Postmenopausal Syndrome

What is Postmenopausal Syndrome?

Menopause is the period in a woman’s life when her menstrual periods stop permanently. You know you have reached menopause when you have not had a period for a year. Most women reach menopause between the ages of 49 and 52, with the average age in the United States being 51. If a woman reaches menopause before the age of 40, this is known as premature menopause. Women spend a third of their lives after menopause.

Menopause occurs because the ovaries, which produce the hormone estrogen, run out of the small structures known as follicles that release the eggs. Most of the symptoms women experience during menopause are due to this lack of estrogen, but can also be caused by aging, making it hard to tell the difference.

About health concerns during menopause, they generally revolve around symptoms like hot flashes, changes in the urinary and genital areas, bone loss (osteoporosis), heart disease, cancer, mental health issues, memory problems, and sexual difficulties. These symptoms are often collectively referred to as postmenopausal syndrome. Understanding these risk factors, how they present and how to address them is key to better care and health for older women. It’s especially important to recognize the four most common symptoms – hot flashes, trouble sleeping, symptoms in the genital/urinary areas and sexual problems, along with mood swings.

What Causes Postmenopausal Syndrome?

Postmenopausal symptoms mainly happen because of lower levels of estrogen in the body. These symptoms can include hot flashes, changes in the genital area, and sexual dysfunction. These changes are part of the complex process that happens during menopause.

In the ovary, the number of follicles (which are small sacs where eggs grow) decrease, especially the granulosa cells that play a key role in the production of hormones. As a result, the ovary is unable to react to hormones from the pituitary gland. Hormones like follicle-stimulating hormone (FSH) and luteinizing hormone (LH) increase because there’s no feedback to stop them. Estrogen, progesterone, and inhibin hormones stop being produced in the ovaries. However, the production of male hormones (androgens) continues in the theca cells in the ovaries and adrenal gland. These androgens can be converted to estrogen in other areas of the body.

Hot flashes are complex – the change or loss of estrogen is thought to result in a reset and a narrowing of the body’s temperature regulation system. Some theories suggest that they might be due to changes in estrogen and FSH levels, or due to changes in brain’s receptors (5-HT2A) in response to reduced serotonin level – a neurotransmitter affecting mood.

Genital tissues are very sensitive to estrogen, so a lack of this hormone can cause damage and shrinking of the vagina, uterine prolapse (when the uterus slips down into or protrudes out of the vagina), and pain during sex. Lower estrogen levels can also impact the urinary tract, including the bladder and urethra, leading many to experience urinary incontinence (difficulty controlling urination). Unfortunately, unlike hot flashes, these genital changes do not get better without treatment.

The cause of sexual dysfunction in post-menopausal women is not clearly linked to hormonal changes. Lower sex drive could also be due to hot flashes, sleep disturbances, and mood changes that come with menopause.

Risk Factors and Frequency for Postmenopausal Syndrome

Each year, about 1.5 million women go through menopause, which is a natural part of aging. Many women, around 70 to 80%, experience symptoms like hot flashes, but only 15 to 20% find these symptoms severe enough to seek help. These hot flashes usually last for an average of 5.2 years, starting a year before a woman’s last period and then slowly decreasing. Around 27 to 60% of women experience vaginal dryness or painful sexual intercourse as a result of menopause. In addition, half of the women reported disturbances in their sleep. Lastly, women going through perimenopause have a 3 times higher risk of experiencing a major episode of depression.

Each year, about 1.5 million women go through the menopause transition.
Approximately 70 to 80% of these women will experience symptoms like hot flashes.
However, only around 15 to 20% find these symptoms intense enough to seek help.
The average duration of these hot flashes is about 5.2 years.
About 27 to 60% of women experience vaginal dryness or pain during sex due to menopause.
Half of the women report disturbances in their sleep.
Lastly, women in perimenopause have a 3 times higher risk of having a major depressive episode.

Signs and Symptoms of Postmenopausal Syndrome

Postmenopausal syndrome is characterized by a range of symptoms. Major symptoms include hot flashes, which feel like a sudden wave of heat spreading on the upper chest and face. These waves can be accompanied by sweating, heart palpitations, chills, shivers, and feelings of anxiety. Hot flashes typically last for two to four minutes and may happen several times a day, often at night, and can persist for many years.

Another key feature of this syndrome is the genitourinary syndrome of menopause, or GSM. This involves mild symptoms such as vaginal dryness, burning, itching, discomfort during intercourse, loss of sex drive, and problems with urination. Visible signs such as lack of vaginal moisture, pale vaginal tissue, loss of pubic hair, loss of elasticity and narrowing of the vagina might be seen. In some cases, organs in the pelvic region may prolapse or drop from their normal position.

During the transition to menopause, irregular menstrual cycles, hot flashes, and night sweats are most common. After menopause, vaginal dryness and other genitourinary symptoms become more prominent. Hormone replacement therapy can be effective in treating these symptoms. In addition, many women experience a decrease in sexual desire and a lower frequency of sexual thoughts and fantasies.

It’s also common for menopausal women to struggle with sleep disturbances. About half of the women experiencing menopause report difficulty with initiating sleep and a higher incidences of obstructive sleep apnea. These sleep issues are not likely to be fully explained by hormonal changes and may be a result of hot flashes, mood disorders, social factors, other medical conditions or restless legs syndrome.

Testing for Postmenopausal Syndrome

The way doctors identify postmenopausal syndrome is mainly based on the symptoms a woman reports. When women who are generally healthy and are over 45 years old experience symptoms, there usually isn’t a need for further examinations. This is because the levels of a hormone called follicle-stimulating hormone, or FSH, can change rapidly during this time, making it an unreliable marker.

However, additional tests such as a blood count or a thyroid function test may be ordered if the doctor thinks there might be a cause for the symptoms that isn’t related to menopause. For younger women, under the age of 40, diagnosis is confirmed by consistently high levels of the FSH hormone. For women in this age group, doctors may also need to rule out other conditions that can cause similar symptoms like pregnancy or polycystic ovarian syndrome, a condition that affects a woman’s ovaries.

Treatment Options for Postmenopausal Syndrome

If you’re experiencing mild hot flashes, some lifestyle changes can help to manage your symptoms. This can include keeping your environment cool, using fans, wearing breathable clothing, and avoiding triggers like stress and spicy foods. There are also therapeutic practices, like mindfulness, stress reduction exercises, cognitive-behavioral therapy (CBT), acupuncture, yoga, and vitamin E that some people find helpful. These have not been scientifically proven to work, but they might provide some relief.

If your hot flashes are moderate to severe, you may need medication along with the changes to your lifestyle. Hormonal therapy is usually the first choice for women who don’t have any issues that prevent them from using hormones. Hormonal therapy is especially safe for women under 60 years of age or who are within ten years of starting menopause. The hormones used in the therapy are usually estrogen and progestin. Transdermal therapy (applying medication through the skin) is often the preferred method for women with certain conditions like diabetes, migraine without aura, liver disease and more. It’s been shown that using either estrogen alone or with progesterone can reduce the frequency of hot flashes by 75% and the severity by 87%.

Additionally, there are some non-hormonal therapies available like making lifestyle changes, using nonprescription therapies, and prescription medicines. Women above 60 years of age or if more than ten years postmenopausal are good candidates for non-hormonal treatment. Particular medicines like SSRIs, SNRIs, clonidine, and gabapentinoids have been shown to decrease the severity and frequency of hot flashes. However, some people may experience mild side effects like nausea, constipation and dry mouth.

If you’re struggling with genitourinary syndrome, which can cause moderate to severe symptoms like itching, burning, and painful sex, you can use low dose topical estrogen. There’s also an option for using lubricants and moisturizers for milder symptoms. Other treatments include selective estrogen receptor modulators, vaginal dehydroepiandrosterone (DHEA), or even laser therapy.

Sexual dysfunction can have many causes. Treatments for hot flashes, mood changes, and vaginal dryness may improve sexual dysfunction. In cases where low levels of androgen cause the symptoms, particularly after surgery-induced menopause, treatments may include DHEA or potentially testosterone therapy. While testosterone therapy has shown potential in improving sexual function, it’s important to be aware of potential risks and side effects.

Finally, if you’re experiencing sleep disturbances, it’s necessary to pinpoint the cause in order to treat it. If hot flashes are causing insomnia, hormone replacement therapy can be effective. Other sleep problems may be addressed with cognitive behavioral therapy, non-benzodiazepine hypnotics, melatonin, or antidepressants. If you continue to struggle with sleep, it may be beneficial to see a sleep specialist.

Identifying the cause of hot flashes can depend on how they occur. However, some conditions that may cause similar symptoms to hot flashes include:

Thyroid disease
Certain types of cancer
Low blood sugar, also known as hypoglycemia
Carcinoid syndrome, a type of rare hormonal disorder
Pheochromocytoma, a rare tumor of the adrenal gland

What to expect with Postmenopausal Syndrome

Changes in how your body regulates temperature, like hot flashes, often get better over time but in some cases, they can last up to 20 years after menopause. How long these symptoms last can vary depending on your ethnicity. For example, Asian women generally experience these symptoms for a shorter period compared to African American women, who may experience them for up to 10 years.

Hormonal therapy is an effective treatment that can reduce the number of hot flashes and their intensity by 75% and 87% respectively. This treatment can also help reduce the risk of bone loss and fractures, and can alleviate the discomfort of genitourinary syndrome associated with menopause, which refers to issues with the urinary and genital areas like dryness and discomfort during sex.

However, it’s important to note that genitourinary symptoms don’t generally get better on their own over time without treatment, and these symptoms are likely to return once hormonal therapy is stopped.

Possible Complications When Diagnosed with Postmenopausal Syndrome

The Women’s Health Initiative trial discovered that using hormone replacement therapy could lead to health risks. These potential risks include heart disease, stroke, blood clots in the veins (venous thromboembolism), and breast cancer. Particular increases in risk were noted in specific scenarios. For instance, a higher risk of breast cancer was identified after four years of combination therapy, and a raised risk of abnormal cell growth in the womb lining (endometrial neoplasia) was associated with estrogen therapy.

Regardless of how it is taken or how much is used, estrogen and progestogen products all carry a boxed warning. To minimize these risks, the guidelines suggest using these products at the smallest possible dose for the shortest possible time duration. These recommendations came from this trial’s findings.

Potential Risks:

Heart disease
Stroke
Blood clots in the veins (venous thromboembolism)
Breast cancer
In women on combination therapy: Increased risk of breast cancer after four years
In women on estrogen therapy: Increased risk of abnormal cell growth in the womb lining (endometrial neoplasia)

Preventing Postmenopausal Syndrome

It’s important to inform the patient about how their symptoms might change over time, what could make their condition worse, and how altering their lifestyle could help improve their condition. Together with the patient, the doctor will develop a plan for treatment, making sure it’s suited to their needs and circumstances.

Frequently asked questions

Postmenopausal syndrome refers to the collection of symptoms that women often experience after menopause, such as hot flashes, changes in the urinary and genital areas, bone loss, heart disease, cancer, mental health issues, memory problems, and sexual difficulties.

Approximately 70 to 80% of women going through the menopause transition will experience symptoms like hot flashes.

The signs and symptoms of Postmenopausal Syndrome include: - Hot flashes, which are characterized by a sudden wave of heat spreading on the upper chest and face. These hot flashes can be accompanied by sweating, heart palpitations, chills, shivers, and feelings of anxiety. They typically last for two to four minutes and may happen several times a day, often at night, and can persist for many years. - Genitourinary symptoms, known as the genitourinary syndrome of menopause (GSM). This includes vaginal dryness, burning, itching, discomfort during intercourse, loss of sex drive, and problems with urination. Visible signs such as lack of vaginal moisture, pale vaginal tissue, loss of pubic hair, loss of elasticity, and narrowing of the vagina might be seen. In some cases, organs in the pelvic region may prolapse or drop from their normal position. - Irregular menstrual cycles, hot flashes, and night sweats are common during the transition to menopause. After menopause, vaginal dryness and other genitourinary symptoms become more prominent. - Decreased sexual desire and a lower frequency of sexual thoughts and fantasies are also common in menopausal women. - Sleep disturbances are another symptom of Postmenopausal Syndrome. About half of women experiencing menopause report difficulty with initiating sleep and a higher incidence of obstructive sleep apnea. These sleep issues may not be fully explained by hormonal changes and can be a result of hot flashes, mood disorders, social factors, other medical conditions, or restless legs syndrome.

Postmenopausal syndrome is a natural part of aging that occurs due to lower levels of estrogen in the body.

Thyroid disease, certain types of cancer, low blood sugar (hypoglycemia), carcinoid syndrome, pheochromocytoma.

The types of tests that may be ordered to properly diagnose postmenopausal syndrome include: 1. Blood count: This test can help identify any abnormalities in the blood that may be causing the symptoms and rule out other conditions. 2. Thyroid function test: This test can determine if the symptoms are related to an underlying thyroid issue rather than menopause. 3. Follicle-stimulating hormone (FSH) levels: For women under the age of 40, consistently high levels of FSH can confirm the diagnosis of postmenopausal syndrome. 4. Pregnancy test: This test may be ordered to rule out pregnancy as a cause of the symptoms. 5. Polycystic ovarian syndrome (PCOS) test: For younger women, a test for PCOS may be necessary to rule out this condition as a cause of the symptoms. It's important to note that in generally healthy women over 45 years old, further examinations may not be needed if the symptoms are consistent with postmenopausal syndrome.

Postmenopausal syndrome can be treated through various methods depending on the specific symptoms. For mild hot flashes, lifestyle changes such as keeping the environment cool, wearing breathable clothing, and avoiding triggers like stress and spicy foods can help. Therapeutic practices like mindfulness, stress reduction exercises, acupuncture, yoga, and vitamin E may also provide relief. For moderate to severe hot flashes, hormonal therapy using estrogen and progestin is usually the first choice. Non-hormonal therapies like SSRIs, SNRIs, clonidine, and gabapentinoids can also be used. Genitourinary syndrome can be treated with low dose topical estrogen, lubricants, moisturizers, selective estrogen receptor modulators, vaginal dehydroepiandrosterone (DHEA), or laser therapy. Sexual dysfunction can be improved with treatments for hot flashes, mood changes, and vaginal dryness. Sleep disturbances can be addressed with hormone replacement therapy, cognitive behavioral therapy, medication, or seeing a sleep specialist.

When treating Postmenopausal Syndrome, there are potential side effects to be aware of. These include heart disease, stroke, blood clots in the veins (venous thromboembolism), and breast cancer. Specifically, combination therapy has been associated with an increased risk of breast cancer after four years, while estrogen therapy has been linked to an increased risk of abnormal cell growth in the womb lining (endometrial neoplasia). It is important to note that these risks were identified in the Women's Health Initiative trial and the guidelines recommend using hormone replacement therapy at the smallest possible dose for the shortest possible time duration to minimize these risks.

The prognosis for Postmenopausal Syndrome can vary depending on the individual, but there are treatment options available to help manage the symptoms. Hormonal therapy is an effective treatment that can reduce the number and intensity of hot flashes, as well as alleviate discomfort in the urinary and genital areas. However, it's important to note that genitourinary symptoms are unlikely to improve without treatment and may return once hormonal therapy is stopped.

A gynecologist or a primary care physician can be consulted for Postmenopausal Syndrome.

Hot Flashes Mood Changes Sexual Dysfunction Sleep Disruption Women's Health