6 Side Effects of Menopause—Besides Hot Flashes

Hot flashes, weight gain, and irregular menstrual bleeding.

You may have heard about some of the most common symptoms leading up to menopause. But plenty of other changes that aren't widely discussed also happen as you approach the end of your reproductive years.

Menopause occurs 12 months after your last period, typically around age 51. During the transition to menopause, also known as perimenopause, hormonal changes occur. For example, your body makes less and less estrogen. And those changes may also spark concerns about your heart, bones, and mental health.

Here's what you should know about some health changes that may happen during perimenopause and menopause.

Bone Loss

Estrogen plays a role in inhibiting bone resorption. During bone resorption, bone cells break down the tissues in your bones. So, when your body makes less estrogen leading to menopause, bone loss starts outpacing new bone building.

"Women can lose up to 20% of their bone density after menopause," JoAnn Pinkerton, MD, OB-GYN and executive director of the North American Menopause Society (NAMS), told Health.

Luckily, you can do plenty of things to keep your skeleton strong. For starters, ensure you're getting enough bone-supporting vitamin D and calcium. Dr. Pinkerton suggested aiming for 1,200 milligrams of calcium daily from your diet or supplements.

In addition to maintaining good posture, weight-bearing and balance exercises can also help.

If your risk of bone fractures is high, your healthcare provider may recommend certain medications. Dr. Pinkerton added that some medicines, including hormone therapy, may prevent further bone loss or decrease fracture risk.

Cognitive Changes

During perimenopause, some people report brain fog. Brain fog may include memory lapses and difficulty finding the right word. But the evidence linking cognitive changes to hormonal changes is weak.

"There's not a lot of data supporting the fact that cognitive function and dementia [are] related to natural menopause," Karen Carlson, MD, OB-GYN and assistant professor of obstetrics and gynecology at the University of Nebraska Medical Center in Omaha, Neb, told Health. "The women who do have a noticeable cognitive impairment, it's probably more related to other menopausal symptoms such as sleep deprivation."

Some research has linked early menopause among people 40 or younger with lasting adverse effects on cognitive function. For instance, one study published in 2014 in BJOG found that early menopause raises people's risk of decreased cognitive function by 30% over seven years.

Heart Disease

Declining estrogen may also increase your risk of heart disease. Usually, estrogen helps keep blood vessels flexible, which improves circulation.

But keep in mind: Menopause itself does not cause heart disease. As you age, other risk factors to watch for include:

• High LDL, or "bad," cholesterol
• High blood pressure
• Low HDL, or "good," cholesterol
• High-fat diet
• Smoking
• Lack of exercise

Generally, eating healthily, regularly exercising, and not smoking can help decrease your risk of heart disease. Dr. Pinkerton added that it's essential to maintain a healthy weight and keep track of your cholesterol and blood pressure.

Mood Swings

Fluctuating from happy to sad to angry and back again is not uncommon during perimenopause. Fluctuating hormone levels are one of the likely culprits of mood changes.

Some evidence suggests that a history of depression may increase your risk of mood changes around menopause. A lack of sleep, often due to night sweats, may also impact your mood.

Activities that reduce stress, like exercise, are good remedies for boosting your mood. Hormone therapy may also help control mood changes. But consult a healthcare provider if you have low moods that last for extended periods or are severe.

Poor Sleep

Problems sleeping are common during perimenopause and menopause. According to a survey published in 2017 by the Centers for Disease Control and Prevention (CDC), poor sleep quality and insomnia affect about 57% of people aged 40 to 59 during perimenopause.

Sleep problems result from hot flashes and night sweats caused by declining estrogen. Additionally, declining progesterone, another sex hormone, may cause sleep disturbances. It's also not uncommon for people to repeatedly get up during the night to pee.

Lifestyle changes may help you get a restful night's sleep, including:

• Lowering the temperature in your bedroom and using fans to circulate air
• Avoiding large meals, alcohol, cigarettes, and caffeine before bedtime
• Regularly exercising—although not before bedtime
• Avoiding afternoon naps
• Powering down your electronics before bedtime
• Enjoying a hot drink, like herbal tea or warm milk, before bedtime

Still, it may help to talk to a healthcare provider if you have problems sleeping. Treatments, like hormone therapy, can help restore estrogen levels and reduce hot flashes and night sweats.

Additionally, sleep apnea and insomnia unrelated to menopause may require treatment so that you can get a restful night's sleep. 

Urinary Problems

In addition to vulvar atrophy and vaginal dryness, some people notice bladder changes around menopause. The range of bladder and genital changes and symptoms of menopause are also known as genitourinary syndrome of menopause (GSM).

"We know that there are estrogen receptors on the bladder and urethra, which help with bladder and urethral functions," explained Dr. Carlson. "With the decrease in estrogen, a lot of women do see changes in bladder function, as well as definitely the vaginal dryness and vulvar atrophy."

Bladder problems often include stress incontinence, which is bladder leakage when coughing or sneezing. According to Dr. Carlson, stress incontinence may be more common among people who have given birth vaginally several times.

Strengthening exercises and hormonal treatments can help. Talk to your healthcare provider about what's best for you. 

Potential Complications of Menopause

Research has found that estrogen has protective effects on your heart, bones, and mind. So, as the body produces less of the hormone around and during menopause, your risk of several chronic diseases may increase, including:

• Osteoporosis: This is a condition causing weak bones that break easily. With menopause, bone loss increases your risk of osteoporosis. Rates of bone loss vary among people experiencing menopause. So, menopause doesn't necessarily mean that you'll develop osteoporosis. 
• Alzheimer's disease: There also may be a link between menopause and Alzheimer's disease. Some evidence suggests that declining estrogen around menopause may increase the risk of the disease.
• Mental health conditions: Some evidence suggests that people have a higher risk of depression and anxiety during perimenopause and menopause.

Healthcare providers may sometimes suggest hormone therapy to replenish low estrogen levels. But research has found that hormone therapy may increase the risk of the following:

• Stroke: Research has found that estrogen reduces stroke risk. Estrogen interacts with your nervous and circulatory systems and inflammatory pathways, impacting your stroke risk. Although rare, some evidence suggests that hormone therapy may increase stroke risk. However, a study published in 2017 in PLOS Medicine found that hormone therapy does not raise stroke risk if implemented early.
• Venous thromboembolism (VTE): Some evidence suggests that combined estrogen-progesterone hormone therapy carries a higher risk of VTE than estrogen-only hormone therapy. Also, local therapies, like Vagifem, have lower risks of VTE than oral therapies.
• Breast cancer: Research has found an increased risk of breast cancer among people who use hormone therapies containing progestin during or around menopause. Progestin is a synthetic form of progesterone.
  

A Quick Review

Menopause can cause symptoms that affect your bones, heart, and mental health. As the body produces less estrogen, the risk of osteoporosis, cognitive impairment, heart disease, and depression increases. 

Hormone therapy is a common treatment to alleviate menopause symptoms and decrease your risk of those health complications. But other potential complications of hormone therapy may include stroke, VTE, and breast cancer.

Therefore, it's essential to consult your healthcare provider about what treatment is best for you.