Gaps In Knowledge And Future Directions
It has been difficult to distinguish between symptoms that result from loss of ovarian function and those from the aging process or from the socio-environmental stresses of midlife years. Symptoms which result from loss of ovarian function should resolve by hormone replacement, but it has not been found so. Further research is required in this direction.
Symptoms have variable onset in relation to menopause. Some women experience symptoms earlier during perimenopause while some experience them at a later time. When should treatment start is also an issue for debate.
As recent data from the WHI establish the risks of long-term HRT use, concern about using HRT, even as a short-term intervention, has increased substantially. Although HRT remains the first-line treatment for hot flushes, the WHI findings have drawn attention to nonhormonal treatments of hot flushes and other menopausal symptoms. Growing evidence to support the efficacy of serotonergic antidepressants and other psychoactive medications in the treatment for hot flushes suggests that nonhormonal interventions will prove important alternatives to HRT. As further evidence of the benefits of psychoactive medications for menopausal symptoms is established, the choice between using hormonal and nonhormonal therapies for the management of menopausal symptoms will continue to evolve.
Difficulty Concentrating And Forgetfulness Or ‘brain Fog’
“I was on the phone earlier and it does make it awkward to hold a conversation when the little grey cells are having a dance instead of doing their job.”
As much as 60% of women experience ‘brain fog’ or forgetfulness as a result of menopause or other menopausal symptoms themselves, such as lack of sleep. It usually occurs during perimenopause when hormones start to change and, for some, it can subside relatively quickly. For others, however, long-term memory issues may require specific treatment, like HRT, or more general lifestyle changes.
What Is Likely To Happen As I Approach And Pass Through The Menopause
Migraine tends to worsen in the years leading up to the menopause, with attacks occurring more frequently and sometimes also lasting longer. Many women notice more of a link with their periods. In the early stages of menopause, when periods become erratic and more frequent, this also means more migraines. Towards the end of menopause, as periods lessen, so does migraine. For women who have noticed a strong link between migraine and hormonal triggers, post-menopause can be a blessing as migraine is very likely to improve. This may take two or three years after the last period, as it can take this long for the hormones to settle. Non-hormonal triggers can still persist after menopause so if these are important causes for migraine, attacks will still continue.
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Causes Of Pain During Menopause
The climacteric period is a grandiose restructuring of the female body. The gradual shutdown of the function of childbearing is accompanied by changes in all organs and systems. This is manifested by unusual and sometimes not the most pleasant sensations, including the pain of different localization, strength, and duration .
The root cause of all types of pain with menopause is a sharp change in hormonal status. The decrease, and then the cessation of secretion of estrogen and progesterone, is reflected not only in the state and functions of the reproductive system. Sex hormone cells are present in various tissues and organs. Therefore, estrogen deficiency during and after menopause leads to changes in the cardiovascular, musculoskeletal, nervous, endocrine systems, affects metabolism, the emotional and psychological sphere, etc. With menopause women are most often concerned about abdominal pain, lower back pain, perineum, headaches, menopause muscle pain, and bone pains. They are quite intense and often reduce the quality of life, especially if combined with other symptoms of the change.
How Long Do Symptoms Last
Perimenopausal symptoms can last four years on average. The symptoms associated with this phase will gradually ease during menopause and postmenopause. Women whove gone an entire year without a period are considered postmenopausal.
Hot flashes, also known as hot flushes, are a common symptom of perimenopause. One study found that moderate to severe hot flashes could continue past perimenopause and last for a
Researchers also found that Black women and women of average weight experience hot flashes for a longer period than white women and women who are considered overweight.
Its possible for a woman to experience menopause before the age of 55. Early menopause occurs in women who go through menopause before theyre 45 years old. Its considered premature menopause if youre menopausal and are 40 years old or younger.
Early or premature menopause can happen for many reasons. Some women can go through early or premature menopause because of surgical intervention, like a hysterectomy. It can also happen if the ovaries are damaged by chemotherapy or other conditions and treatments.
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What Happens After Menopause
During post-menopause the time after menopause your body is still producing hormones. As reproductive hormones, estrogen and progesterone decline once your childbearing years end. But that doesnt mean theyre not needed at all, so your body still makes them, just in lower amounts.
In the years of post-menopause, you may still experience symptoms of hormonal imbalance or maybe even have certain symptoms for the first time. For example, its not unusual to have continuing hot flashes as a result of estrogen deficiency. Some women in post-menopause experience vaginal dryness, which affects a womans interest in sex and can make sexual activity uncomfortable or even painful. The most common post-menopausal symptoms are:
- Hot flashes
- Bone loss and fracture
- Memory loss
If you experience postmenopausal bleeding no matter how slight or brief talk with your OB/GYN healthcare provider as soon as possible to rule out any serious issues.
How Long Does Menopause Last
Perimenopause and menopause symptoms can last anywhere from a few months to more than 10 years. Menopause officially begins and ends when you havent had your period for 12 consecutive months. We say officially because theres a lot more involved in the transition than just that specific time without a menstrual cycle.
For many women, its hard to pin down exactly when menopause starts and even more difficult to know exactly when it will be finished which can make it seem so much longer.
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Treating Your Migraine Attacks
The good news is that there are therapies to help you if you notice more migraine attacks as you near menopause. For instance, adopting healthy sleep habits, eating well, daily aerobic exercise, and stress management may be helpful for your migraines and will also improve your overall health. In addition, your healthcare provider may consider a migraine preventive medication.
Hormone replacement therapy at the lowest effective dose may be used during perimenopause or early menopause to relieve hot flashes and vaginal atrophy. Its effect on migraine prevention during perimenopause or menopause is controversial, with some studies showing worsening of the migraines during HTR. In addition, there is the potential for increased risk of strokes and heart attacks with HTR. If HTR is considered, low doses used continuously is preferable, and the patients should be counseled about potential side effects.
Other medications, such as, venlafaxine, escitalopram, paroxetine, and gabapentin as well as non-medication strategies can be helpful in some perimenopause patients by not only decreasing migraine frequency, but also improving mood and vasomotor symptoms that are common during this period of time.
Hormonal Interventions For Migraine Associated With Menopause
The estrogen withdrawal theory of migraine implies that women may be vulnerable to an exacerbation in migraine in the perimenopausal years, when the orderly cycling of estrogen and progesterone secretion becomes more erratic, but that physiologic menopause, once it is established is likely to produce migraine improvement.
Unfortunately, many studies of headache and migraine in menopause include women who are perimenopausal and those who are postmenopausal. This makes it difficult to determine the true prevalence and impact of migraine, because the hormonal environment and resulting impact on migraine is likely to be very different during these times. By way of illustration, the title of a study by Obermeyer et al indicates it is a survey of menopausal symptoms, but in fact it evaluated Spanish women between the ages of 45 and 55 because this is the interval during which most women become menopausal. Thus, the study conflates symptoms of both the perimenopause and menopause. In this particular case, headaches were reported by 47% of the sample, with 10% indicating headache was their most troublesome symptom. Twenty-three percent indicated they had consulted a physician about headaches.
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Migraines And Menopause: The Headache Connection
The transition through menopause can feel like a headache perhaps quite literally.
Headaches and migraines are a common perimenopause side effect. Estimates show that up to eighty-five percent of perimenopausal women experience tension headaches, and up to twenty-nine percent suffer from migraines.
Lets explore this connection and what your options are, aside from popping pain meds and retreating to a dark room.
Translating Knowledge Into Treatment
There is no evidence that hormonal treatments for migraine are more effective or safer than nonhormonal treatments. Most hormonal treatments for migraine have been tested in case series or small clinical trials in selected populations that are inadequate to fully establish their harm to benefit balance. The long-term effects of additional or increased hormone exposure from these regimens are unknown. Total exposure to hormones increases significantly with extended duration regimens, although daily hormone exposure does not increase and there is no accumulation of hormones. A recent Cochrane report on extended duration or continuous contraceptive regimens concluded that the long term health effects have not been documented.
No hormonal treatment regimen has United States Food and Drug Administration approval for a migraine or headache indication. Most importantly, because of the risk of ischemic stroke, treatment guidelines from 3 authoritative groups recommend against the use of estrogen-containing contraceptives in many women with migraine.- Results of the Women’s Health Initiative Study have led to recommendations against the routine use of estrogen replacement therapy in most women.-
Selected Nonhormonal Treatment Strategies Studied for Hormonally Related Headaches
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Why Are My Menopause Symptoms Getting Worse
Symptoms of perimenopause leading up to menopause may increase in frequency and intensity as hormonal shifts become more severe. Around the age of 35, estrogen and progesterone production enters a phase of gradual decline. You may notice any symptoms from these gradual shifts.
In your 40s, the ratios between estrogen and progesterone will be in flux. Ovulation may not happen with every period or your periods may become irregular. These shifts in your hormones can cause more noticeable symptoms.
Migraine During The Menopausal Transition
Although most women with migraine develop the disorder in their teens or twenties, 813% of women with migraine report the new onset of migraine during perimenopause . In general, migraine is commonly under diagnosed in the population . Thus, although some cross-sectional studies suggest that prevalence of migraine increases as women progress through the MT , this may be due to increased ascertainment among women who present to the health care system with migraine when the frequency/burden reaches a critical threshold in perimenopause . In a cross-sectional community based study of 1436 Taiwanese women aged 4054, prevalence of migraine was similar in the premenopausal and early perimenopausal groups and significantly higher in the late perimenopausal group . Data from the cross-sectional American Migraine Prevalence and Prevention study showed that among 3664 women with migraine , the risk of high frequency headache was significantly greater in the peri-menopause and early post-menopause stages compared to pre-menopause . Though the factors affecting these differences across menopausal stages are not entirely understood, it has been shown that women in whom migraine frequency is exacerbated by hormones and associated with pre-menstrual syndrome, appear to have the best prognosis post-menopause, often experiencing complete resolution.
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The Average Timeline For Menopause
The menopause age range varies by more than a decade. The average age is 51, but menopause can start in women from their mid-40s to late 50s. Most women experience the menopause stage in this age range, while some report symptoms into their 60s.
Natural menopause happens in three stages:
Sometimes perimenopause is confused with menopause. Perimenopause is when a woman starts to have hot flashes, night sweats and vaginal dryness. This can start as early as the 30s or as late as the 60s. This is considered either early or premature menopause and late menopause, and can occur for a variety of reasons, such as surgeries or hormonal changes.
Some women in perimenopause may also have the following symptoms:
- Breast tenderness
- Worsening of premenstrual syndrome
- Irregular periods or skipping periods
- Periods that are heavier or lighter than usual
Additional symptoms may include:
- Joint and muscle aches and pains
- Changes in libido
- Difficulty concentrating, memory lapses
- Weight gain
- Hair loss or thinning
These symptoms are normal as part of the loss of estrogen production. However, if these are new symptoms after starting perimenopause, consult your doctor in order to rule out other health issues.
How To Treat Headaches And Nausea During Menopause
Nausea and headaches can be extremely unpleasant at any time in your life. Many women come to expect these symptoms during their period or with pregnancy. However, theyre less commonly thought of as symptoms of menopause.
Just like with pregnancy, nausea during menopause tends to be worse in the morning. It can also be associated with symptoms of premenstrual syndrome during the perimenopausal phase. To alleviate nausea or prevent it from occurring entirely, try to avoid foods that are spicy, fatty, or greasy.
You can also try removing things from your bedroom that can cause strong odors and adjust the temperature to a comfortable setting for better sleep. If necessary, open a window for a few minutes to remove any stuffiness or stale air. Fatigue can make nausea worse.
You might try some natural remedies for nausea that are believed to be effective during menopause and pregnancy. Upon awakening, take your time getting out of bed. Herbal teas, ginger, and plain crackers or toast might help alleviate nausea, particularly first thing in the morning. However, theres no scientific evidence of their effectiveness.
Some doctors may prescribe creams or tablets containing estrogen, progesterone, or both if you have severe menopausal symptoms in addition to nausea and headaches. Make sure to educate yourself about the possible side effects of hormone replacement therapy. Always discuss any concerns you have about your health and about any new medication with a health professional.
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Causes Of Headaches During Menopause
Research studies have established a strong link between headaches and female sex hormones. The most common culprit is estrogen. Hormone levels can also influence the severity of headaches during menopause as well as during your period and when youre pregnant.
Fluctuating hormone levels during the perimenopausal phase can increase the frequency of headaches.
How Long Do Headaches Last After Quitting Smoking
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Effects Of Menopausal Hrt On Migraine
Women with menopause occurring before 45 years of age are at increased risk for long-term health consequences, including premature cardiovascular disease, mortality, Parkinsonism, cognitive decline, depression, anxiety, and sexual dysfunction. HRT is typically recommended for these women until the age of expected natural menopause in order to reduce the risks as well as to relieve menopausal symptoms and to slow down the decrease in bone density that occurs after menopause.
Other studies showed that worsening of migraine in menopause may be a predictor of migraine worsening on HRT., In a questionnaire survey performed in a UK menopause clinic, women were asked about headache and were invited to note its severity on a visual analog scale. Women with improved or unchanged headache during menopause generally followed a similar pattern on HRT use, however, the women with headache worsening during menopause showed a variable response to HRT. The probability of headache worsening at menopause and with use of HRT was significantly increased with reported history of migraine. Moreover, a retrospective study conducted on 451 female migraineurs found an association between self-reported worsening of headache on HRT and worsening of headache during menopause .
We’d Love To Hear About Your Menopause And Headache Stories
Wed love to know if youve experienced changes. Even if youre not perimenopausal, whats your experience with head pain? Every voice or menopause story adds to the conversation, so please join in in the comments or on or .
*As ever, the information in this blog is not meant to replace expert advice by a medical professional. If you have concerns that what youre experiencing needs medical attention, stop reading this right now and go get it.
This blog is part of our symptom of the month series. While this may sound like a lot less fun than the wine or cheese of the month clubs, hormone changes at midlife are responsible for a surprisingly creative and festive array of symptoms in women we think you should know about. Some were all familiar with: hot flashes, irregular periods, mood swings. Some are less known, like headaches, hair loss, and dry eyes. We think its important that women know what to expect so they recognize it when it comes and have the tools to deal with it.
We also think its important to have a ballpark idea of whats normal and when you might want to consult with a medical professional. Some symptoms that are dismissed as menopausal can actually be more serious, if caused by an under- or overactive thyroid, uterine fibroids, or endometrial or cervical cancer, for example.
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