HERSHEY, Pa. — Hot flashes, 2 a.m. wake-ups, night sweats, a low libido and emotional swings: Menopause and perimenopause affect every person who experiences them differently, and some may experience additional symptoms, including being cold, feeling bloated and losing hair.
Cynthia Chuang, a women’s health and internal medicine physician at Penn State Health Cocoa Outpatient Center, sees a variety of menopause symptoms daily in her new virtual Menopause Clinic. The clinic, a collaboration between OB-GYN and general medicine at Penn State Health, helps women in perimenopause and menopause find treatments that work for their lives.
What are menopause and perimenopause?
Chuang said understanding less common symptoms first requires understanding what menopause and perimenopause are.
“The only definition for menopause is that you haven’t had a menstrual period for a year, coinciding with decreasing estrogen levels,” Chuang said. “There’s no blood test to certify you are in menopause, but the average age is 51.”
Perimenopause, a term that has gained more attention in recent years, is the time before menopause when estrogen hormones start to fluctuate, and menstrual periods become irregular. Chuang said perimenopause can last several years and shares many of the same symptoms as menopause.
“In the beginning of perimenopause, you may have more frequent and heavier cycles. A lot of women will get their period unexpectedly and sometimes bleed through their clothing, similar to the irregular cycles they had as teenagers,” Chuang said. “In the second half of perimenopause, the cycles start slowing down. You might go three or four months without a period, and when it comes, it may be lighter.”
Even after a woman has entered perimenopause, there is still a chance of pregnancy, so many may still need birth control options. Hormonal birth control can provide contraception and relief of some symptoms, Chuang said, and low-dose birth control is an effective treatment for symptoms like hot flashes or night sweats. However, it may not be appropriate for all.
According to Chuang, since most menopause symptoms are the result of depleted hormone levels, hormone replacement therapy is a popular treatment. However, for some women, especially those with a history of blood clots, uterine or breast cancer, non-hormonal treatments may be needed. Chuang said that some antidepressants have been effective for hot flashes. A new non-hormonal treatment, fezolinetant, treats hot flashes by blocking the chemical that triggers sudden temperature changes.
Four not-as-common menopause symptoms
Although hot flashes and night sweats might get the majority of the attention, some women may experience other symptoms. Chuang said that many menopause symptoms fall into two camps: hot and dry. Hot symptoms can include hot flashes and night sweats, while dry symptoms can include vaginal dryness and general dryness of the skin. Other symptoms may include:
- Cold chills: The same part of the brain controls both temperature sensations — hot and cold. Some women may have a hot flash followed by chills, or their body temperature may drop without any initial hot flash. Chuang referred to either sensation as “temperature dysregulation” and says the same therapies may help both extremes.
- Thinning hair: Hair thinning is influenced by androgens, Chuang said, which are considered male hormones, such as testosterone. However, hair-thinning is more pronounced during midlife. Topical treatments such as minoxidil can help restart the growth process, but they may take several months to produce noticeable results. Some oral medications can also help, but may cause unwanted hair in other parts of the body. Chuang said that some people may decide the medications are worth the trade-off.
- Loss of fullness in breasts: Bra size will likely change during menopause. Chuang explained that hormones affect breast size and fullness throughout life, whether that’s increasing during breastfeeding or decreasing during and after menopause. Since breast tissue is replaced by fatty tissue as humans age, breast shape may morph over time.
- Digestive issues and bloating: Sarah Horvath, an obstetrician-gynecologist at Penn State Health Obstetrics and Gynecology in Hershey, said estrogen also plays a part in regulating digestion. As estrogen production slows, it can lead to bloating and slower digestion. Focusing on a high-fiber diet rich in fruits and vegetables can help regulate digestion.
Other symptoms attributed to menopause may be signs of aging rather than hormonal changes, Chuang explained. Some women report ringing in their ears, itchy ears, a burning sensation on their tongue, a metallic taste or tingling in their toes or fingers. Chuang said that while these symptoms may coincide with menopause, she would investigate other possible causes.
Related content:
- The Medical Minute: Keep your bones strong during menopause and beyond
- Can hormone therapy improve heart health in menopausal women?
- The Medical Minute: Finding the right OB-GYN
Schedule a virtual appointment at the Penn State Health Menopause Clinic to have menopause questions answered: Call 833-948-1103.
The Medical Minute is a health news feature produced by Penn State Health. Articles feature the expertise of faculty, physicians and staff, and are designed to offer timely, relevant health information of interest to a broad audience.