**3.2 Vasomotor symptoms**

Vasomotor symptoms are the main bothering and common symptoms in the early menopause. They include hot flushes, night sweats, and palpitation and are termed vasomotor symptoms because of vascular reactivity with initial prominent vasodilatation.

**49**

*Symptoms of Menopause*

**3.3 Mood disorders**

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

osteoporosis, fragility fractures, and diabetes [4].

other menopausal symptoms as hot flushes and night sweats.

tive life events, impairment of activity, or physical illnesses.

flushes, employment status, ethnicity, and cultural attitudes.

obese women are at a higher risk.

**3.4 Genitourinary symptoms**

Hot flushes are transient periods of intense heat in the upper part of the body usually accompanied by sweating. Its exact mechanism is not known, but is believed to be due to narrowing of thermoregulatory zone of the hypothalamus with decline of estrogen level. Hot flushes and night sweats are experienced by about 40% in early transition, increasing to 60–80% in late menopausal women [3]. About 25% can be severe to cause significant distress. Sleep disturbances caused by hot flushes and sweating can lead to lethargy, poor physical functioning, and depressed mood. In about 25% of women, hot flushes may continue for over 5 years; in a small percentage of women, it may continue up to 10 years or more. In surgical menopause, vasomotor symptoms are abrupt and severe. Low body weight, lack of exercise, and smoking are risk factors for hot flushes. Severity, frequency, and duration of hot flushes vary with menopausal status, ethnicity, age, cultural factors, and woman's perception of menopause. In many western countries and Australia, 60–80% of women experience hot flushes, while the prevalence is 20–30% in Chinese and Japanese women. In Asia 40–60% of women have hot flushes. Hot flushes have a negative impact on quality of life as well as an association with adverse morbid conditions like cardiovascular disease,

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

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 nega-

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

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

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

#### *Symptoms of Menopause DOI: http://dx.doi.org/10.5772/intechopen.88572*

*Hormone Therapy and Replacement in Cancer and Aging-Related Diseases*

ing menopause commence) and the first year after menopause.

This term can be used synonymously with "premenopausal."

fied from the WHO 96238) is shown in the table below.

biological marker for the event does not exist.

Terminology Reproductive Menopausal

Natural menopause is recognized to have occurred after 12 consecutive months of amenorrhea, for which there is no other obvious pathological or physiological cause. Menopause occurs with the final menstrual period, which is known with certainty only in retrospect a year or more after the event. An adequate independent

The term "perimenopause" should include the time immediately prior to the menopause (when the endocrinological, biological, and clinical features approach-

The term "menopausal transition" should be reserved for the time before the final menstrual period when variability in the menstrual cycle is usually increased.

Stages −5 to –4 −3 −2 −T″ +1 +2

transition

Early peak Late Early Late Early late

Duration of stage variable Variable l year 4 years

length > 7 days different from normal

Regular Variable cycle

Endocrine Normal FSH ↑ FSH ↑ FSH FSH

*Stages of reproductive aging workshop (STRAW) system.*

Relationship between different time periods surrounding the menopause (modi-

Post Menopause

12 months amenorrhea

>2 skipped cycles and an interval of amenorrhea

demise

None

Until

Menstrual irregularities are a common complaint during menopause transition. Infrequent **ovulation** and anovulation lead to changes in the length of proliferative phase, and in the absence of progesterone, decline of estrogen leads to heavier and irregular menstruation. In some women scanty periods with long cycles may be the main symptom. The changes of bleeding pattern due to hormonal fluctuation usually occurs during perimenopause. The analysuisreported median age at inception of perimenopause is 47.5 years and smokers have not only early but a shorter perimenopause [2]. However, postcoital bleeding, prolonged bleeding, and post-

Vasomotor symptoms are the main bothering and common symptoms in the early menopause. They include hot flushes, night sweats, and palpitation and are termed vasomotor symptoms because of vascular reactivity with initial prominent vasodilatation.

**2. Definition**

**FMP**

**Perimenopause**

Menstrual cycles

**3. Symptoms of menopause**

Variable to regular

menopausal bleeding require further investigation.

**3.1 Menstrual irregularities**

**3.2 Vasomotor symptoms**

**48**

Hot flushes are transient periods of intense heat in the upper part of the body usually accompanied by sweating. Its exact mechanism is not known, but is believed to be due to narrowing of thermoregulatory zone of the hypothalamus with decline of estrogen level. Hot flushes and night sweats are experienced by about 40% in early transition, increasing to 60–80% in late menopausal women [3]. About 25% can be severe to cause significant distress. Sleep disturbances caused by hot flushes and sweating can lead to lethargy, poor physical functioning, and depressed mood. In about 25% of women, hot flushes may continue for over 5 years; in a small percentage of women, it may continue up to 10 years or more. In surgical menopause, vasomotor symptoms are abrupt and severe. Low body weight, lack of exercise, and smoking are risk factors for hot flushes.

Severity, frequency, and duration of hot flushes vary with menopausal status, ethnicity, age, cultural factors, and woman's perception of menopause. In many western countries and Australia, 60–80% of women experience hot flushes, while the prevalence is 20–30% in Chinese and Japanese women. In Asia 40–60% of women have hot flushes. Hot flushes have a negative impact on quality of life as well as an association with adverse morbid conditions like cardiovascular disease, osteoporosis, fragility fractures, and diabetes [4].
