**3.3 Mood disorders**

Mood swings, anxiety, and depression are some of the psychological symptoms during menopausal change. Nearly half of women on menopause transition can get easily irritated. They become less patient with the members of the family, friends, and colleagues and often feel tired and sad. With emotional changes, they can appear nervous, stressful, and sometimes aggressive. Mood swings are due to changes in serotonin activity following estrogen decline but may also be caused by other menopausal symptoms as hot flushes and night sweats.

Anxiety in the form of nervousness, worry, or panic attacks may occur during perimenopause. Hormonal changes, vasomotor symptoms, and midlife stresses contribute to anxiety during this period. Panic disorders are associated with negative life events, impairment of activity, or physical illnesses.

Depression is more common in the menopause transition and early postmenopause than premenopausal. A number of reports indicate that there is a significant increased risk of new-onset depression in women during menopause [5]. Those who had previous episodes of depression are at a higher risk. Depression is associated with hormonal changes during this period, stressful life events, poor sleep, hot flushes, employment status, ethnicity, and cultural attitudes.

Insomnia may be seen in some women, and they are more likely to have anxiety, stress, and depressive disorders. Sleep disorders are associated with menopause transition and also related to hot flushes, other physical health problems, psychosocial problems, and medication. Sleep apnea too may occur during this period, and obese women are at a higher risk.

### **3.4 Genitourinary symptoms**

Estrogen receptors are present abundantly in the vagina, vestibule, and trigone area of the bladder. With estrogen deficiency after menopause, many anatomical and physiological changes occur in this area, which results in GSM. Genitourinary syndrome of menopause (GSM) is the new term for vulvovaginal atrophy (VVA). In 2012, the International Society for the study of Women's Sexual Health and the North American Menopause Society introduced genitourinary syndrome of menopause as a more accurate, comprehensive, and publicly acceptable term to replace atrophy or atrophic vaginitis. The Society considered "atrophy" to be a negative

term, which suggests "wasting away" and that vaginitis imply an infective or inflammatory condition. Neither the old terms encompass the urological symptoms. Furthermore, "vagina" was not regarded as a socially acceptable enough word to use in public discourse or the media (Maturitas 2014; 79–349).

Due to menopause, the withdrawal of estrogen causes dryness of the vagina, loss of elasticity and flexibility of the vagina, and damage of the vaginal epithelium. So women complain of the following:

Vaginal dryness or lack of lubrication Dyspareunia Postcoital soreness and bleeding (Maturitas 2014; 79–349) Vulval/vaginal itching, soreness, burning, and discomfort Urinary frequency, urgency, nocturia, and recurrent UTIs Urge incontinence

On examination the vagina seems short and narrow, with the absence of rouge, and appears pale. About 20–30% of postmenopausal women have urgency and have urinary incontinence. With genital prolapse, women may suffer from recurrent urinary tract infections.

This dryness of the vagina causes decreased lubrication and sexual dysfunction [6]. The single entity of dyspareunia affects all that domains of sexual function. If not treated timely, women complain severe sexual dysfunction, which totally disrupt the conjugal life.

#### **3.5 Osteoporosis**

Accelerated osteoclastic activity and reduced osteoblastic activity and calcitonin activity due to reduced estrogen and aging process lead to osteoporosis. Osteoporosis is a systemic skeletal disease characterized by low bone mass and micro architectural deterioration of bone tissue leading to enhanced bone fragility and a consequent increase in fracture risk. Osteoporotic fracture burden is increasing worldwide. About half of women 50 and older will have an osteoporosis-related fracture in their lifetime. During the menopausal transition period, the average reduction in bone mass density (BMD) is about 10%. Approximately half of women are losing bone even more rapidly, perhaps as much as 10–20% in those 5–6 years around menopause.

Women could be asymptomatic, or they might have persistent unexplained back pain, recurrent fractures, fracture from minimal trauma, loss of height, and spinal deformities. The incidence of fractures increases, particularly of the distal radius, vertebral body, and upper femur beyond menopause. Wedge compression fractures of the spine lead to backache. Women complaining chronic back pain, bone pain, joint pain, and muscle pain must consult a doctor to exclude osteoporosis. Maintaining optimum body weight and avoiding sedentary work, bone toxic agents, too much alcohol, and smoking are the key strategies to prevent osteoporosis.

#### **3.6 Cardiovascular disease**

With the loss of cardioprotective action of estrogen by its action on lipids, endothelial function, and anti-inflammatory effect, menopausal women are more liable to get ischemic heart disease. Symptoms of coronary heart disease (CHD) in women are somewhat different from typical male type of angina, which are usually brought by exertion and relieved by rest. Women with myocardial infarction have atypical symptoms like fatigue, shortness of breath, and atypical chest pain. Many may have nonobstructive coronary heart disease (CHD); angiogram may not show typical obstruction in the coronary arteries. CHD is the commonest cause of death among postmenopausal women; the ratio of CHD in men to women becomes 1:1

**51**

*Symptoms of Menopause*

and cardiovascular disease.

the knees and hands are mostly affected.

**3.8 Skin changes**

**3.9 Joints**

**3.10 Sarcopenia**

**3.11 Eyes**

**3.12 Teeth**

**3.13 Memory loss**

**3.7 Obesity**

*DOI: http://dx.doi.org/10.5772/intechopen.88572*

might decrease during menopause [7].

after menopause. The SWAN study suggested that the protective effects of HDL

Menopause along with aging process is associated with an increased risk of obesity and a shift to an abdominal fat distribution with associated increase in health risks. Changes in body composition at menopause may be caused by the decrease in circulating estrogen. For fat distribution shifts, the relative increase in the androgen-estrogen ratio is likely to be important. Large majority of these women have an increased body mass index and waist circumference. Midsection fat distribution is pronounced during menopause and beyond. Women gaining weight especially with increased abdominal girth are prone to develop metabolic syndrome

But weight gain during midlife and beyond is just not due to menopausal

Dry skin and wrinkling are due to the loss of subcutaneous fat and changes in composition of connective tissue. Dry hair and hair loss and increased facial hair are caused by reduction in estrogen and relative increase in male hormones. Skin becomes less elastic and wrinkling appears. Nails become brittle and nail growth becomes slow.

Osteoarthritis is commoner in females after menopause, and many epidemiological and clinical studies indicate estrogen deficiency as one of the etiological factors in addition to familial tendency, obesity, and aging. In menopausal women,

Menopausal transition is associated with accelerated loss of fat-free mass, a decline in resting metabolic rate, and increased central body fatness. The causes of sarcopenia or loss of muscle mass are due to hormonal changes at menopause, low levels of physical activity, reduced protein intake, and increased oxidative stress.

Postmenopausal women are at a higher risk of developing age-related macular

In the menopausal woman, osteoporosis may lead to loss of the alveolar bone of the jaws, resulting in periodontal disease, loose teeth, and tooth loss. Estrogen

As estrogen affects cognitive function and neurotransmitters, memory loss has been noted at menopause, especially episodic memory and verbal fluency. Estrogen

degeneration, and association with estrogen deficiency has been suggested.

therapy has been shown to increase the alveolar bone mass.

status [8]. So women must try to maintain the optimum body weight.

after menopause. The SWAN study suggested that the protective effects of HDL might decrease during menopause [7].
