5 Unexpected Signs Of Menopause That Aren't Hot Flashes

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Menopause is, for most women, an inevitable part of life. This stage, which typically occurs in your 40s or 50s, marks the very end of the menstrual cycle. Your body starts to use energy differently and your ovaries stop producing eggs and estrogen ― a sex hormone that’s intimately involved in a wide range of body functions. As a result, your body may begin to feel, look and behave differently.

Anyone who’s experienced menopause will tell you: Hot flashes might get the most buzz, but they aren’t the only bothersome symptom of menopause.

“This drop in estrogen levels is felt by the entire body, including the brain, heart, skin and reproductive organs like the vagina, uterus and ovaries,” Kyle Graham, an OB-GYN and medical director at Pediatrix Medical Group in San Jose, California, told HuffPost.

While the symptoms vary from person to person, particularly in terms of duration and severity, evidence consistently shows that the vast majority of women experience some type of physical or emotional change during menopause that seriously impacts their quality of life.

We spoke to three women’s health experts who specialize in menopause to understand how the end of the menstrual cycle affects the body. Here’s what they said.

Persistent fatigue

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According to Sherry Ross, an OB-GYN and women’s health expert at Providence Saint John’s Health Center in Santa Monica, California, many people feel exceptionally exhausted throughout menopause. That’s because the dip in estrogen and progesterone can disrupt circadian rhythms and mess with the part of the brain that regulates sleep.

In addition, the hot flashes and night sweats menopausal women are prone to can keep them tossing and turning at night.

Chronic fatigue can trigger a cascade of negative health consequences, including brain fog, memory loss and poor concentration, Ross said. “All of the collateral damage caused by fatigue has a negative impact on a person’s overall quality of life.”

To boost your energy levels, try to adopt a healthy lifestyle. The reason: Inactivity, diets high in overly processed foods, smoking and excessive alcohol consumption can exacerbate fatigue, Ross noted.

Regular physical activity ― ideally, 30 minutes of exercise three times a week ― can improve your metabolism and energy levels. Finally, good sleep hygiene ―avoiding caffeine before bedtime, skipping late-afternoon naps and adhering to a regular sleep-wake cycle ― can improve your quality of sleep throughout menopause, according to the National Institutes of Health.

Vaginal dryness

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The vagina is packed with estrogen receptors, so when there’s a decline in estrogen levels, it becomes more difficult for the organ to stay lubricated. Estrogen also plays a crucial role in maintaining healthy levels of bacteria in the vagina, which, in return, keep the surrounding skin healthy and moisturized, Graham explained.

“With all of these changes, the skin of the vaginal area becomes irritated, painful and even inflamed,” Graham said, adding that some people may notice their vagina appears redder or pinker than usual.

The good news: It is entirely possible to keep the vagina feeling and looking healthy throughout menopause. Vaginal moisturizers can be applied to the vagina and vulva every few days to keep the tissues healthy. Low-dose estrogen therapy, in the form of a cream, tablet or ring, can also be prescribed by a health care professional to combat dryness. The final trick: Stay sexually active. Regular sex or vaginal stimulation can increases blood flow to the vagina and moisturize the vaginal tissues.

Painful intercourse

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Of course, for some people, having more sex might not be an easy feat. The decrease in estrogen can thin the vaginal tissues and, as explained above, reduce the vagina’s natural lubrication.

“Vaginal dryness, burning, irritation, itching, soreness, tenderness and/or vaginal discharge ― which, in turn, can lead to pain, dryness and/or bleeding during sex ― can lead to an inability to have penetrative sex at all,” said Dr. Madeline Dick-Biascoechea, a urogynecologist at the University of Maryland Medical Center and assistant professor at the University of Maryland School of Medicine.

If sex is off the table, she recommends using vaginal moisturizers, silicone-based lubricants and, in certain cases, vaginal estrogen therapy. A sex therapist can also help identify any outside stressors that may be affecting your sex life and help you feel confident and comfortable in your body again. No one should have to deal with the pain and irritation that might make it impossible to continue enjoying sex, Dick-Biascoechea said.

Mood changes

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Mood changes can, too, be attributed to the loss of estrogen throughout menopause. The hormone, after all, is directly tied to the production of serotonin and dopamine, which are neurotransmitters that influence mental health.

“The mood-regulating neurotransmitters decrease [during menopause], worsening mood changes and depression,” Ross explained. Sleep issues and stressful life issues that tend to occur during this age, including chronic health problems, career pressures and aging parents, can further impact one’s emotional well-being.

Ross said there are a number of helpful practices that can improve your mood. Eating a well-balanced diet, exercising regularly, and limiting alcohol consumption have been linked to lower rates of depression.

Stress-reduction techniques such as yoga, tai chi, and mindfulness can also provide protection against developing depressive symptoms. Cognitive behavior therapy, antidepressants and anti-anxiety medications have been shown to effectively treat depression and anxiety, too.

Some people may want to consider taking hormone replacement therapy, a medication that replaces lost hormones. “HRT can control mood swings, depression and anxiety by adding back the much-needed estrogen hormone,” Ross explained.

Bladder issues

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You may also find that you’re running to the bathroom all the time or suddenly experiencing incontinence. Many people also develop recurrent urinary tract infections, sometimes getting three or more times in a year, Dick-Biascoechea added. Once again, the dip in estrogen is to blame.

“These symptoms can affect their ability and desire to participate at work, travel, social gatherings, and even in their relationships with friends, family, and significant others,” Dick-Biascoechea said. This can, understandably, decrease quality of life, research suggests, and cause people to feel lonely, isolated and depressed.

Only half of menopausal women experiencing urinary changes will seek help, according to Dick-Biascoechea, which means the bladder issues persist and, in some cases, worsen. But the good news is that there are multiple strategies ― including diet and fluid intake changes, mild soaps and detergents, pelvic floor exercises, vaginal estrogen, prescription medications, and pelvic or vaginal surgery ― that can help.

If you have any of these symptoms, talk to a doctor such as your primary care physician or OB-GYN. Menopausal symptoms are notorious for impairing people’s quality of life ― but they don’t have to.

“There are highly effective treatments,” Dick-Biascoechea said. “And nobody should have to tolerate daily bothersome symptoms.”This article originally appeared on HuffPost.