cancer treatments
• family history of heart disease and genetic factors

Research suggests that estrogen replacement therapy may protect against heart disease caused by early menopause. More research is needed to confirm these findings. Maintaining an ideal body weight, exercising, and avoiding smoking can also help protect from heart disease. 

For most people, heart disease is treated with medications. When heart disease is caught early, it is more treatable. It's important for post-menopausal people to have an annual physical exam and to report to their doctor any shortness of breath, abnormal heart rhythm, chest pains or other symptoms.

Bone weakening

Experts use the terms “normal,” “osteopenia,” or “osteoporosis” to describe bone health and weakening. Osteopenia refers to low bone mass or density. Osteoporosis is a more serious loss of bone density, which weakens the bones. Some degree of bone thinning occurs as a natural part of the aging process. Loss of estrogen through natural or surgical menopause can lead to weakening of the bones, increasing the risk for broken bones.

A bone density test can tell whether a person’s bones are weakened or normal. Doctors often recommend a baseline bone density test around the time of menopause or surgery, and followup bone density tests yearly, or every two years after that. 

Hormonal and nonhormonal medications can lower the risk for broken bones caused by loss of bone density. Proper nutrition, including adequate calcium intake is important for bone health. Weightbearing or resistance exercises may strengthen bones in postmenopausal women. 

Urinary incontinence

Urinary incontinence refers to abnormalities of the bladder. The two most common types of urinary incontinence are leakage of urine and a persistent urge to urinate. Both are common side effects of menopause. There are hormonal and non-hormonal treatments for incontinence. Special exercises (called Kegel exercises) that strengthen your pelvic muscles can help. When medication and exercises don't help, surgery may also be used to treat incontinence.