Ask the Expert: Dr. Melynda Barnes on Menopause Insomnia, Symptoms, and Anxiety

Let’s talk about menopause. For how totally common and natural this life phase is for women, it can be tough to find helpful, encouraging information out there. So we decided to turn to the experts. We asked Melynda Barnes, MD and Clinical Director for Rory, some of our most pressing menopause questions. (You can see part one of Dr. Barnes’ Q&A here.)

Dr. Barnes

What hormonal changes are causing menopause insomnia?

During perimenopause and menopause, both estrogen and progesterone levels decrease. Progesterone promotes sleep and the decreasing levels can contribute to difficulty with falling asleep or staying asleep during perimenopause and menopause. The decreasing levels of estrogen affect your hypothalamus which is the body regulator for appetite, sleep, libido, and body temperature. The combination of a decline in estrogen and progesterone contributes to insomnia or difficulty sleeping being a very common symptom of perimenopause and menopause.

Are the symptoms for menopause fairly similar among all women or are the symptoms more dependent on the woman? 

There are “standard” symptoms associated with menopause but the degree of which an individual woman experiences symptoms is completely dependent on the woman. The typical symptoms of menopause are:

  • Hot flashes: This is the most common symptom of menopause and perimenopause affecting up to 80% of women. They typically last 5–7 years but can last up to 10–15 years. 
  • Absence of menstrual cycles: This is the hallmark of menopause. Once a woman stops ovulating, her uterine lining no longer grows and sheds.
  • Loss of bone density: Normally, bone remains strong by having a perfect balance between the cells that make bone (osteoblast) and cells that breakdown bone (osteoclast). Up until menopause, estrogen protects bones from being broken down in excess by osteoclasts. When estrogen is lost and osteoclasts go unchecked, bone density is lost. This can result in osteoporosis leading to a higher risk of hip fractures, wrist fractures, and spine fractures, among others.
  • Weight gain and bloating: Estrogen helps regulate the deposit of fat tissue. Many women gain weight during and after the menopausal transition.
  • Mood changes: Mood changes, like depression, are common during perimenopause and menopause.
  • Sleep disturbances: Sleep disturbances can be related to the underlying hormonal changes or simply from night sweats.
  • Increased risk of cardiovascular disease: When estrogen levels decline, LDL cholesterol (the harmful kind) levels increase and HDL cholesterol (the positive kind) levels decrease. This causes fat and cholesterol to build up in the arteries which contributes to heart attack and stroke. 
  • Genital changes: These include vaginal shrinkage, thinning of the vaginal tissue, loss of vaginal folds, loss of vaginal lubrication, vaginal itching and discomfort, and painful sex (dyspareunia).
  • Urinary symptoms: Women can feel the sudden need to urinate (urgency), frequent urination, and pain during urination—mimicking a urinary tract infection.

Do you have any advice for women who are feeling fearful or anxious about menopause?

First, take a deep breath and try to release the fear or anxiety that you’re feeling. Menopause is a normal and natural transition that all women in midlife will experience. There can be incredible benefits to no longer having a menstrual period and with women living longer, the average woman will be postmenopausal for almost a third of her life. The other thing to keep in mind is that there are treatments and medications (both prescription and over the counter) that can help manage and alleviate bothersome symptoms of perimenopause and menopause. Finally, you are not alone. There are approximately 43 million women in the United States of perimenopausal and menopausal age. Almost all women will experience at least one symptom of menopause, if not many. Taking the time to talk to your physician about your experience can really do wonders to alleviate any fears that you may have. Also having a good talk with your girlfriends who are a few years older or the same age can also help relieve fears and anxiety as they talk about their experiences and give you advice.

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