The Medical Minute: I’m Cold, Bald, Flat and Bloated, What’s Wrong? Blame Menopause

You’ve heard about the symptoms so often they feel like clichés — hot flashes, 2 a.m. wake-ups, night sweats, a lower-than-low libido and a surging hatred for your spouse. Welcome to perimenopause and menopause. While these symptoms are certainly accurate, they’re also individualistic. Menopause affects every woman differently, and some women experience symptoms that are outside of the usual norms.

Dr. Cynthia Chuang, a women’s health and internal medicine physician at Penn State Health Cocoa Outpatient Center, sees the variety of menopause symptoms daily in her new virtual Menopause Clinic. The clinic, a collaboration between OB/GYN and general medicine at Penn State Health, helps women in perimenopause and menopause find treatments that work for their lives.

Chuang says understanding less common symptoms first requires understanding what menopause and perimenopause are.

Chuang says ,“There’s no blood test to certify you are in menopause, but the average age is 51.”

Perimenopause, a term that has gained more attention in recent years, is the time before menopause when estrogen hormones start to fluctuate, and menstrual periods are irregular. Chuang says perimenopause can last several years and shares many of the same symptoms as menopause.

“In the beginning of perimenopause, you may have more frequent and heavier cycles. A lot of women will get their period unexpectedly and sometimes bleed through their clothing, similar to the irregular cycles they had as teenagers,” Chuang says. “In the second half of perimenopause, the cycles start slowing down. You might go three or four months without a period, and when it comes, it may be lighter.”

Fortunately, hormonal birth control can provide contraception and relief of some symptoms. Chuang says that low-dose birth control is an effective treatment for symptoms like hot flashes or night sweats.

Since most menopause symptoms are the result of depleted hormone levels, hormone replacement therapy is a very popular treatment. For some women, especially those with a history of blood clots, uterine or breast cancer, non-hormonal treatments are needed. Chuang says that some antidepressants have been effective for hot flashes. A new non-hormonal treatment, fezolinetant, treats hot flashes by blocking the chemical that triggers sudden temperature changes.

Although hot flashes and night sweats get the majority of the attention, some women may experience symptoms that don’t fit the norm. Chuang says that many menopause symptoms fall into two camps: hot and dry. Hot symptoms can include hot flashes and night sweats, while dry symptoms can include vaginal dryness and general dryness of the skin. However, four lesser-known symptoms are still common.

• Cold chills: The same part of the brain controls both temperature sensations – hot and cold. Some women may have a hot flash followed by chills, or their body temperature may drop without any initial hot flash. Chuang refers to either sensation as “temperature dysregulation” and says the same therapies may help both extremes.

•  Thinning hair: Hair thinning is influenced by androgens, says Chuang, which are considered male hormones, such as testosterone. However, hair thinning is more pronounced during midlife. Topical treatments such as minoxidil can help restart the growth process, but they may take several months to produce noticeable results. Some oral medications can also help, but may cause unwanted hair in other parts of the body. Chuang says that for some people, the medications may be worth the trade-off.

•  Loss of fullness in breasts: Your bra size will likely change during menopause. Chuang explains that hormones affect our breast size and fullness throughout life, whether that’s increasing during breastfeeding or decreasing during and after menopause. Since breast tissue is replaced by fatty tissue as we age, your breast shape may morph over time.

•  Digestive issues and bloating: Dr. Sarah Horvath, an obstetrician/gynecologist at Penn State Health Obstetrics and Gynecology in Hershey, says estrogen also plays a part in regulating digestion. As estrogen production slows, it can lead to bloating and slower digestion. Focusing on a high-fiber diet rich in fruits and vegetables can help regulate digestion.

Other symptoms attributed to menopause may be signs of aging rather than hormonal changes. Some women report ringing in their ears, itchy ears, a burning sensation on their tongue, a metallic taste or tingling in their toes or fingers.

(Newswise/VK)