During perimenopause, there’s a gradual decline in the functioning of your ovaries and oestrogen production as your body begins to change in preparation for menopause, when menstruation stops and you become permanently infertile.

The decline and sudden absence of oestrogen during perimenopause and menopause has a huge impact on your body and emotions. Here we take a look at what happens to your body during menopause, the common symptoms,. why they occur and what to expect:

Hot flushes

One of the first things to become seriously mixed up is the temperature-control centre in your brain, and that’s the reason for hot flushes.

Experiencing hot flushes is the feature that has made the menopause notorious, and is the most common symptom: an estimated 75%-80% of women suffer these feelings of intense heat over the trunk and face with an accompanying flushing of the skin.

A hot flush generally lasts less than five minutes, and the sweating that accompanies this “attack” usually starts a minute after the feeling of palpitations.

The frequency of flushing may range from one or two per day to one every 15-30 minutes. Flushing is more pronounced late in the day, in hot weather, after ingestion of hot foods or drinks, or during periods of stress and tension.

Hot flushes can begin during perimenopause, before menstruation stops.

Most women have hot flushes for more than a year while 25%-50% will suffer for up to five years if they’re not treated. New studies indicate that hot flushes often last 10-12 years.

Sleep disturbances

Insomnia can be caused by hot flushes at night, which may be accompanied by night sweats as a result of fluctuating hormone levels.

Sleeplessness may already be experienced some years before menopause, and it’s a problem mainly because it can cause daytime tiredness.

Erratic periods

Very few women simply suddenly stop menstruating. Before ovulation stops altogether, the menstrual cycle generally becomes more irregular in length. Changes in the flow may be experienced – blood flow may be heavier or lighter. This can start anything from 2-8 years before menopause.

Finally, the intervals between menstruations become longer, with missed periods or episodes of spotting only. The irregularity may last two or three years before menstruation finally ceases. When no bleeding has occurred for one year, the menopausal transition is said to have occurred.

Bleeding after this time can be a sign of a serious underlying problem and should be seen to as soon as possible.

Also see a doctor if you notice any of the following:

    • Spotting between menstrual periods

    • Periods that last more than seven days (or two days longer than usual)

    • Very heavy or gushing flow

    • Bleeding from the vagina during intercourse

Psychological symptoms

Psychological symptoms such as moodiness, irritability, anxiety, depression, tearfulness, forgetfulness and difficulty in concentrating are often the focus of menopause jokes, but there’s no objective evidence that cessation of ovarian function is linked to severe emotional disturbance or personality changes.

Stress and mood swings can be a problem, particularly for women with a history of premenstrual syndrome (PMS) or post-natal depression. During the perimenopausal time span, some women notice worsening PMS or experience it for the first time. Menopause ends PMS.

The symptoms of menopause can precipitate an underlying psychological problem, but it cannot cause it.

Joint pain

Many women suffer joint pain as one of their earliest symptoms. Often starting during perimenopause, it may suddenly become painful to get out of bed, walk upright to the bathroom or get dressed. Quite often the joints of the back, fingers, knees and ankles are affected.

The severity of the joint pain may decrease after a few months.

Vaginal dryness and sexual discomfort

Decreased oestrogen can lead to thinning of the epithelial lining and the underlying tissues of the vaginal wall may become thinner and less elastic, a condition known as atrophy. This causes decreased lubrication, which in turn may lead to substantial pain during and after intercourse. As painful intercourse is seldom a turn-on, it might lead to a decline in the desire for making love.

Vaginal dryness and thinning may continue after menopause. Some doctors estimate that at least half of all women over 60 have some degree of vaginal dryness.

Vaginal changes may also increase the risk of infections due to reduced local protection against micro-organisms, which may enter the vagina due to self-contamination or sexual intercourse.

Middle-age spread and weight gain

Oestrogen is responsible for the female pear-type fat distribution and a lack of oestrogen will cause the fat distribution to change to the male apple-type fat (the so-called middle-age spread) distribution. This type of fat distribution is associated with an increase in the risk for cardiovascular disease.

Appetite may decrease, but the stress associated with this period often leads to an increase in appetite. The associated weight gain doesn't do the mood any good either.

Other gastrointestinal symptoms associated with menopause include nausea, flatulence, constipation and/or diarrhoea.

Decreased libido

Beginning in perimenopause, some women may experience a gradual decline in sexual desire (libido). However, 60% of women experience no change in libido, 20% experience a decrease, and in 20% of cases libido improves.

Although no correlation has been found between oestrogen levels and libido, it appears that testosterone may also affect it.

Other factors that could lead to changes in sexual function include:

    • Painful intercourse due to vaginal dryness (atrophy)

    • A woman’s perception of her changing body

    • Incontinence, which could lead to sexual avoidance

    • Sleep disturbances due to night sweats

    • Depression, stress and anxiety

    • Many medications, including some antidepressants

    • Reduced libido and impotence in the male sexual partner

Urinary incontinence (leaking bladder)

Decreasing oestrogen levels can weaken the pelvic floor muscles controlling the bladder and urethra – the tube through which urine is passed from the bladder. The tissue of your urinary tract also becomes less elastic, leading to urinary incontinence.

These changes could lead to:

    • Painful urination (dysuria)

    • Urination at night (nocturia)

    • The need to urinate urgently (urge incontinence)

Another symptom that may be associated with these changes is stress incontinence, which is involuntary urine leakage, occurring with coughing, laughing, sneezing, exercising or sudden exertion.

Other problems that may arise are frequent bladder and vaginal infections.

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Read more about Menopause:

>> A natural approach to menopause

>> Different stages of menopause

>> Top tips to minimise menopause symptoms