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Wellbeing during menopause

Last Update: September 12, 2013; Next update: 2016.

Although different women cope differently with menopause, severe menopause symptoms can greatly affect your wellbeing. But the higher risk of certain 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 sleep. This can make women have difficulty concentrating and feel tired during the day.

But not all physical and emotional changes during this phase of life are due to menopause. Changes in mood, emotional wellbeing, problems with concentration and memory, and physical problems like back ache are not directly related to menopause. 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 does not usually have any direct health consequences. But it can be a good time to think about how to stay healthy or improve your health in older age.

What are hot flashes and what causes them?

Hot flashes are probably triggered in the part of the brain that regulates 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 affects 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 does not usually have anything to do with heart disease. Hot flashes last about three minutes on average. Some women feel chilly after a hot flash.

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 arousal or less interest in sex, 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 evidence that menopause itself has a negative effect on sexual pleasure, sexual desire or sexual activity. 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.

It can be a problem if the vagina is not lubricated well enough through arousal or if a woman worries about this beforehand. Then sex might be uncomfortable 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 does not 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 seen as a sign of getting older, and commonly associated with losses: loss of attractiveness and femininity, loss of health – or loss of certain roles within the family or at work. 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 does not 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 and more comprehensive 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."

There is no “right” way to deal with menopause – each woman has to find the way that suits her best. Some women 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.

Some women go through menopause during a phase of reorientation in their lives, for example when their children have left home. They may change their lifestyle and their priorities and/or focus more on their own interests or their own 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?

Many women share their experiences and feelings with friends who are also going through menopause. They might want to talk to their partner about it too, but that is not always easy. Some women find that their partner is not interested in menopause issues or shows little understanding. A lot of men do not know much about this stage of a woman’s life.

Some women prefer to avoid the topic completely, or talk to their doctor or another professional. Menopause is sometimes still a taboo subject among older generations. But many women wish to talk about things with their own mother. Mothers’ and older sisters’ experiences can help women deal with their own symptoms and get an idea of when they might reach menopause themselves.

How do women experience the physical changes?

As long as they do not suffer from severe symptoms, many women consider the physical changes to be just one of many aspects of the menopause. The way women feel about their physical appearance during this stage of life varies greatly. Some women’s self-image changes and they worry that they are no longer considered to be attractive. Others do not feel any less attractive or feminine. Some feel calmer and more serene, have more self-confidence and see menopause as a normal part of life. A number 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.

The physical symptoms of menopause can also be unsettling, though – after all, most people want to feel comfortable in their own body. Hot flashes make some women feel very uncomfortable. Having a hot flash in public, for example during a business meeting, can be embarrassing. But hot flashes vary in intensity, and are not always unpleasant.

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