What are the most common symptoms of menopause? And which can hormone therapy treat?
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Despite decades of research, navigating menopause seems to have become harder – with conflicting information on the internet, in the media, and from health care providers and researchers.
Adding to the uncertainty, a recent series in the Lancet medical journal challenged some beliefs about the symptoms of menopause and which ones menopausal hormone therapy (also known as hormone replacement therapy) can realistically alleviate.
So what symptoms reliably indicate the start of perimenopause or menopause? And which symptoms can menopause hormone therapy help with? Here’s what the evidence says.
Remind me, what exactly is menopause?
Menopause, simply put, is complete loss of female fertility.
Menopause is traditionally defined as the final menstrual period of a woman (or person female at birth) who previously menstruated. Menopause is diagnosed after 12 months of no further bleeding (unless you’ve had your ovaries removed, which is surgically induced menopause).
Perimenopause starts when menstrual cycles first vary in length by seven or more days, and ends when there has been no bleeding for 12 months.
Both perimenopause and menopause are hard to identify if a person has had a hysterectomy but their ovaries remain, or if natural menstruation is suppressed by a treatment (such as hormonal contraception) or a health condition (such as an eating disorder).
What are the most common symptoms of menopause?
Our study of the highest quality menopause-care guidelines found the internationally recognised symptoms of the perimenopause and menopause are:
- hot flushes and night sweats (known as vasomotor symptoms)
- disturbed sleep
- musculoskeletal pain
- decreased sexual function or desire
- vaginal dryness and irritation
- mood disturbance (low mood, mood changes or depressive symptoms) but not clinical depression.
However, none of these symptoms are menopause-specific, meaning they could have other causes.
In our study of Australian women, 38% of pre-menopausal women, 67% of perimenopausal women and 74% of post-menopausal women aged under 55 experienced hot flushes and/or night sweats.
But the severity of these symptoms varies greatly. Only 2.8% of pre-menopausal women reported moderate to severely bothersome hot flushes and night sweats symptoms, compared with 17.1% of perimenopausal women and 28.5% of post-menopausal women aged under 55.
So bothersome hot flushes and night sweats appear a reliable indicator of perimenopause and menopause – but they’re not the only symptoms. Nor are hot flushes and night sweats a western society phenomenon, as has been suggested. Women in Asian countries are similarly affected.
Maridav/Shutterstock
Depressive symptoms and anxiety are also often linked to menopause but they’re less menopause-specific than hot flushes and night sweats, as they’re common across the entire adult life span.
The most robust guidelines do not stipulate women must have hot flushes or night sweats to be considered as having perimenopausal or post-menopausal symptoms. They acknowledge that new mood disturbances may be a primary manifestation of menopausal hormonal changes.
The extent to which menopausal hormone changes impact memory, concentration and problem solving (frequently talked about as “brain fog”) is uncertain. Some studies suggest perimenopause may impair verbal memory and resolve as women transition through menopause. But strategic thinking and planning (executive brain function) have not been shown to change.
Who might benefit from hormone therapy?
The Lancet papers suggest menopause hormone therapy alleviates hot flushes and night sweats, but the likelihood of it improving sleep, mood or “brain fog” is limited to those bothered by vasomotor symptoms (hot flushes and night sweats).
In contrast, the highest quality clinical guidelines consistently identify both vasomotor symptoms and mood disturbances associated with menopause as reasons for menopause hormone therapy. In other words, you don’t need to have hot flushes or night sweats to be prescribed menopause hormone therapy.
Often, menopause hormone therapy is prescribed alongside a topical vaginal oestrogen to treat vaginal symptoms (dryness, irritation or urinary frequency).
Monkey Business Images/Shutterstock
However, none of these guidelines recommend menopause hormone therapy for cognitive symptoms often talked about as “brain fog”.
Despite musculoskeletal pain being the most common menopausal symptom in some populations, the effectiveness of menopause hormone therapy for this specific symptoms still needs to be studied.
Some guidelines, such as an Australian endorsed guideline, support menopause hormone therapy for the prevention of osteoporosis and fracture, but not for the prevention of any other disease.
What are the risks?
The greatest concerns about menopause hormone therapy have been about breast cancer and an increased risk of a deep vein clot which might cause a lung clot.
Oestrogen-only menopause hormone therapy is consistently considered to cause little or no change in breast cancer risk.
Oestrogen taken with a progestogen, which is required for women who have not had a hysterectomy, has been associated with a small increase in the risk of breast cancer, although any risk appears to vary according to the type of therapy used, the dose and duration of use.
Oestrogen taken orally has also been associated with an increased risk of a deep vein clot, although the risk varies according to the formulation used. This risk is avoided by using estrogen patches or gels prescribed at standard doses
What if I don’t want hormone therapy?
If you can’t or don’t want to take menopause hormone therapy, there are also effective non-hormonal prescription therapies available for troublesome hot flushes and night sweats.
In Australia, most of these options are “off-label”, although the new medication fezolinetant has just been approved in Australia for postmenopausal hot flushes and night sweats, and is expected to be available by mid-year. Fezolinetant, taken as a tablet, acts in the brain to stop the chemical neurokinin 3 triggering an inappropriate body heat response (flush and/or sweat).
Unfortunately, most over-the-counter treatments promoted for menopause are either ineffective or unproven. However, cognitive behaviour therapy and hypnosis may provide symptom relief.
The Australasian Menopause Society has useful menopause fact sheets and a find-a-doctor page. The Practitioner Toolkit for Managing Menopause is also freely available.
Susan Davis, Chair of Women’s Health, Monash University
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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Healthy Heart, Healthy Brain – by Dr. Bradley Bale & Dr. Amy Doneen
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We’ve often written that “what’s good for your heart is good for your brain”, because the former feeds the latter and takes away detritus. You cannot have a healthy brain without a healthy heart.
This book goes into that in more detail than we have ever had room to here! This follows from their previous book “Beat The Heart Attack Gene”, but we’re jumping in here because that book doesn’t really contain anything not also included in this one.
The idea is the same though: it is the authors’ opinion that far too many interventions are occurring far too late, and they want to “wake everyone up” (including their colleagues in the field) to encourage earlier (and broader!) testing.
Fun fact: that also reminded this reviewer that she had a pending invitation for blood tests to check these kinds of things—phlebotomy appointment now booked, yay!
True the spirit of such exhortation to early testing, this book does include diagnostic questionnaires, to help the reader know where we might be at. And, interestingly, while the in-book questionnaire format of “so many points for this answer, so many for that one”, etc is quite normal, what they do differently in the diagnostics is that in cases of having to answer “I don’t know”, it assigns the highest-risk point value, i.e. the test will err on the side of assume the worst, in the case of a reader not knowing, for example, what our triglycerides are like. Which, when one thinks about it, is probably a very sensible reasoning.
There’s a lot of advice about specific clinical diagnostic tools and things to ask for, and also things that may raise an alarm that most people might overlook (including doctors, especially if they are only looking for something else at the time).
You may be wondering: do they actually give advice on what to actually do to improve heart and brain health, or just how to be aware of potential problems? And the answer is that the latter is a route to the former, and yes they do offer comprehensive advice—well beyond “eat fiber and get some exercise”, and even down to the pros and cons of various supplements and medications. When it comes to treating a problem that has been identified, or warding off a risk that has been flagged, the advice is a personalized, tailored, approach. Obviously there’s a limit to how much they can do that in the book, but even so, we see a lot of “if this then that” pointers to optimize things along the way.
The style is… a little salesy for this reviewer’s tastes. That is to say, while it has a lot of information of serious value, it’s also quite padded with self-congratulatory anecdotes about the many occasions the authors have pulled a Dr. House and saved the day when everyone else was mystified or thought nothing was wrong, the wonders of their trademarked methodology, and a lot of hype for their own book, as in, the book that’s already in your hands. Without all this padding, the book could have been cut by perhaps a third, if not more. Still, none of that takes away from the valuable insights that are in the book too.
Bottom line: if you’d like to have a healthier heart and brain, and especially if you’d like to avoid diseases of those two rather important organs, then this book is a treasure trove of information.
Click here to check out Healthy Heart, Healthy Brain, and secure your good health now, for later!
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You’re Not Forgetful: How To Remember Everything
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Elizabeth Filips, medical student busy learning a lot of information, explains how in today’s video:
Active processing
An important thing to keep in mind is that forgetting is an active process, not passive as once believed. It has its own neurotransmitters and pathways, and as such, to improve memory, it’s essential to understand and manage forgetting.
So, how does forgetting occur? Memories are stored with cues or tags, which help retrieve information. However, overloading cues with too much information can cause “transient forgetting”—that is to say, the information is still in there somewhere; you just don’t have the filing system required to retrieve the data. This is the kind of thing that you will try hard to remember at some point in the day when you need it, fail, and then wake up at 3am with an “Aha!” because your brain finally found what you were looking for. So, to avoid that, use unique and strong cues to help improve recall (mnemonics are good for this, as are conceptual anchors).
While memory does not appear to actually be finite, there is some practical truth in the “finite storage” model insofar as learning new information can overwrite previous knowledge, iff your brain mistakes it for an update rather than addition. So for that reason, it’s good to periodically go over old information—in psychology this is called rehearsal, which may conjure theatrical images, but it can be as simple as mentally repeating a phone number, a mnemonic, or visually remembering a route one used to take to go somewhere.
Self-perception affects memory performance. Negative beliefs about one’s memory can worsen performance (so don’t say “I have a bad memory”, even to yourself, and in contrast, find more positive affirmations to make about your memory), and mental health in general plays a significant role in memory. For example, if you have ever had an extended period of depression, then chances are good you have some huge gaps in your memory for that time in your life.
A lot of what we learned in school was wrong—especially what we learned about learning. Traditional (vertical) learning is harder to retain, whereas horizontal learning (connecting topics through shared characteristics) creates stronger, interconnected memories. In short, your memories should tell contextual stories, not be isolated points of data.
Embarking on a new course of study? Yes? (If not, then why not? Pick something!)
It may be difficult at first, but experts memorize things more quickly due to built-up intuition in their field. For example a chess master can glance at a chess board for about 5 seconds and memorize the position—but only if the position is one that could reasonably arise in a game; if the pieces are just placed at random, then their memorization ability plummets to that of the average person, because their expertise has been nullified.
What this means in practical terms: building a “skeleton” framework before learning can enhance memorization through logical connections. For this reason, if embarking on a serious course of study, getting a good initial overview when you start is critical, so that you have a context for the rest of what you learn to go into. For example, let’s say you want to learn a language; if you first quickly do a very basic bare-bones course, such as from Duolingo or similar, then even though you’ll have a very small vocabulary and a modest grasp of grammar and make many mistakes and have a lot of holes in your knowledge, you now have somewhere to “fit” every new word or idea you learn. Same goes for other fields of study; for example, a doctor can be told about a new drug and remember everything about it immediately, because they understand the systems it interacts with, understand how it does what it does, and can compare it mentally to similar drugs, and they thus have a “place” in that overall system for the drug information to reside. But for someone who knows nothing about medicine, it’s just a lot of big words with no meaning. So: framework first, details later.
For more on all this, enjoy:
Click Here If The Embedded Video Doesn’t Load Automatically!
Want to learn more?
You might also like to read:
How To Boost Your Memory Immediately (Without Supplements)
Take care!
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Coca-Cola vs Diet Coke – Which is Healthier?
10almonds is reader-supported. We may, at no cost to you, receive a portion of sales if you purchase a product through a link in this article.
Our Verdict
When comparing Coca-Cola to Diet Coke, we picked the Diet Coke.
Why?
While the Diet Coke is bad, the Coca-Cola has mostly the same problems plus sugar.
The sugar in a can of Coca-Cola is 39g high-fructose corn syrup (the worst kind of sugar yet known to humanity), and of course it’s being delivered in liquid form (the most bioavailable way to get, which in this case, is bad).
To put those 39g into perspective, the daily recommended amount of sugar is 36g for men or 25g for women, according to the AHA.
The sweetener in Diet Coke is aspartame, which has had a lot of health risk accusations made against it, most of which have not stood up to scrutiny, and the main risk it does have is “it mimics sugar too well” and it can increase cravings for sweetness, and therefore higher consumption of sugars in other products. For this reason, the World Health Organization has recommended to simply reduce sugar intake without looking to artificial sweeteners to help.
Nevertheless, aspartame has been found safe (in moderate doses; the upper tolerance level would equate to more than 20 cans of diet coke per day) by food safety agencies ranging from the FDA to the EFSA, based on a large body of science.
Other problems that Diet Coke has are present in Coca-Cola too, such as its acidic nature (bad for tooth enamel) and gassy nature (messes with leptin/ghrelin balance).
Summary: the Diet Coke is relatively less unhealthy, but is still bad in numerous ways, and remains best avoided.
Read more:
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How to Prevent Dementia – by Dr. Richard Restak
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We’ve written about this topic here, we know. But there’s a lot more we can do to be on guard against, and pre-emptively strengthen ourselves against, dementia.
The author, a neurologist, takes us on a detailed exploration of dementia in general, with a strong focus on Alzheimer’s in particular, as that accounts for more than half of all dementia cases.
But what if you can’t avoid it? It could be that with the wrong genes and some other factor(s) outside of your control, it will get you if something else doesn’t get you first.
Rather than scaremongering, Dr. Restak tackles this head-on too, and discusses how symptoms can be managed, to make the illness less anxiety-inducing, and look to maintain quality of life as much as possible.
The style of the book is… it reads a lot like an essay compilation. Good essays, then organized and arranged in a sensible order for reading, but distinct self-contained pieces. There are ten or eleven chapters (depending on how we count them), each divided into few or many sections. All this makes for:
- A very “read a bit now and a bit later and a bit the next day” book, if you like
- A feeling of a very quick pace, if you prefer to sit down and read it in one go
Either way, it’s a very informative read.
Bottom line: if you’d like to better understand the many-headed beast that is dementia, this book gives a far more comprehensive overview than we could here, and also explains the prophylactic interventions available.
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Are Supplements Worth Taking?
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It’s Q&A Day at 10almonds!
Have a question or a request? We love to hear from you!
In cases where we’ve already covered something, we might link to what we wrote before, but will always be happy to revisit any of our topics again in the future too—there’s always more to say!
As ever: if the question/request can be answered briefly, we’ll do it here in our Q&A Thursday edition. If not, we’ll make a main feature of it shortly afterwards!
So, no question/request too big or small 😎
❝There seems to be a lot of suggestions to take supplements for every thing, from your head to your toes. I know it’s up to the individual but what are the facts or stats to support taking them versus not?❞
Short answer:
- supplementary vitamins and minerals are probably neither needed nor beneficial for most (more on this later) people, with the exception of vitamin D which most people over a certain age need unless they are white and getting a lot of sun.
- other kinds of supplement can be very beneficial or useless, depending on what they are, of course, and also your own personal physiology.
With regard to vitamins and minerals, in most cases they should be covered by a healthy balanced diet, and the bioavailability is usually better from food anyway (bearing in mind, we say vitamin such-and-such, or name an elemental mineral, but there are usually multiple, often many, forms of each—and supplements will usually use whatever is cheapest to produce and most chemically stable).
However! It is also quite common for food to be grown in whatever way is cheapest and produces the greatest visible yield, rather than for micronutrient coverage.
This goes for most if not all plants, and it goes extra for animals (because of the greater costs and inefficiencies involved in rearing animals).
We wrote about this a while back in a mythbusting edition of 10almonds, covering:
- Food is less nutritious now than it used to be: True or False?
- Supplements aren’t absorbed properly and thus are a waste of money: True or False?
- We can get everything we need from our diet: True or False?
You can read the answers and explanations, and see the science that we presented, here:
Do We Need Supplements, And Do They Work?
You may be wondering: what was that about “most (more on this later) people”?
Sometimes someone will have a nutrient deficiency that can’t be easily remedied with diet. Often this occurs when their body:
- has trouble absorbing that nutrient, or
- does something inconvenient with it that makes a lot of it unusable when it gets it.
…which is why calcium, iron, vitamin B12, and vitamin D are quite common supplements to get prescribed by doctors after a certain age.
Still, it’s best to try getting things from one’s diet first all of all, of course.
Things we can’t (reasonably) get from food
This is another category entirely. There are many supplements that are convenient forms of things readily found in a lot of food, such as vitamins and minerals, or phytochemicals like quercetin, fisetin, and lycopene (to name just a few of very many).
Then there are things not readily found in food, or at least, not in food that’s readily available in supermarkets.
For example, if you go to your local supermarket and ask where the mimosa is, they’ll try to sell you a cocktail mix instead of the roots, bark, or leaves of a tropical tree. It is also unlikely they’ll stock lion’s mane mushroom, or reishi.
If perchance you do get the chance to acquire fresh lion’s mane mushroom, by the way, give it a try! It’s delicious shallow-fried in a little olive oil with black pepper and garlic.
In short, this last category, the things most of us can’t reasonably get from food without going far out of our way, are the kind of thing whereby supplements actually can be helpful.
And yet, still, not every supplement has evidence to support the claims made by its sellers, so it’s good to do your research beforehand. We do that on Mondays, with our “Research Review Monday” editions, of which you can find in our searchable research review archive ← we also review some drugs that can’t be classified as supplements, but mostly, it’s supplements.
Take care!
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Are You Flourishing? (There’s a Scale)
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What does it mean, to flourish? And how can you do it more?
In 2009, psychologists Diener et al developed the “Flourishing Scale”, or as it was more prosaically called originally, “Subjective Wellness Scale”. The name was changed later, as it was noted that it went beyond what was typically considered mere “wellness”.
This scale was so useful, that colleagues scrambled to see if they could improve on it, such as with PERMA (2012), which looked at:
- Positive emotion
- Engagement
- positive Relationships
- Meaning
- Accomplishment/Achievement
While popular (despite the tenuous acronym, it is a very good list of things to foster in your life), this was studied and measured scientifically and found to not be an improvement on the Flourishing Scale / SWS, so we’re going to stick to the original version for now.
We couldn’t find an interactive online quiz for the scale though (apart from this NY Times one, which is paywalled for NYT subscribers, so enjoy if you’re a NYT subscriber!), so here’s the source material, still hosted on the website of the (now deceased, as of a couple of years ago) author:
Flourishing Scale (FS) ← it’s an eight-question, ranked choice scale
How did you score? And…
What are the keys to flourishing more?
According to Jeffrey Davis M.A., of Tracking Wonder, there are five key attributes that we must develop and/or maintain:
The ability to direct and re-direct your attention
This isn’t just a task-related thing.This is about your mind itself. For example, the ability to recognize what your emotions are telling you, thank them for the message, and then set them aside. Or the ability to cut through negative thought spirals! How often have you worried about future events that didn’t transpire, or twisted yourself in knots over a past event that you can’t change?
Action: check out our previous article “The Off-Button For Your Brain” ← this is a technique for switching off racing thoughts, and it’s really good
Want more? We also did this:
The tendency to shape your time with intention and for impact
Time is an incredibly precious asset. How you use it is a very personal choice. You don’t have to maximize productivity (though you can if you want), but for example there’s a difference between:
- Deciding to spend an hour watching a TV show you really enjoy
- Wondering what’s on TV, browsing aimlessly, watching listlessly, just a distraction
In the former case, you are enjoying your time. Literally: you are experiencing joy during your time.
In the latter case, to borrow from Jim Steinman, “you were only killing time and it’ll kill you right back”!
Action: do a time audit for a week, and see where your time really goes, rather than where you expect or hope for it to go. Use this information to plan your next week more intentionally. Repeat as and when it seems like it might be useful!
The practice of constant improvement
Fun fact: you are good enough already. And you can also improve. You don’t have to, but improving in the areas that are meaningful to you can really add up over time. This could be becoming excellent at something for which already have a passion… It could also be brushing up something that you feel might be holding you back.
Action: do a quick SWOT* self-assessment. Then plan your next step from there!
*Strengths, Weaknesses, Opportunities, Threats. What are yours?
The ability to communicate and listen to others
A lot of this is about feedback. Giving and receiving feedback are often amongst the hardest things we do in the category of communication… Especially if the feedback is negative. How to decide what to disregard as baseless criticism, and what to take on board (and try not to take it personally), or the other way around, how to present negative feedback in a way that won’t trigger defensiveness.
Action: check out our previous article “Save Time With Better Communication” for some tips that really make relationships (of any kind) so much easier.
The commitment to positive experiences
Many things in life are not fun. Often, we know in advance that they will not be fun. The key here is the ability to make the most of a bad situation, and seek out better situations by your actions. Not like a lost person in a desert seeks water, but like a chess player who employs a general strategy to make tactical advantages more likely to appear.
Action: think about something you have to do but don’t want to. How could it be made more fun? Or failing that, how could it be made at least more comfortable?
See also: Working Smarter < Working Brighter!
Want to read more?
Check out: What Is Flourishing in Positive Psychology? (+8 Tips & PDF)
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