Central Nervous System
Some of the earliest changes during the menopause are the onset of vasomotor symptoms that often appear during the perimenopausal years. The colloquial term applied to vasomotor symptoms is ‘hot flush’ and when a hot flush occurs at night it is termed ‘night sweat’.
The exact aetiology of a vasomotor symptom is unknown but is thought to be loss of the modulating effect of estrogen on serotinergic receptors within the thermoregulatory centre in the brain, resulting in exaggerated peripheral vasodilatory responses to minor atmospheric changes in temperature.
Hot flushes occur in up to 80% of women with less than 30% seeking help. Perhaps the most distressing effect of vasomotor symptoms is through the occurrence of night sweats. The woman may be asleep at the time of the sweat, but during the episode she can be fully woken or her level of sleep can be converted from deep REM sleep to a shallower sleep that is less refreshing. Such disturbances lead to tiredness, exhaustion, poor performance during the day and impaired quality of life.
Whilst hot flushes tend to appear unpredictably additional triggers include alcohol, caffeine and smoking. Women with a high BMI tend to get worse vasomotor symptoms.
Whilst there is little evidence to support a direct effect of the menopause as a cause for depression it is clear that menopause is associated with low mood, irritability, lack to energy, tiredness and impaired quality of life from the early perimenopausal period.
Some of these symptoms may be attributed to hormonal changes but it is also important to consider other external influences on mood such as relationship and family changes, financial issues, previous history of depression and anxiety and the woman’s attitude to ageing.
At present there is no clear evidence that menopause is associated with an acceleration of the onset or incidence of dementia. Most women, however complain of some change in memory and global cognitive function around the time of the menopause. It is likely that these changes can partly be explained by the impact of vasomotor symptoms and other symptoms on patterns of sleep.