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The Underbelly of Menopause

Updated: Jun 2, 2023

The term "underbelly of menopause" generally refers to the less discussed or hidden aspects of the menopausal experience that may not receive as much attention or awareness. Menopause is a natural stage in a woman's life, but it can be accompanied by various physical, emotional, and psychological changes that affect each woman differently.

I bring you the menopause underbelly mini-series of blogs. These are the less commonly discussed symptoms and challenges that some women may face during this transition. Insomnia, dry eyes, dry mouth, low libido, dry vagina, stubborn belly fat, recurrent thrush, recurrent UTIs, incontinence, painful intercourse, depression, anxiety, suicidal thoughts, lack of confidence, second guessing yourself, joint pains, fatty liver, pre-diabetes, high cholesterol, high blood pressure, memory dysfunction, IBS type of symptoms, muscle cramps, restless legs, jaw clenching, Fibromyalgia like symptoms, crawling feeling under the skin, itching, rashes, acne, rosacea, tinnitus, palpitations, headaches, vertigo, medically unexplained chest pain, feeling faint, alopecia, facial hairs, back pain, muscle aches. The underbelly of menopause also extends to the psychological and emotional aspects, such as feelings of loss, grief, and a sense of aging. Menopause often marks the end of a woman's reproductive years and may trigger emotions related to identity, self-worth, and societal expectations and a feeling of invisibility and lack of desirability.

Today, we will focus on Insomnia in menopause:

Insomnia, or difficulty falling asleep or staying asleep, can be a common symptom experienced during menopause. There are several factors that can contribute to insomnia in menopause.

#1. Hormonal changes:

During menopause, there is a decline in the production of estrogen, progesterone and testosterone, which can affect sleep patterns. Estrogen has a role in promoting sleep and regulating body temperature, so its decrease can lead to sleep disturbances.

#2. Hot flashes and night sweats:

Hot flashes, sudden feelings of heat, and night sweats, excessive sweating during sleep, are common symptoms during menopause. These can disrupt sleep and make it difficult to fall asleep or stay asleep. However, when women are observed in sleep studies laboratories for research purposes, it has been found that women wake up before the hot flashes happen. But there's no doubt that sweating and the sudden chills that follow the flash will wake anyone up.

#3. Mood changes and stress:

Menopause can be accompanied by mood swings, anxiety, and increased stress levels. These emotional changes can interfere with sleep and contribute to insomnia. ADHD is diagnosed late in females. ADHD and menopause symptoms overlap. If your brain is racing all night and can't seem to switch off, it may be worth looking at this excellent article on ADHD and menopause.

#4. Other menopausal symptoms:

Symptoms such as vaginal dryness, urinary frequency, and joint pain can also disrupt sleep and contribute to insomnia.

#5. Lifestyle factors:

Certain lifestyle factors can worsen insomnia during menopause. These can include poor sleep habits, caffeine consumption, self-medication with alcohol, lack of physical activity, weight gain, poor relationships, not coping at work, and excessive electronic device use before bed.

#6. Sleep-disordered breathing (SDB) e.g Sleep apnoea

Airflow limitation, chronic intermittent lack of oxygen due to airway collapse, or apnea leads to a lack of supply of oxygen to your organs and reduced blood flow hence recurrent arousal in sleep. These episodes of apnoea otherwise called hypoxia (starvation of oxygen) can lead to tissue inflammation and inflammaging. Sleep apnoea will affect your quality of sleep and physical and emotional and mental well-being. Do you snore loudly? Do you wake yourself up because of snoring? Does your sleeping mate say that you snore loudly? Here's a link for sleep apnoea score

It is important to note that not all women will experience insomnia during menopause but most will. In fact, 99% of the women that I see in my clinic here in Cookernup have some degree of distressing insomnia. Body identical hormone replacement is an effective treatment for insomnia in menopause. The breakdown product of body identical progesterone (Prometrium in Australia), Allopregnanolone, has a natural sedating, calming relaxing effect. 9/10 of women who take Progesterone as part of HRT say it helps them get to sleep and remain asleep. If you have good quality sleep, your memory is better, your mood is better, your body gets a chance to repair your muscles and bones and the hunger hormone Grelin does not spike, so your appetite is much more controlled.

It is important to note that while menopause can be challenging for some women, it is a natural process that every woman will go through in her life. However, just because menopause is a natural process, doesn't mean that women should be ignored and left to suffer in a corner, and neither should women be made to feel "less than" if they seek help for their menopause symptoms.

You don't have to " suck it up and get on with it" there's help available. Speak to your doctor about your symptoms and expect to be listened to. If you're dismissed or fobbed off with non-evidence-based treatment, seek help from a doctor who is willing to take the time to listen to you and explain all the treatment options that will benefit your current and future health. There are various strategies, lifestyle changes, and medical interventions available to help manage your symptoms and improve your overall well-being during perimenopause and menopause. Body-identical HRT is a safe and effective treatment for menopause.

Dr Purity Carr is a GP and Menopause Doctor in Harvey, Western Australia

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