Mood swings, joint pain, insomnia, and more—why do so many menopause symptoms go unnoticed or misunderstood? Dragana explains how women can work with healthcare providers to navigate the menopause transition, address overlooked issues like GSM, and combat fears surrounding hormone therapy for improved health and quality of life.
Why do symptoms like mood changes, joint pain, and insomnia often go unrecognized as related to menopause?
Many symptoms are associated with and observed in the menopause transition. This is a time in women’s lives when the production and levels of different hormones, such as estrogen and progesterone, start changing. These changes are often unpredictable and somewhat dramatic, and they could trigger various symptoms. Vasomotor symptoms such as hot flashes and night sweats are recognized as they are hallmark symptoms of menopause; however, a whole list of other symptoms, such as low mood, mood swings, joint pain, difficulty sleeping, irritability, etc., often go unrecognized. Interestingly, a long list of symptoms observed in menopause transitions is non-specific and quite usually, they are attributed to getting older, stress, or not coping well. Many patients and healthcare professionals do not recognize these symptoms as related to hormonal changes observed in menopause transition.
How can women work with their healthcare providers to determine the best options for their needs?
Women often find themselves in a frustrating situation, feeling unheard or unappreciated by their healthcare providers when they present with symptoms associated with menopause transition. Recognizing that these symptoms can be non-specific and are sometimes approached and treated separately, not as a group of symptoms related to the menopausal changes. A woman’s responsibility is to advocate for themselves, keep track of all the symptoms, record their severity and frequency, notice any new symptoms, track their menstrual periods, which are still used to determine where they are with menopause transition, and then present them to a physician. Sometimes, it’s a good idea to rank them in order of severity or which ones are the most bothersome. This would ensure an appropriate assessment is performed when presented to the patient’s healthcare provider.
In the past, women did not even talk about symptoms because they thought it was something they should put up with; they should cope with it and not complain about it. Quite often, I see women using fans to cool their faces while talking about fatigue, insomnia, and mood issues without even telling me they are experiencing hot flashes. They might not think this needs to be addressed, or it could be an essential part of this big puzzle of symptoms presented. It is up to women to present all the symptoms and discuss them with their physician. It is our health, and we need to be heard.
Genito-urinary syndrome of menopause, or GSM, often remains undiscussed. Why do you think this is, and how does it affect Women’s Health and quality of life?
Indeed, women do not like to talk about anything that has to do with the genito-urinary area. Numerous studies have been done in the past, and it has been observed that women do not complain or discuss any changes in vaginal dryness, pain with intercourse, or even incontinence until the symptoms are so bothersome they need help. An additional problem is that women assume these changes are normal parts of aging, and they just have to live with it. This is not true. It has been researched and proven that maintaining normal levels of estrogen in the genito-urinary area by providing local estrogen products and local estrogen therapy can provide numerous benefits. Benefits include: preventing the breakdown of the vaginal lining, irritation and pain, it can prevent uterine and urinary bladder prolapse, minimize the risk of developing incontinence. Local vaginal applications of estrogen or DHEA are safe for most women; however, the approach has to be discussed with healthcare professionals. Untreated GSM can affect the health and quality of life of women. It is essential to address it even if women do not engage in intercourse. Often, women who are not in a relationship will dismiss her symptoms as not necessary to be addressed, not needed or not important. Later in life, if left untreated, these symptoms can get worse and can produce scarring, even requiring surgical intervention to maintain normal urine flow. And can lead to ongoing chronic pain issues that are very difficult to treat.
What are the potential long-term health risks associated with menopausal symptoms? Why do you think there is so much fear surrounding hormonal treatments for menopause?
The history of hormonal treatments for menopause reveals significant shifts over time. In the early 1940s, estrogen tablets were introduced to alleviate menopausal symptoms and prevent osteoporosis, becoming widely prescribed. However, in the late 1990s and early 2000s, a major study examined the cardiovascular effects of estrogen in older women with underlying health conditions.
The study had two groups: one received both estrogen and progestogen due to an intact uterus, while the other, with a hysterectomy, received only estrogen. The first group was stopped early due to a trend of increased heart attacks, strokes, and breast cancer, leading to global panic about hormone use. The second group showed similar increased risks but a slightly lower breast cancer risk, prompting many to stop hormone therapy entirely.
After a decade of data analysis from the Women’s Health Initiative Study, it was found that starting hormone therapy earlier—close to menopause or before age 60—could offer significant cardiovascular benefits. Unfortunately, the initial study’s alarming findings fostered a long-lasting perception that hormone therapy was harmful.
Currently, after better analysis and additional studies proving the potential benefits of menopausal hormone therapy, the global guidelines state that menopausal hormone therapy is the first-line treatment for patients experiencing menopause-related symptoms.
However, the fears and misconceptions about hormonal therapy are still very prevalent. We have to keep in mind that menopausal hormone therapy is not an option for everyone. The treatment approach has to be individualized; every single patient has to discuss their personal history, family history, and health status when they’re suffering symptoms and then do the proper health screenings and immunizations before trying menopausal standard therapy. Appropriate follow-ups are needed, and proper dose adjustments, if warranted, are required.
