As the estrogen levels slowly drop the Follicular Stimulating Hormone (FSH) levels rise. The period cycles may then get shorter and then subsequnetly longer. Some women experience heavier, clottier and more painful periods during this time due to the hormonal imbalance (more estrogen in the system with less progesterone available).
Problems such as fibroids, adenomyosis, uterine hyperplasia (thickening of uterine lining), cancer and ovarian cysts should be ruled out.
Changes in the breasts (tenderness, tingling, nipple sensitivity, heaviness) can occur at the same time.
Vasomotor Symptoms (VMS)
Vasomotor symptoms such as hot flushes (heat accompanied by sweating and flushing, especially around the head, neck, chest and upper back) and night sweats (waking up in the middle of the night sweating) affects 60 to 80 % of women entering the menopause. In about 25% of these women, these symptoms affect the quality of their lives.
Although most postmenopausal women experience hot flashes for less than 7 years, 15% of women continue having hot flushes for 15 years and more.
Perimenopausal women can experience hot flushes and night sweats pre periods which often worry them that menopause is around the corner.
Local Malaysian studies have shown the incidence of hot flushes to be about 57% in our women.
- NN Ismael. A study of menopause in Malaysia. Maturitas 1994;19:205-09
- Premitha D, P Nadkarni, ST Nathan, et al. Malaysian women with regards to menopause and hormone replacement therapy.Abstract.9th Malaysian Congress of Obstetrics & Gynaecology 1999;29
Insomnia, memory loss, mood swings, anxiety, difficulty in concentration and irritability can happen with the menopause. Depression was 2.5 times more likely to happen during the menopause transition than at any other time.
Serotonin levels (which have a positive effect on mood) decrease when the estrogen levels drop leading to the emotional disturbances during the transition.
Other early menopausal symptoms are headaches, palpitations, tiredness and general lethargy, joint pains and sleep disturbances.