Sleep Pattern Disorders Following Menopause

Hot flashes and night sweats can interrupt sleep and at least 3 out of every 4 menopausal women will experience hot flashes, and over half of postmenopausal women face sleep disorders.

Medical Treatments for menopausal insomnia

  • HRT: patch,cream or pill format with associated risks under supervision.
  • Antidepressants that help: Effexor/Paxil/Prozac and Lexapro
  • Non Hormonal treatment of Hot flashes: Brisdelle (fluoxetine)​

Over the counter Aids & Tips

  • Melatonin: decreases with advancing age and has less production in bright light.
  • Keep your bedroom cool at night.
  • Avoid exercise before bed.
  • Avoid spicy food at nights.
  • Avoid caffeine at late hours.
  • Avoid mid day napping.
  • Keep routine bedtime schedules.

One-third of women experience postmenopausal vaginal dryness which intensifies with advancing age.
Symptoms of vaginal dryness are due to:

  • Estrogen reduction
  • Reduced lubrication
  • Reduced Vaginal wall laxity
  • Atrophic changes

Treatment options for Vaginal Dryness:

Topical estrogen:

  • Vaginal estrogen creams: These are creams that are inserted into your vagina with an applicator or applied externally in the genital region. Common estrogen creams include Premarin and Estrace.
  • Vaginal estrogen tablets: vaginal tablets can be inserted into the vagina using an applicator.
  • Vaginal ring: elastic rings that can be inserted into the vagina, where it slowly releases estradiol into the surrounding tissues. The ring cannot be felt once inserted and can be left in place for 3 months until it needs to be replaced.

History of breast and endometrial cancer is a contraindication to vaginal estrogens and can be replaced with lubricants.

Pain with intercourse after menopause

Painful intercourse is a persistent or reoccurring pain in the genitals that can happen just before, during, or immediately after sexual intercourse.

​Dyspareunia is known to have a variety of causes, both physical and psychological.
Lack of lubrication resulting from lower estrogen levels is a major factor causing dyspareunia post menopause.

Treatment Options for Vaginal Dryness

  • Painless laser procedure: that delivers controlled energy to the vaginal tissue & stimulates collagen production and is a safe and outpatient therapy for those not suitable with Hormonal therapies.
  • Vaginal Estrogens
  • Hormone replacement therapies
  • Lubricants

Urinary Tract Infections

Women are fairly prone to urinary tract infections because of the shortness of their urethra and the close proximity of the urethra to the vagina and anus. Bacteria that live in this moist environment can spread to the urinary tract during sex or with the use of certain vaginal birth control methods. If the bacteria reach the bladder, the woman may develop a bladder infection, also known as cystitis. A kidney infection is known as pyelonephritis and can be a serious medical condition.​

Symptoms of a Urinary Tract Infection:

  • Urge to urinate.
  • Pain with urination.
  • Frequent urination.
  • Cloudy urine or color changes
  • Fever, chills
  • Nausea or vomiting
  • Back pains
  • Risk factors:
  • Multiple vaginal births
  • Diabetics
  • History of UTIs
  • Obesity
  • Post-menopause
  • Kidney stones​

Diagnosing a Urinary Tract Infection:

  • Urinalysis
  • Urine culture
  • History taking
  • Treatment options;
  • Outpatient antibiotics specific to culture sensitivity
  • increased fluid intake
  • Frequent voiding
  • Voiding prior & after intercourse
  • Inpatient therapy in severe Pyelonephritis
  • Prophylaxis for recurrent infections
  • Cranberry juice or cranberry pills may aid in preventing UTIs, but the effect is not well understood.
  • Estrogen therapy can help prevent UTIs in women who are going through menopause.


  • Pyelonephritis is a serious and more aggressive version of a UTI affecting upper urinary tract and Kidneys.
  • Many times outpatient therapy is inadequate and during pregnancy, if ignored may lead to adult respiratory distress and become fatal.
  • Urinary tract infection, plus these additional symptoms, may indicate pyelonephritis:
  • Fever, chills, nausea, and/or vomiting
  • Back pain or pain in the sides
  • Disorientation or confusion
  • Urine color changes
  • Pyelonephritis Risk increased with:
  • Diabetes
  • Use of steroids
  • Immunosuppression like pregnant state or HIV
  • renal or ureteral stones
  • Urinalysis, Urine culture, WBC and CRP infection markers plus ultrasounds are diagnostic tools.

Reduced sexual desire and libido

A Woman’s sex drive is dependent on many factors:
Physical, Psychological, Emotional and Social including religious beliefs.

Hormonal changes are both physical and psychological which can decrease the desire for sex. Reduction in Estrogen levels result in a decreased interest in sex, reduce lubrication in the vagina, which adds discomfort or even pain during sex, which can have a rippling effect on sexual desire.

​Many women and their partners struggle to cope with these changes.Eventhough many couples continue to enjoy sexual intercourse post menopause.​

Couples commonly express:

  • loss of intimacy with their partners
  • Disagreements on sexual needs
  • Inability to communicate with each other​

Feeling comfortable with your Physician:​

It is uncomfortable to talk with your doctor about your sexual health but it is appropriate to seek help and improve on quality of your life.The result can impact your life in a significant way.​

Confidentialy ask us:​

  • Can we treat reduced libido?
  • Can I return to my previous state?
  • Can I make changes to improve my condition?

Share with your doctor the specific issues at hand, Pain with sex,vaginal dryness, difficulty with orgasm or arousal and your emotional status.​

Treating reduced libido:​

​Reintroducing estrogens can improve libido, improve lubrication and help with mood changes when given as a pill,Cream,Patch,Spray or even IV supplementation however it needs physician supervision due to increased side effects in existing breast and endometrial cancers.

Incontinence related menopausal effects

Urinary incontinence refers to an inability to control the leakage of urine.

Types of Urinary Incontinence:

1. Overflow incontinence: Slow, minor leakage after urinating. This can occur when the urethra is blocked or when the bladder muscles fail to completely empty the bladder.
2. Urge incontinence: Also known as the overactive or spastic bladder, urge incontinence is leakage that results from a strong, immediate urge to urinate. This happens when a muscle spasm contracting the bladder overpowers the sphincter muscles that regulate the flow of urine through the urethra.
3. Stress incontinence: This is leakage that is caused by the physical stress of coughing, sneezing, laughing, or exercising. Stress incontinence is usually due to the deterioration of the tissues and muscles that support the urinary organs.
4. Mixed incontinence: Exhibiting symptoms of both urge and stress incontinence.


  • ​Urinating more often than normal
  • The urge to urinate, even if the bladder is empty
  • Feelings of pressure or discomfort in the lower abdomen
  • Pain or burning while urinating
  • The need to get out of bed to urinate several times a night
  • Urinating the bed while asleep

Common causes of Urinary Incontinence

  • Medical conditions & neuromuscular disorders
  • medication related
  • Urinary tract infections
  • Anatomical defects and fistulas
  • Pelvic organ prolapse​

Diagnosing Urinary Incontinence

  • ​History & Diary of symptoms
  • Pelvic exam
  • Stress test:Your doctor will have you cough with a full bladder to observe any leakage.
  • Post void residual volume test:After urinating and with the use of ultrasound or a catheter to measure the amount of liquid left in your bladder.
  • Dye test:To verify Fistulas or amount of leakage
  • Cystoscopy: flexible tube into your urethra to see inside your urinary tract and bladder.
  • Urodynamic testing​

Treatment Options:

  • Drinking less fluid, especially caffeinated drinks
  • Quitting smoking
  • Losing excessive weight (for overweight women)
  • Avoiding constipation, through diet changes and supplements
  • Treating stressors such as chronic coughing
  • removing adversley affecting medications
  • Treatment of underlying medical disorders
  • Physical therapy
  • Laser vaginal stress incontinence reenforcement
  • Hormonal treatment
  • Surgical approach and restoration of anatomy

Bone Loss & Osteoporosis

Bone changes with menopause:

Osteoporosis: brittle and fragile bones
Osteopenia: less severe than osteoporosis

Symptoms of Osteoporosis are:

  • Asymptomatic in the majority of women
  • Back pain
  • Bone fractures
  • shrinking stature
  • Slouching Posture​

Risk Factors of Osteoporosis:

  • Sex: Females>Males after age 50.
  • Age
  • Hereditary history
  • Short and Petite women at higher risk
  • Race: worse in Asian women
  • Early Menopause
  • Steroid use
  • Hormonal imbalance
  • Anorexia
  • Lack or reduced exercise
  • Alcohol & Smoking​

Reducing your risks:

  • Avoiding smoking.
  • Avoiding alcohol.
  • Preventing falls.
  • Routine check-ups​


  • A bone density scan, also known as a DEXA scan.​

Treatment for Osteoporosis:

  • Biphosphonates like: Fosamax, Atelvia, Reclast, and Boniva
  • Hormone replacement therapy

Facial hair growth after menopause

Increased chin or upper lip patches are very common and affect 4 out of 10 women over age of 45.
Hormonal changes:Reduced estrogens but continued testosterone production post menopause.
Medical conditions : testosterone producing tumors of ovaries and Cushing diseases adrenals may lead to excess unwanted hair growth.


  • Waxing
  • shaving
  • tweezing
  • Electrolysis & Laser Hair removal
  • topical creams

Joint Pain increases after menopause

Achy, swollen joints are another common symptom of menopause. As a woman approaches menopause, her body goes through drastic hormonal fluctuations that can affect her in many ways. The medical community is unclear as to why menopause seems to have this effect on joints. One theory is that estrogen affects joints by keeping inflammation down. As estrogen levels decline, the joints can swell and become painful.

​Joint pain during menopause is associated with both osteoporosis and arthritis. Osteoporosis is a condition in which the bones lose density and can become brittle. Arthritis is the medical term for “inflammation,” and can refer to many different types of joint conditions. Some of the most common types of arthritis are osteoarthritis and rheumatoid arthritis. These conditions are complicated and varied, so it’s important to make an appointment with us to discuss your concerns.

What Does Joint Pain Feel Like?

Menopausal joint pain usually hits the worst in the morning and eases as the joints loosen up with the day’s activities. Most women complain of pain in the neck, jaw, shoulders, and elbows, but wrists and fingers can also be affected.

The pain can be accompanied by stiffness, swelling, or even a shooting pain traveling down the back, arms, and legs. Some women report more of a burning sensation, especially after a work-out.

Easing Joint Pain During Menopause

Making an appointment with your primary care physician or gynecologist is a good first step towards alleviating your joint pain; however, there are many simple, non-invasive ways to treat joint pain by making some changes to your daily routine.

Keeping active

Exercise is a great way to strengthen your joints and stay flexible. Swimming, tai chi, and yoga are great options for seniors. Avoid activities that put a lot of strain on your joints, like jogging. Staying active can also help keep your weight down, which can relieve some of the pressure on your joints.


Cortisol, the stress hormone, is known to excite inflammation in the joints. Practicing stress relief techniques and getting regular exercise can manage cortisol levels.

Watch your diet

Diets high in carbohydrates and sugars and low in omega-3 fatty acids have been shown to trigger chronic inflammation. Replace white bread, white rice, and flour with whole grain foods like wheat breads and pastas, oatmeal, brown rice, and quinoa. Choose seafood like fresh tuna, salmon, and mackerel, and seek out leafy greens like kale and spinach. Some foods, like blackberries, blueberries, and cherries, provide the body with natural anti-inflammatories. You can also supercharge your diet with omega-3 and D supplements.

Over-the-counter medication

Hyaluronic acid might help lubricate the joints, and ibuprofen can help relieve everyday aches and pains.

What if my Joint Pain is Severe?

If fever or weight loss accompanies your joint pain, or if the pain becomes worse and lasts more than a few days, please contact your doctor.

Headaches & Migraines

70% of migraine sufferers are women and mostly due to estrogen fluctuations. Hormone replacement therapy may worsen your intensity and frequency of migraines as are the case with hormonal contraceptive use with susceptible women.

  • Throbbing pain, worse on one side
  • Nausea & vomiting
  • Light sensitivity
  • Lasting for hours to days​

Migraine associated “Aura”:

  • A tingling or numb sensation in the face or fingers
  • Mild visual hallucinations, like flashing lights or floating shapes
  • Temporary blindness in peripheral vision
  • Distortions in perception, like sense of taste, touch, or smell
  • Confusion, mental fog​

Triggers :

  • Stress
  • Lack of sleep
  • Hunger
  • Bright lights​

Some treatment options for migraines include:

  • Nonsteroidal anti-inflammatory drugs (NSAIDS): ibuprofen (Advil and Motrin) and aspirin.
  • Acetaminophen (Tylenol) and Excedrin Migraine
  • Triptans (tryptamine-based serotonin receptor agonists): Imitrex, Maxalt, Axert, and Zomig. They work by causing constriction of blood vessels and blocking pain pathways in the brain.
  • Hormone Replacement Therapy (HRT): can improve certain types and adversely affect others.
  • Botox: may be helpful.
  • Other medications: antidepressants and anti-seizure drugs seem to prevent or reduce the frequency of migraine headaches.
  • Vitamins and minerals: coenzyme Q10, magnesium, and high doses of vitamin B2 may also prevent or reduce the frequency of headaches.