Early menopause (EM) is marked by the absence of menstrual periods, which may or may not be associated with menopausal symptoms such as hot flushes and/or night sweats (vasomotor symptoms), vaginal dryness, loss of libido and/or incontinence (genitourinary symptoms), mood changes, sleep disturbance, fatigue, and cognitive difficulties. Symptoms vary between women, by cause of EM, and over time. Women who experience surgical menopause (bilateral oophorectomy or hysterectomy with oophorectomy) often experience more severe symptoms (see also Symptoms of early menopause (Health Practitioners’ perspectives)). To learn about treatments that have been shown to be effective for EM symptoms (including Hormone Replacement Therapy (HRT) and selected non-hormonal medications), and complementary medicines and alternative therapies or lifestyle changes that some women find helpful, see ‘Further Information’ at the end of this Talking Point.
This Talking Point covers women’s experiences of vasomotor and genitourinary symptoms. For information on mood changes, sleep disturbance, fatigue, cognitive difficulties, and the absence of menstrual periods please see Women’s experiences of symptoms of early menopause – Part 2.
Hot flushes and night sweats
Most of the women we talked with described experiencing ‘vasomotor symptoms’ – hot flushes and/or night sweats. Together with their menstrual periods changing or stopping, hot flushes and/or night sweats were often one of the first ‘signs’ of spontaneous EM (see Early signs and symptoms of spontaneous early menopause) or symptoms of medically-induced EM. Some women experienced both hot flushes during the day and at night (night sweats), while for others hot flushes during the day were worse than night sweats or vice versa.
Maree compared the night sweats and daytime hot flushes she experienced as a result of medically-induced EM.
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The symptoms that I get are – hot flushes are probably the biggest one. Initially they started happening at night, which is most common I guess. They get pretty intense. It’s kind of like your thermostat inside you is broken and I’ve been told some people get the hot flushes as well as the other end of the spectrum; they start shivering with cold, which is pretty extreme. But I only get the hot flushes. So when you’re in bed at night, it’s like, a hot flush will suddenly happen. You can actually feel them coming on and you can feel this intense heat and you’ve got to kick all the blankets off and – you get night sweats as well.
And then just as quickly as they come, they’ll go away. So it’s kind of like you’re putting the blankets on, kicking them off, putting them on [laughing], kicking them off. Also I take medication now, I take anastrozole which, as far as I understand [laughing] it stops the oestrogen production. And one of the side effects, is it increases the symptoms of menopause. So the hot flushes and things like that, they can increase basically [laughing].
I get them during the day now as well as at night, but they’re not very bad during the day for me at least. It kind of feels like someone is turning the temperature up. It happens quite quickly. I get, like, a hot prickly feeling and it sort of feels like it starts low and then rushes up. And then at the peak – I’m not sure exactly how long it lasts, but they don’t feel like they last very long. Sort of at the peak sometimes they’re so intense I pant a little [laughing] and then after the rush happens, it sort of goes back down. It sort of feels like that; it comes up, it goes down like a wave [laughing].
And during hot weather, they’re particularly horrible because I sort of started getting mine at the end of the hot weather and it was definitely worse then – sometimes during winter they’re actually welcome [laughing]. We live in quite a cold house and there’s no heating in our bedroom, only in the outer rooms [laughing]. And with low blood pressure – it’s, like, you don’t have a very good circulation so where other people are cold, I’m icy. And when they started coming in cold weather at night that was actually a welcome thing in a way. It’s the only way I could thaw out.
Women varied in how severe they found hot flushes and/or night sweats. Some found them very challenging, describing them as ‘debilitating’, ‘out of control’, or ‘terrible’. Other women who found them less intense described them as ‘manageable’, ‘annoying’ or ‘tedious.’ One woman, Tracey, began taking HRT the day after having a risk-reducing BSO and didn’t have ‘any issues with any menopause-type symptoms.’
Naomi’s night sweats and hot flushes weren’t ‘too bad’.
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I did get a few hot flushes and night sweats and things, but nothing totally unbearable. You hear horror stories about people having total bed drenching night sweats and all of that. I haven’t had that. I certainly had them to some degree but not unmanageable.
With the hot flushes during the day, I often found that they were worse in summer – and the night sweats as well, when the ambient temperature was warmer anyway. And, it was just of a matter of getting somewhere cooler or taking off layers [laughing] and during the night it’s just, throw off the covers and [laughing] try and cool down. But, it wasn’t too bad.
Several women talked about the emotional aspects of hot flushes. On the one hand, feeling stressed or upset could make hot flushes worse; on the other, hot flushes could trigger distressing emotions such as anxiety or sadness. As Alex said, ‘hot flushes remind me that I’m in menopause and not a fertile 32-year-old woman anymore. So there’s a little bit of an emotional sadness sometimes with a hot flush.’
Lydia found that stress or anxiety could trigger a hot flush.
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I think the hot flushes which don’t seem like a big deal but if you are already worked up or if you are working yourself up, it would usually bring one on. So, if I was in the middle of disciplining the children for example, because they’d been doing something, or I’d been saying something over and over again and I’m going “Look I’ve already told you,” then I could feel it rising up. So, I actually had to say to them, “I’ll deal with it in a minute.” Like, you can’t keep going with what you’re doing because it’s just like this heat that rises up which almost like it feels like a rage. It’s not, but that’s how it feels like. It comes from the pit of your stomach and it just overtakes you. So I just made sure that I just had to walk away and just wait for it to pass and then I’d come back and say, “Hey, how we were talking about this.”
The hot flushes definitely did ease off. So, I probably have five or 10 a day now and I know what makes it worse. I know if I have wine, then I’m just going to have more hot flushes the next day and I just try and not get anxious about things because that might trigger one. And I know that on a hot day I might have a couple more, but that’s okay because I’m aware and I just go, “That’s all right, I can have a fan nearby if I’m at home, and if I’m out, I just gently fan myself.”
Vaginal dryness, loss of libido, and bladder problems
Vaginal dryness was mentioned by many women as a symptom of EM, along with a loss of interest in sex, or problems with continence. Health practitioners have grouped these symptoms under the title ‘genitourinary syndrome of menopause’ (GSM). Some women saw vaginal dryness as a problem mainly in the context of heterosexual relationships, including Linda: ‘I was celibate for so long [before meeting my partner], so vaginal dryness wasn’t an issue really then.’ However, others found vaginal dryness difficult whether or not they were sexually active.
Jenni, who experienced spontaneous EM, suffered from vaginal dryness and incontinence.
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I’ve also suffered from a lot of vaginal dryness so that has at times gotten so bad it’s been painful even just to walk. It’s responsible for vulnerability for a lot of UTIs that I’ve had, and I’ve got bladder problems, an increase in thrush. The bladder problems caused a loss of self-confidence. I suppose, some incontinence problems. I’ve been taking Ural quite frequently and OVESTIN [oestriol] cream and REPLENS cream. OVESTIN [oestriol] cream is on prescription, REPLENS you can just get over the counter, it’s non-hormonal and they have helped quite a bit and having a hysterectomy also helped with the bladder problems.
Night sweats and bladder control problems were the first symptoms of spontaneous early menopause for
Maddy.
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Seven years ago, when I just turned 40, the first thing that happened to me was – two things actually. I couldn’t hold my urine so I’d be walking home from the station and just suddenly need to go to the toilet and I’d have to just run. And I was also waking up in the night hot. I wouldn’t say I was sweating. I was just hot. And I was always someone who didn’t have a problem falling asleep or staying asleep. so this was very unusual. So I went to a doctor about having to rush to the toilet and we did an internal and that was all fine. There was nothing wrong with that.
But that was a really big thing because it was happening quite a lot and then this waking up in the night. Then I was getting really tired so I was going off to GPs and then I skipped a period which I’ve never ever skipped a period since I got my period on my 14th birthday and every month, 28 days, was very regular. So I went off to a doctor saying “I’ve missed my period. I’m waking up hot in the night and I’m finding it hard to control going to the toilet.”
For women in relationships, loss of libido and vaginal dryness could be very challenging (see Intimacy, sex and dating after early menopause). Sylvia, who was in a heterosexual relationship, described her experience of the impacts of surgical menopause: ‘My relationship has definitely suffered. My confidence as a female has suffered. From a sexual perspective there is just no drive at all.’ Some women had, as Anna said, opted for ‘less sex overall,’ while others were trying to work through this with their partners.
Maree described the impact of vaginal dryness on intimacy with her partner.
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The side effects a lot of women get is vaginal dryness, which can be dryness of your skin everywhere. But with that in particular, I did actually discuss that at the menopause clinic. That was something they brought up which I found really helpful. And there are vaginal moisturisers that you can use. There were other things they went through, but that option appealed to me the most so I can’t actually remember what the other options were. That was something that appealed to me because it sounded like it was an easy way to deal with the problem.
Also they recommended that during sexual intercourse, you use lube. They recommended, I think it was KY Jelly. I think with some lubrication, there’s also other factors involved like whether it’s flavoured or whether it has extra chemicals. But they also recommended using a personal lubricant during sex that lasts a long time and it’s a comfort thing. Obviously a dry vagina is not a comfortable vagina, [laughing] particularly during sex. But it’s also something you need to worry about in regards to tears and things like that. It can affect you in that way as well. And that’s obviously something you really want to avoid, so use lubrication every single time. [laughing] It’s not something we can have sex without now because of the dryness.
It definitely makes a huge difference during sex. That’s when I noticed it. My partner and I were talking about it just the other day and I mentioned to him that the first time we had sex after my oophorectomy, I had already been using the vaginal moisturiser, but I think I’d only used it once. I’m not sure how effective it was at that point, and we did use lubrication, but it felt like my first time.
It was quite painful the first time we had sex after the oophorectomy even though we were doing all the right things. And we had to take very slow and very gently [laughing]. So it changes everything pretty much. Or at least it has for us. It’s something we need to be very aware of now. It’s not a spontaneous thing anymore. It’s something we have to prepare for and, that’s changed. It’s not changed in a bad way really but it is something we need to think about and manage as opposed to something that could be more spontaneous [laughing].
Further information:
Talking Points (Women)
Talking Points (Health Practitioners)
Other resources
