Wellbeing during menopause

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PantherMedia / Phovoi R.

Although different women cope differently with menopause, severe menopause symptoms can greatly affect your wellbeing. But the higher risk of particular diseases after middle age is mainly due to increasing age, not hormonal changes.

Hot flashes (also called hot flushes), sweats and vaginal dryness are the most common menopause symptoms. Hot flashes and sweats at night can disturb your sleep. Women may then have trouble concentrating and feel tired the next day.

But not all physical and emotional changes during this phase of life are due to menopause. Mood swings, problems with concentration and memory, and physical problems like back ache aren't directly caused by the hormonal changes. They can happen at any other age and be caused by many other things too. The higher risk of diseases such as osteoporosis and cardiovascular disease are also related to growing older.

So menopause itself doesn't usually directly affect your health. But it can be a good time to think about how to stay healthy or improve your health and wellbeing in older age.

What are hot flashes and what causes them?

Hot flashes are probably triggered in the part of the brain that regulates your body temperature. If your body temperature increases too much, your brain can send signals that temporarily make the blood vessels in your skin widen (“dilate”). This process is called vasodilation. It allows more blood to flow through your skin, so more heat is released and your body can cool off. This is felt as a hot flash. Scientists believe that the reduced hormone production in the ovaries during menopause influences the regulation of women’s body temperature. But it is not known for sure what causes hot flashes.

Many women start having hot flashes around the time of their last menstrual period. Hot flashes are often quite frequent and intense at first, and get better with time. They are typically described as sudden waves of heat that usually start in your chest, face and the back of your neck, and spread throughout your whole body. Hot flashes can make your skin look blotchy and red, and cause you to sweat. Some women feel their heart race at the same time. This doesn't usually have anything to do with heart disease. Hot flashes last about three minutes on average. Some women feel cold afterwards.

Various things are believed to make hot flashes worse. These include being in a warm environment and/or dressing too warmly, drinking strong coffee or tea, eating hot spices, as well as feeling stressed or nervous. Alcohol and some medications can also have this effect.

Does menopause affect sexuality?

The effect of menopause on sexuality is different in different women. Some fear that the related changes might make sex less enjoyable, while others are satisfied with their sex lives. Some women experience less sexual desire, while others have a better sex life than before. Many are happy that they no longer have to think about contraception.

These differences already indicate that changes in sexuality in middle age might not only be related to menopause. There is no that the hormonal changes have a negative effect on sexual pleasure or desire. Growing older appears to play a bigger role here. Other things that affect sexuality include psychological, social and cultural factors and, last but not least, relationship issues.

But it can be a problem if the vagina isn't lubricated well enough during sexual arousal or if a woman worries about this beforehand. Then sex might be uncomfortable or painful if no lubricants are used. About 3 out of 10 women start having problems with this just before menopause because the lining of the vagina becomes more sensitive and drier than before. This can cause itching and make infections more likely. The lining of the vagina doesn't change suddenly, but over the course of the menopausal transition. Some women only notice this long after they have had their last menstrual period.

How do women feel about menopause?

Menopause is often mainly viewed as a sign of aging and also associated with loss: such as the loss of attractiveness, femininity and health – as well as the loss of certain roles, both at work and within the family. But the way women feel about and deal with this stage of their life greatly depends on their personal life circumstances, their self-image and their attitude towards aging.

Although the way society views older women is gradually changing, menopause doesn't generally have a particularly positive image. No wonder: After all, for decades now there have been claims that menopause speeds up the aging process and that women should be more concerned about their health after menopause. This attitude has made menopause seem like a medical problem that needs treatment.

But when women are asked how they judge their own experience of menopause, they often describe a very different picture. Experiences of menopause are about as varied as women are themselves: They range from "new sense of freedom and energy" and "a fresh start" to "feeling old and useless."

The way women feel about their physical appearance during this stage of life varies greatly. Some worry that they are no longer considered to be attractive. Others feel just as attractive or feminine as they did before. A lot of women are happy and relieved to no longer have periods – this is particularly true of women who used to have heavy and/or very painful periods, or were affected by a medical condition such as endometriosis.

There is no “right” way to deal with menopause. Most women find a way that suits them: Some pay very little attention to it. Others see it as an important stage of their life that is associated with positive changes too. Some use it as an opportunity to think about their life and reconsider their priorities.

Many women go through menopause during a phase of re-orientation in their lives, for example because their children become adults or have already left home. They may change their lifestyle and focus more on their own goals and future. It is absolutely normal to feel unsure of yourself or have mixed feelings during a time like this.

How do women cope with their emotions?

A lot of women share their experiences and feelings with friends who are around the same age as them, or with their own mother. Some women prefer to avoid the topic completely, or talk to their doctor or another professional.

Mothers’ and older sisters’ experiences can help women deal with their own symptoms and get an idea of when they might reach menopause themselves. But menopause is sometimes still a taboo subject among older generations.

Many women want to talk to their partner about it too, but that's not always easy. Some women find that their partner isn't interested in their menopause or shows little understanding for what they're going through. Other women don't want to talk about it anyway – because they're ashamed or worried that their partner won't find them attractive anymore. A lot of men don't know much about this stage of a woman’s life.

How do women experience the physical changes?

As long as the typical symptoms like hot flashes aren't very severe, a lot of women just see them as one of many aspects of the menopause. Severe symptoms can be unsettling, though – after all, most people want to feel comfortable in their own body. But some women suddenly feel like a stranger in their own body during a hot flash, or like they're losing control of their body. Having a visible hot flash in public, for example during a business meeting, can be embarrassing. Hot flashes vary in intensity, though, and the warmth you feel isn't always unpleasant.

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IQWiG health information is written with the aim of helping people understand the advantages and disadvantages of the main treatment options and health care services.

Because IQWiG is a German institute, some of the information provided here is specific to the German health care system. The suitability of any of the described options in an individual case can be determined by talking to a doctor. informedhealth.org can provide support for talks with doctors and other medical professionals, but cannot replace them. We do not offer individual consultations.

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Updated on July 2, 2020
Next planned update: 2023

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Institute for Quality and Efficiency in Health Care (IQWiG, Germany)

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