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What is menopause?

Menopause is a natural part of the aging process. The first stage of menopause — perimenopause — begins to affect a woman’s ability to reproduce. Perimenopause typically begins during the early to mid-40s and can last from three to five years.

A woman is considered in menopause when she has gone 12 months without menstruating. The average age of menopause onset in the Unites States is 51.

Perimenopause and menopause are triggered by hormones that fluctuate and decrease. Many parts of the body are affected as hormonal levels decline. These include:

  • reproductive system
  • vaginal tract
  • urinary system
  • nervous system
  • heart
  • brain
  • bones
  • skin

A common symptom often associated with hormonal changes is pain.

Your menstrual cycle is regulated by the luteinizing hormone and follicle stimulating hormone. These two hormones are manufactured in the pituitary gland. They stimulate the ovaries to produce estrogen and progesterone. During perimenopause and menopause these hormones fluctuate and can cause the following painful symptoms.

Cramps and breast tenderness

Changes in your period may be accompanied by cramping that is more painful and intense than you were used to. You may also experience increased breast tenderness before and during menstruation. And you may find that your menstrual flow is light some months and heavy during others.

Migraine headaches

Fluctuations in estrogen are linked to migraine headaches. You may get migraines for the first time or see an increase in severity or frequency during perimenopause.

Some women have the reverse reaction, and see a reduction in migraine occurrence as they enter menopause. This may be because high levels of estrogen can trigger headaches and diminishing levels can cause a decrease.

Joint pain

Menopause may cause joint pain that can affect the knees, shoulders, neck, elbows, or hands. Old joint injuries may begin to ache. As time goes on, you may start to notice that you feel more aches and pains in those areas than you used to. That’s because estrogen helps to reduce inflammation. As it’s levels decline, inflammation may increase, causing discomfort and menopause-related arthritis.


The outside of the body is also affected by fluctuating and declining hormones. Low levels of estrogen can cause a decrease in skin’s elasticity. It also lessens skin’s ability to retain water, which it uses as a buffer against injury. This makes skin thinner, and painful bruising is often the result. The backs of the hands are particularly sensitive to bruising.


For women diagnosed with fibromyalgia, menopause may bring heightened sensitivity to pain. Fibromyalgia is a chronic pain condition that is often diagnosed for the first time in women entering perimenopause or menopause.

Some symptoms of menopause like pain, fatigue, and vaginal dryness overlap with those associated with fibromyalgia. For that reason, it is not always easy to determine which issue is causing the symptoms.

Pain during intercourse

Pain can sometimes accompany sex when you’re in menopause. This can make maintaining intimacy challenging. But women can find ways to keep their sex lives pleasurable during perimenopause, menopause, and beyond.

Estrogen, the hormone which is in short supply during menopause, helps keep vaginal tissues elastic. It also supports moisture production in the vagina, which helps to make sex comfortable. As estrogen levels recede, vaginal tissues get thinner. This can make intercourse painful. The vagina also becomes less lubricated, and more prone to inflammation, dryness, and tearing.

Vaginal atrophy can also occur. This can cause the vagina to shrink and shorten in length. Vaginal atrophy is often accompanied by urinary tract symptoms, such as:

  • urinary leakage
  • burning during urination
  • urgent need to urinate

Changes in hormone levels may also create a reduction in sexual desire, and a lessened ability to become sexually stimulated. This can make it even harder for the vagina to become lubricated.

These changes may happen at any point during perimenopause or menopause.

Don’t wait to seek help for pain. Most menopause-related pain can be reduced or eliminated with at-home remedies, medical treatment, or lifestyle changes.

The type of discomfort you have may determine what type of doctor you see. You may want to start with your gynecologist.

A good way to prepare for an appointment is by writing down your symptoms. The more specific you are, the better. For example, are your headaches on one side of your head, or all over? Are you able to tell if the pain you feel during intercourse is within the vagina, or in your vulva? (The vulva includes the inner and outer lips of the vagina, the clitoris, and the external opening to your vagina.) The more detail about the pain you feel, the better armed your doctor will be to analyze your symptoms and help treat them.

Your doctor will give you a blood test to determine your hormone levels. You may also get tested for hypothyroidism, or underactive thyroid. This condition presents many symptoms similar to those of menopause.

Pain, discomfort, and other symptoms of menopause can be treated different ways. Pain-reducing treatments include:

  • Over-the-counter (OTC) pain medication, such as NSAIDs (ibuprofen) may help with joint pain, or with headache.
  • Ice packs can help reduce knee and lower back pain.
  • Dietary supplements, such as evening primrose oil, may help reduce breast tenderness.

Talk to your doctor before you begin at-home treatments, to determine the benefits vs. the risks for you.

Phytoestrogens or plant-based estrogen, such as soy products, may help to alleviate menopause symptoms in some women. However, this treatment is controversial. Make sure to discuss this option with your doctor before you start.

Painful intercourse can diminish your quality of life if left untreated. Some treatments include:

  • Using vaginal lubricants before intercourse can help make sex more comfortable.
  • Using vaginal moisturizers daily alleviate irritation by reducing discomfort and dryness.
  • Eating foods high in omega-3 fatty acids may help support greater levels of vaginal moisture.
  • Staying hydrated by drinking lots of water or other beverages high in electrolytes can help prevent dryness.
  • Taking vaginal estrogen, a form of hormone replacement therapy (HRT), may help reduce dryness, and increase comfort during sex.
  • Applying topical creams containing estrogen may help alleviate vaginal symptoms.
  • Maintaining an active sex life can help increase blood flow to the vagina and reduce thinning of the vaginal walls.

Other ways to increase blood flow to the vagina include acupuncture, aerobic exercise, and yoga.

Keeping active can help reduce body aches and tone muscles, making you less susceptible to injury. If you find that aching knees make running, dancing, or brisk walking difficult, try using knee sleeves. They provide compression, which can help keep active knees comfortable. They also make injury less likely. You can also forgo the running track for the pool. Swimming is an easy-on-the-body alternative and may help you get your mind off of any pain you are feeling.

Other ways to reduce pain can include deep muscle massage, acupuncture, heat or cold application, and hypnosis. If you smoke, or have other habits which adversely affect your health, work on eliminating them. This may increase feelings of vigor, improve circulation, and reduce stress, which may all help to reduce pain.

Pain related to menopause is quite common. Most aches and pains, including those related to intercourse, may be reduced or eliminated with treatment. Pain and menopause do not have to impact the quality of your day-to-day life.