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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Make Your Negativity Work For You
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What’s The Right Balance?
We’ve written before about positivity the pitfalls and perils of toxic positivity:
How To Get Your Brain On A More Positive Track (Without Toxic Positivity)
…as well as the benefits that can be found from selectively opting out of complaining:
A Bone To Pick… Up And Then Put Back Where We Found It
So… What place, if any, does negativity usefully have in our lives?
Carrot and Stick
We tend to think of “carrot and stick” motivation being extrinsic, i.e. there is some authority figure offering is reward and/or punishment, in response to our reactions.
In those cases when it really is extrinsic, the “stick” can still work for most people, by the way! At least in the short term.
Because in the long term, people are more likely to rebel against a “stick” that they consider unjust, and/or enter a state of learned helplessness, per “I’ll never be good enough to satisfy this person” and give up trying to please them.
But what about when you have your own carrot and stick? What about when it comes to, for example, your own management of your own healthy practices?
Here it becomes a little different—and more effective. We’ll get to that, but first, bear with us for a touch more about extrinsic motivation, because here be science:
We will generally be swayed more easily by negative feelings than positive ones.
For example, a study was conducted as part of a blood donation drive, and:
- Group A was told that their donation could save a life
- Group B was told that their donation could prevent a death
The negative wording given to group B boosted donations severalfold:
Read the paper: Life or Death Decisions: Framing the Call for Help
We have, by the way, noticed a similar trend—when it comes to subject lines in our newsletters. We continually change things up to see if trends change (and also to avoid becoming boring), but as a rule, the response we get from subscribers is typically greater when a subject line is phrased negatively, e.g. “how to avoid this bad thing” rather than “how to have this good thing”.
How we can all apply this as individuals?
When we want to make a health change (or keep up a healthy practice we already have)…
- it’s good to note the benefits of that change/practice!
- it’s even better to note the negative consequences of not doing it
For example, if you want to overcome an addiction, you will do better for your self-reminders to be about the bad consequences of using, more than the good consequences of abstinence.
See also: How To Reduce Or Quit Alcohol
This goes even just for things like diet and exercise! Things like diet and exercise can seem much more low-stakes than substance abuse, but at the end of the day, they can add healthy years onto our lives, or take them off.
Because of this, it’s good to take time to remember, when you don’t feel like exercising or do feel like ordering that triple cheeseburger with fries, the bad outcomes that you are planning to avoid with good diet and exercise.
Imagine yourself going in for that quadruple bypass surgery, asking yourself whether the unhealthy lifestyle was worth it. Double down on the emotions; imagine your loved ones grieving your premature death.
Oof, that was hard-hitting
It was, but it’s effective—if you choose to do it. We’re not the boss of you! Either way, we’ll continue to send the same good health advice and tips and research and whatnot every day, with the same (usually!) cheery tone.
One last thing…
While it’s good to note the negative, in order to avoid the things that lead to it, it’s not so good to dwell on the negative.
So if you get caught in negative thought spirals or the like, it’s still good to get yourself out of those.
If you need a little help with that sometimes, check out these:
Take care!
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Healthy Made Simple – by Ella Mills
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Often, cookbooks leave a gap between “add the beans to the rice, then microwave” and “delicately embarrass the green-shooted scallions with assiduous garlic before adding to the matelote of orrazata flamed in Sapient Pear Brandy”. This book fills that gap:
It has dishes good for entertaining, and dishes good for eating on a Tuesday night after a long day. Sometimes, they’re even the same dishes.
It has a focus on what’s pleasing, easy, healthy, and consistent with being cooked in a real home kitchen for real people.
The book offers 75 recipes that:
- Take under 30 minutes to make*
- Contain 10 ingredients or fewer
- Have no more than 5 steps
- Are healthy and packed with goodness
- Are delicious and flavorful
*With a selection for under 15 minutes, too!
A strength of the book is that it’s based on practical, real-world cooking, and as such, there are sections such as “Prep-ahead [meals]”, and “cook once, eat twice”, etc.
Just because one is cooking with simple fresh ingredients doesn’t mean that everything bought today must be used today!
Bottom line: if you’d like simple, healthy recipe ideas that lend themselves well to home-cooking and prepping ahead / enjoying leftovers the next day, this is an excellent book for you.
Click here to check out Healthy Made Simple, enjoy the benefits to your health, the easy way!
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STI rates are increasing among midlife and older adults. We need to talk about it
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Globally, the rates of common sexually transmissible infections (STIs) are increasing among people aged over 50. In some cases, rates are rising faster than among younger people.
Recent data from the United States Centers for Disease Control and Prevention shows that, among people aged 55 and older, rates of gonorrhoea and chlamydia, two of the most common STIs, more than doubled between 2012 and 2022.
Australian STI surveillance data has reflected similar trends. Between 2013 and 2022, there was a steady increase in diagnoses of chlamydia, gonorrhoea and syphilis among people aged 40 and older. For example, there were 5,883 notifications of chlamydia in Australians 40 plus in 2013, compared with 10,263 in 2022.
A 2020 study of Australian women also showed that, between 2000 and 2018, there was a sharper increase in STI diagnoses among women aged 55–74 than among younger women.
While the overall rate of common STIs is highest among young adults, the significant increase in STI diagnoses among midlife and older adults suggests we need to pay more attention to sexual health across the life course.
Fit Ztudio/Shutterstock Why are STI rates rising among older adults?
STI rates are increasing globally for all age groups, and an increase among midlife and older people is in line with this trend.
However, increases of STIs among older people are likely due to a combination of changing sex and relationship practices and hidden sexual health needs among this group.
The “boomer” generation came of age in the 60s and 70s. They are the generation of free love and their attitude to sex, even as they age, is quite different to that of generations before them.
Given the median age of divorce in Australia is now over 43, and the internet has ushered in new opportunities for post-separation dating, it’s not surprising that midlife and older adults are exploring new sexual practices or finding multiple sexual partners.
People may start new relationships later in life. Tint Media/Shutterstock It’s also possible midlife and older people have not had exposure to sexual health education in school or do not relate to current safe sex messages, which tend to be directed toward young people. Condoms may therefore seem unnecessary for people who aren’t trying to avoid pregnancy. Older people may also lack confidence negotiating safe sex or accessing STI screening.
Hidden sexual health needs
In contemporary life, the sex lives of older adults are largely invisible. Ageing and older bodies are often associated with loss of power and desirability, reflected in the stereotype of older people as asexual and in derogatory jokes about older people having sex.
With some exceptions, we see few positive representations of older sexual bodies in film or television.
Older people’s sexuality is also largely invisible in public policy. In a review of Australian policy relating to sexual and reproductive health, researchers found midlife and older adults were rarely mentioned.
Sexual health policy generally targets groups with the highest STI rates, which excludes most older people. As midlife and older adults are beyond childbearing years, they also do not feature in reproductive health policy. This means there is a general absence of any policy related to sex or sexual health among midlife or older adults.
Added to this, sexual health policy tends to be focused on risk rather than sexual wellbeing. Sexual wellbeing, including freedom and capacity to pursue pleasurable sexual experiences, is strongly associated with overall health and quality of life for adults of all ages. Including sexual wellbeing as a policy priority would enable a focus on safe and respectful sex and relationships across the adult life course.
Without this priority, we have limited knowledge about what supports sexual wellbeing as people age and limited funding for initiatives to engage with midlife or older adults on these issues.
Midlife and older adults may have limited knowledge about STIs. Southworks/Shutterstock How can we support sexual health and wellbeing for older adults?
Most STIs are easily treatable. Serious complications can occur, however, when STIs are undiagnosed and untreated over a long period. Untreated STIs can also be passed on to others.
Late diagnosis is not uncommon as some STIs can have no symptoms and many people don’t routinely screen for STIs. Older, heterosexual adults are, in general, less likely than other groups to seek regular STI screening.
For midlife or older adults, STIs may also be diagnosed late because some doctors do not initiate testing due to concerns they will cause offence or because they assume STI risk among older people is negligible.
Many doctors are reluctant to discuss sexual health with their older patients unless the patient explicitly raises the topic. However, older people can be embarrassed or feel awkward raising matters of sex.
Resources for health-care providers and patients to facilitate conversations about sexual health and STI screening with older patients would be a good first step.
To address rising rates of STIs among midlife and older adults, we also need to ensure sexual health promotion is targeted toward these age groups and improve accessibility of clinical services.
More broadly, it’s important to consider ways to ensure sexual wellbeing is prioritised in policy and practice related to midlife and older adulthood.
A comprehensive approach to older people’s sexual health, that explicitly places value on the significance of sex and intimacy in people’s lives, will enhance our ability to more effectively respond to sexual health and STI prevention across the life course.
Jennifer Power, Associate Professor and Principal Research Fellow, Australian Research Centre in Sex, Health and Society, La Trobe University
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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Topping Up Testosterone?
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The Testosterone Drop
Testosterone levels decline amongst men over a certain age. Exactly when depends on the individual and also how we measure it, but the age of 45 is a commonly-given waypoint for the start of this decline.
(the actual start is usually more like 20, but it’s a very small decline then, and speeds up a couple of decades later)
This has been called “the male menopause”, or “the andropause”.
Both terms are a little misleading, but for lack of a better term, “andropause” is perhaps not terrible.
Why “the male menopause” is misleading:
To call it “the male menopause” suggests that this is when men’s menstruation stops. Which for cis men at the very least, is simply not a thing they ever had in the first place, to stop (and for trans men it’s complicated, depending on age, hormones, surgeries, etc).
Why “the andropause” is misleading:
It’s not a pause, and unlike the menopause, it’s not even a stop. It’s just a decline. It’s more of an andro-pitter-patter-puttering-petering-out.
Is there a better clinical term?
Objectively, there is “late-onset hypogonadism” but that is unlikely to be taken up for cultural reasons—people stigmatize what they see as a loss of virility.
Terms aside, what are the symptoms?
❝Andropause or late-onset hypogonadism is a common disorder which increases in prevalence with advancing age. Diagnosis of late-onset of hypogonadism is based on presence of symptoms suggestive of testosterone deficiency – prominent among them are sexual symptoms like…❞
…and there we’d like to continue the quotation, but if we list the symptoms here, it won’t get past a lot of filters because of the words used. So instead, please feel free to click through:
Source: Andropause: Current concepts
Can it be safely ignored?
If you don’t mind the sexual symptoms, then mostly, yes!
However, there are a few symptoms we can mention here that are not so subjective in their potential for harm:
- Depression
- Loss of muscle mass
- Increased body fat
Depression kills, so this does need to be taken seriously. See also:
The Mental Health First-Aid That You’ll Hopefully Never Need
(the above is a guide to managing depression, in yourself or a loved one)
Loss of muscle mass means being less robust against knocks and falls later in life
Loss of muscle mass also means weaker bones (because the body won’t make bones stronger than it thinks they need to be, so bone will follow muscle in this regard—in either direction)
See also:
- Resistance Is Useful! (Especially As We Get Older)
- Protein vs Sarcopenia
- Fall Special (How to Proof Yourself Against Falls)
Increased body fat means increased risk of diabetes and heart disease, as a general rule of thumb, amongst other problems.
Will testosterone therapy help?
That’s something to discuss with your endocrinologist, but for most men whose testosterone levels are lower than is ideal for them, then yes, taking testosterone to bring them [back] to “normal” levels can make you happier and healthier (though it’s certainly not a cure-all).
See for example:
Testosterone Therapy Improves […] and […] in Hypogonadal Men
(Sorry, we’re not trying to be clickbaity, there are just some words we can’t use without encountering software problems)
Here’s a more comprehensive study that looked at 790 men aged 65 or older, with testosterone levels below a certain level. It looked at the things we can’t mention here, as well as physical function and general vitality:
❝The increase in testosterone levels was associated with significantly increased […] activity, as assessed by the Psychosexual Daily Questionnaire (P<0.001), as well as significantly increased […] desire and […] function.
The percentage of men who had an increase of at least 50 m in the 6-minute walking distance did not differ significantly between the two study groups in the Physical Function Trial but did differ significantly when men in all three trials were included (20.5% of men who received testosterone vs. 12.6% of men who received placebo, P=0.003).
Testosterone had no significant benefit with respect to vitality, as assessed by the Functional Assessment of Chronic Illness Therapy–Fatigue scale, but men who received testosterone reported slightly better mood and lower severity of depressive symptoms than those who received placebo❞
Source: Effects of Testosterone Treatment in Older Men
We strongly recommend, by the way, when a topic is of interest to you to read the paper itself, because even the extract above contains some subjectivity, for example what is “slightly better”, and what is “no significant benefit”.
That “slightly better mood and lower severity of depressive symptoms”, for example, has a P value of 0.004 in their data, which is an order of magnitude more significant than the usual baseline for significance (P<0.05).
And furthermore, that “no significant benefit with respect to vitality” is only looking at either the primary outcome aggregated goal or the secondary FACIT score whose secondary outcome had a P value of 0.06, which just missed the cut-off for significance, and neglects to mention that all the other secondary outcome metrics for men involved in the vitality trial were very significant (ranging from P=0.04 to P=0.001)
Click here to see the results table for the vitality trial
Will it turn me into a musclebound angry ragey ‘roidmonster?
Were you that kind of person before your testosterone levels declined? If not, then no.
Testosterone therapy seeks only to return your testosterone levels to where they were, and this is done through careful monitoring and adjustment. It’d take a lot more than (responsible) endocrinologist-guided hormonal therapy to turn you into Marvel’s “Wolverine”.
Is testosterone therapy safe?
A question to take to your endocrinologist because everyone’s physiology is different, but a lot of studies do support its general safety for most people who are prescribed it.
As with anything, there are risks to be aware of, though. Perhaps the most critical risk is prostate cancer, and…
❝In a large meta-analysis of 18 prospective studies that included over 3500 men, there was no association between serum androgen levels and the risk of prostate cancer development
For men with untreated prostate cancer on active surveillance, TRT remains controversial. However, several studies have shown that TRT is not associated with progression of prostate cancer as evidenced by either PSA progression or gleason grade upstaging on repeat biopsy.
Men on TRT should have frequent PSA monitoring; any major change in PSA (>1 ng/mL) within the first 3-6 months may reflect the presence of a pre-existing cancer and warrants cessation of therapy❞
Those are some select extracts, but any of this may apply to you or your loved one, we recommend to read in full about this and other risks:
Risks of testosterone replacement therapy in men
See also: Prostate Health: What You Should Know
Beyond that… If you are prone to baldness, then taking testosterone will increase that tendency. If that’s a problem for you, then it’s something to know about. There are other things you can take/use for that in turn, so maybe we’ll do a feature on those one of these days!
For now, take care!
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Mediterranean Air Fryer Cookbook – by Naomi Lane
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There are Mediterranean Diet cookbooks, and there are air fryer cookbooks. And then there are (a surprisingly large intersection of!) Mediterranean Diet air fryer cookbooks. We wanted to feature one of them in today’s newsletter… And as part of the selection process, looked through quite a stack of them, and honestly, were quite disappointed with many. This one, however, was one of the ones that stood out for its quality of both content and clarity, and after a more thorough reading, we now present it to you:
Naomi Lane is a professional dietician, chef, recipe developer, and food writer… And it shows, on all counts.
She covers what the Mediterranean diet is, and she covers far more than this reviewer knew it was even possible to know about the use of an air fryer. That alone would make the book a worthy purchase already.
The bulk of the book is the promised 200 recipes. They cover assorted dietary requirements (gluten-free, dairy-free, etc) while keeping to the Mediterranean Diet.
The recipes are super clear, just what you need to know, no reading through a nostalgic storytime first to find things. Also no pictures, which will be a plus for some readers and a minus for others. The recipes also come complete with nutritional information for each meal (including sodium), so you don’t have to do your own calculations!
Bottom line: this is the Mediterranean Diet air fryer cook book. Get it, thank us later!
Get your copy of “Mediterranean Air Fryer Cookbook” on Amazon today!
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100 Things Productive People Do – by Nigel Cumberland
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This is a book of a hundred small chapters (the book is 396 pages, so 2–3 pages per chapter) which makes for a feeling of quick reading, and definitely gives an option of “light bites”, dipping into the book here and there.
Cumberland offers a wide range of practical wisdom here, and while the book is (per the title) focused on productivity, it also includes all due weight to not burning out and/or breaking down. Because things productive people do does not, it turns out, include working themselves directly into an early grave.
But—despite the author’s considerable and obvious starting point of social privilege—nor is this a tome of “offer your genius leadership and otherwise just coast while everyone does your work for you”, either. This is a “brass tacks” book and highly relatable whether your to-do list most prominently features “personally manage the merger of these Fortune 500 companies” or “sort out that junk in the spare room”
Bottom line: we’d be surprised if this book with 100 pieces of advice failed to bring you enough value to more than pay for itself!
Pick up your copy of 100 Things Productive People Do from Amazon today!
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