The decrease in estrogen that occurs after menopause causes many different symptoms, including:
- Hot flashes: This is the most common symptom of menopause and perimenopause affecting up to 80% of women. They typically last 5–7 years but can last up to 10–15 years.
- Absence of menstrual cycles: This is the hallmark of menopause. Once a woman stops ovulating, her uterine lining no longer grows and sheds.
- Loss of bone density: Normally, bone remains strong by having a perfect balance between the cells that make bone (osteoblast) and cells that breakdown bone (osteoclast). Until menopause, estrogen protects bones from being broken down in excess by osteoclasts. When estrogen is lost and osteoclasts go unchecked, bone density is lost. This can result in osteoporosis leading to a higher risk of hip fractures, wrist fractures, and spine fractures, among others.
- Weight gain and bloating: Estrogen helps regulate the deposit of fat tissue. Many women gain weight during and after the menopausal transition.
- Mood changes: Mood changes, like depression, are common during perimenopause and menopause.
- Sleep disturbances: Sleep disturbances can be related to the underlying hormonal changes or simply from night sweats.
- Increased risk of cardiovascular disease. When estrogen levels decline, LDL cholesterol (the harmful kind) levels increase and HDL cholesterol (the positive kind) levels decrease. This causes fat and cholesterol to build up in the arteries which contributes to heart attack and stroke.
- Genital changes: These include vaginal shrinkage, thinning of the vaginal tissue, loss of vaginal folds, loss of vaginal lubrication, vaginal itching and discomfort, and painful sex (dyspareunia).
- Urinary symptoms: Women can feel the sudden need to urinate (urgency), frequent urination, and pain on urination—mimicking a urinary tract infection.