The doctor about hormonal changes and symptoms during menopause

What is menopause?

Menopause, also known as the transition period, is the period in a woman's life when menstruation stops and fertility ends because the ovaries gradually stop producing the hormones needed for the menstrual cycle. Menopause is the time of the last menstrual period, which usually occurs between the ages of 45 and 55 (average around 51 years). However, menopause is only known after twelve months without a period. Menopause usually lasts several years and can be divided into three phases: the years before menopause (sometimes called premenopause/perimenopause or transition phase), menopause itself, and the time after menopause (postmenopause). During the transition phase, menstruation often begins to become irregular as the hormone balance changes. Menopause is a natural part of aging in women, but the changes that occur can give rise to various problems.

Do you suspect that you are in, or about to enter, menopause? Get insight into your values, follow-up and review with Elenor Ängek, a doctor with specialist services in gynecology – read more and order Menopause Test Plus.

Hormonal changes during the transition phase and menopause

What happens in the body during menopause is that hormone levels change significantly. Above all, the levels of estrogen (mainly the hormone estradiol) and progesterone, which are produced in the ovaries, as well as the hormones FSH and LH (follicle-stimulating hormone and luteinizing hormone, respectively), are affected.

“During the transitional phase, which lasts for the years before menopause, the function of the ovaries gradually begins to decline as the egg reserve decreases. This leads to uneven hormone production, where the levels of estrogen and progesterone can fluctuate. As a result, ovulation and the menstrual cycle become irregular. This hormonal instability is one of the main reasons why many women already in perimenopause can experience symptoms such as mood swings, hot flashes and sleep disturbances." - says Elenor Ängek.

When ovarian function then declines further, hormone production drops sharply. During menopause, estrogen and progesterone levels decrease to very low values. The low estrogen leads directly to many of the typical menopausal symptoms (which are described in more detail below). At the same time as the sex hormones fall, the body's production of FSH and LH increases. These two hormones are formed in the brain and their task is normally to stimulate the ovaries. When the ovaries do not respond as before, the body tries to compensate by secreting more FSH and LH, which causes FSH and LH levels to rise sharply during menopause. Elevated FSH levels in the blood are actually a sign that doctors can use to confirm menopause (FSH > 40 IU/L indicates that menopause has occurred. These hormonal changes – low estrogen/progesterone and high FSH/LH – mark the transition to menopause.

Hormonal levels and symptoms during menopause.

The diagram illustrates how estrogen (green curve) and progesterone (light purple curve) gradually decrease from around age 40 until menopause (around age 51), while FSH (turquoise dashed curve) and LH (purple dashed curve) rise as the body tries to stimulate the ovaries. The thick purple line shows how the intensity of symptoms typically develops: During the early transition phase, symptoms such as mood swings and hot flashes begin to appear, they often intensify around menopause, and in early postmenopause most symptoms gradually subside. In late postmenopause, mainly problems related to mucous membranes and bone health remain.

Common symptoms during menopause – and how you can deal with them

The lack of estrogen and the hormonal fluctuations during menopause can affect the body in many ways. Here are common symptoms and complaints during menopause and Elenor Ängek's advice on how to deal with them:

1. Hot flashes and sweating:

Sudden feelings of intense heat that often spread throughout the body, sometimes accompanied by redness and heavy sweating. They often occur at night (night sweats) and can disrupt sleep. Around 70–75% of women in menopause suffer from hot flashes and sweating. The hot flashes are caused by the body's temperature regulation becoming unbalanced when estrogen levels drop.

"Many women find hot flashes bothersome, but there are ways to deal with them. In addition to dressing cool and sleeping cool, estrogen or combined estrogen and progesterone treatment is the most effective treatment for hot flashes and sweating. The choice of preparation and duration of treatment is based on an individual benefit-risk assessment," says Elenor Ängek.

2. Sleep problems:

Many people find it harder to sleep during menopause. You may have difficulty falling asleep, wake up more often at night and your sleep becomes more easily disturbed. Nighttime hot flashes and sweating often contribute to waking up feeling overheated or in a cold sweat. Lack of sleep, in turn, leads to fatigue during the day.

3. Mood swings and depression:

It is common for mood to be affected when hormone levels change. Many people feel irritable, anxious or have periods of depression for no apparent reason. Some may also experience difficulty concentrating or memory problems. Menopause is a transition that can be mentally stressful, and both the biological changes and the life situation can make you feel more sensitive than usual.

"Be kind to yourself and to your "mood". Remember that your mood swings partly have physical causes. Try to reduce stress levels where possible – plan time for recovery and things you know make you feel good. says Elenor Ängek,

4. Dry mucous membranes:

The mucous membranes in the body are affected by estrogen deficiency. Vaginal dryness is common as the mucous membrane in the vagina becomes thinner and drier, which can cause itching, burning and pain during intercourse. The mucous membranes in the urethra, eyes, mouth and nose can also become drier. Dry mucous membranes lead to an increased risk of irritation and infection (for example, urinary tract infections).

"When estrogen drops, the mucous membranes become fragile. This can cause symptoms such as burning, pain during intercourse and a feeling of dryness. Avoid washing the genitals too often and do not use strong soaps that dry them out – plain water is enough, possibly a mild unscented intimate soap if necessary. There are local estrogen treatments (suppositories, creams or vaginal tablets) available over the counter at pharmacies that can increase the moisture in the mucous membranes and relieve the discomfort. If you have a lot of trouble with dryness, burning or pain during intercourse, talk to a doctor.” – says Elenor Ängek,

5. Altered metabolism:

It is common for the body's metabolism to change. Many people notice that it becomes easier to gain weight or that fat is redistributed more to the stomach during middle age. Weight gain and increased abdominal fat around menopause have been observed in many women. At the same time, muscle mass decreases somewhat, which can affect strength and energy expenditure. These changes are partly due to aging itself and partly to hormonal changes.

6. Reduced sex drive:

Some also describe decreased sex drive, Elenor Ängek, explains that this may be due to hormonal changes, dry mucous membranes and psychological factors such as stress and relationship problems.

7. Other complaints:

Some women also experience palpitations, episodes of dizziness or headaches, and pain in joints and muscles during menopause. The symptoms and their intensity vary greatly from person to person – some barely notice menopause at all, while others experience severe discomfort.

Seek support and help

Do the discomfort feel overwhelming? Talk to your doctor about your symptoms – there is help available if menopause is affecting your quality of life a lot. Sometimes it can be a relief just to confirm that the discomfort you are feeling is actually related to menopause and is temporary.

If you would like to discuss your hormonal discomfort with Testmottningen's doctor Eleonor Ängek, read more here: Hormonal consultation