Understanding and Treating Menopause Symptoms

What is menopause?

Menopause is associated with various symptoms for many women. Hot flashes, sleep disturbances, mood swings, or changes in the vaginal mucosa often occur. Menopause (medically: climacteric or perimenopause/menopause) refers to the natural hormonal transition phase in a woman’s life when ovarian function declines and the production of estrogen and progesterone permanently decreases. This transition phase is divided into three stages:

• Perimenopause – hormonal fluctuations begin (around ages 40–45)
• Menopause – the last spontaneous menstruation (average age in Europe: ~51 years)
• Postmenopause – all years after the last menstrual period 

When does menopause begin?

Most women notice first changes between the ages of 40 and 55. The onset depends on several factors:

• Genetic predisposition (strongest single factor)
• Lifestyle and nutrition
• Smoking (accelerates onset by an average of 1–2 years)
• Surgical procedures on the ovaries or oncological therapies (premature menopause possible)

First symptoms such as irregular cycles or hot flashes can already appear in perimenopause – often years before the last menstrual period. 

What hormonal changes occur during menopause?

The central event of menopause is the decline of estradiol (estrogen) and progesterone. At the same time, pituitary control hormones – especially FSH (follicle-stimulating hormone) – increase in response to declining ovarian function.

Why does estrogen deficiency cause so many symptoms?

The decline of the hormone estrogen affects numerous organ systems simultaneously. Since estrogen receptors are present in many tissues, various physical and psychological symptoms can occur at the same time. Estrogen acts through specific receptors in almost all body tissues. When levels drop, many systems respond simultaneously:

• Brain & nervous system: influence on serotonin, dopamine, and noradrenaline → mood swings, sleep problems, hot flashes
• Thermoregulation in the hypothalamus → vasomotor symptoms (hot flashes, sweating)
• Cardiovascular system: altered vascular elasticity
• Bone metabolism: increased risk of osteoporosis
• Mucous membranes (vagina, urinary tract): thinner, drier, more vulnerable → genitourinary syndrome of menopause (GSM) 

Which menopausal symptoms occur most frequently?

Menopausal symptoms are often clinically assessed using the Menopause Rating Scale (MRS) – a validated 11-point questionnaire (scale 0–4 per symptom; lower = better). The symptoms can be divided into three groups:

Physical-autonomic symptoms

• Hot flashes and sweating episodes (most common symptom, affecting up to 80% of women)
• Night sweats and sleep disturbances
• Palpitations / rapid heartbeat
• Joint and muscle pain
• Headaches, fatigue, exhaustion
• Weight gain / metabolic changes

Psychological symptoms

• Mood swings and irritability
• Depressive moods
• Anxiety and inner restlessness
• Concentration and memory problems ("brain fog")
• Reduced resilience and lack of drive

Urogenital symptoms (GSM)

The genitourinary syndrome of menopause (GSM) refers to structural changes in the vaginal mucosa and urinary tract caused by estrogen deficiency:

• Vaginal dryness (vaginal atrophy)
• Burning, itching, and irritation in the intimate area
• Pain during intercourse (dyspareunia)
• Reduced sexual sensation
• Frequent urination, recurring urinary tract issues 

How long do menopausal symptoms last?

The duration of menopausal symptoms varies individually. While some women experience hormone-related symptoms for only a few years, others may have symptoms for a longer period. Most symptoms occur during the so-called perimenopause, the transition phase before the last menstrual period.

On average, this phase lasts about 4 to 8 years, with individual symptoms lasting for different lengths of time. Hot flashes and sleep disturbances often occur for several years and can persist after menopause. Urogenital symptoms such as vaginal dryness or irritation of the vaginal mucosa often develop gradually and can persist long-term without treatment.

How long menopausal symptoms last depends, among other things, on genetic factors, lifestyle, hormonal changes, and individual health conditions. Targeted treatment can help significantly reduce symptoms and improve quality of life during this phase.

Which factors can worsen menopausal symptoms?

The intensity of menopausal symptoms is not only determined by hormonal changes. Various lifestyle and environmental factors can influence how strongly symptoms are perceived.

The main factors include:

• chronic stress
• Lack of sleep
• Smoking
• high alcohol consumption
• Overweight
• Lack of exercise

Certain dietary habits can also play a role. Very spicy foods, caffeinated drinks, or alcohol can, for example, intensify hot flashes.

Furthermore, individual stress management can also influence symptom perception. Women with high stress levels more often report sleep disturbances, mood swings, or exhaustion during menopause. A healthy lifestyle with regular exercise, balanced nutrition, and sufficient sleep can therefore help reduce menopausal complaints.

How do menopausal complaints affect quality of life?

Menopausal complaints can significantly affect quality of life, as symptoms like hot flashes, sleep disturbances, mood swings, and intimate area discomfort can cause both physical and psychological burdens in daily life.

Sleep disturbances and hot flashes

Nighttime hot flashes disrupt sleep and lead to chronic sleep deprivation over time. Consequences include reduced concentration, increased irritability, decreased work performance, and a higher risk of depressive episodes.

Dyspareunia and partnership

Pain during intercourse caused by GSM directly affects intimacy and relationship quality. Studies show that persistent dyspareunia is associated with reduced self-esteem, emotional stress, and decreased sexual activity.

Cognitive and psychological strain

Hormonal fluctuations affect neurotransmitters that regulate mood and cognition. Combined with sleep deprivation, this often creates a cycle of exhaustion, concentration problems, and emotional strain. 

What role does the vaginal mucosa play in menopausal complaints?

The vaginal mucosa plays a central role in many complaints during and after menopause. Due to the decline of the hormone estrogen, the structure of the mucosal tissue changes. The vaginal mucosa becomes thinner, less elastic, and produces less natural moisture. These changes can lead to typical symptoms of the so-called genitourinary syndrome of menopause (GSM). These include vaginal dryness, burning, itching, or pain during intercourse. At the same time, the natural protective function of the mucosa can be impaired, making irritation or infections more likely. Since these changes often persist permanently, supporting mucosal health plays an important role in treating menopausal complaints. Local therapies that promote hydration and regeneration of the vaginal mucosa can help relieve symptoms and improve quality of life.

What treatment options are available for menopausal symptoms?

The therapy depends on the type, severity, and combination of symptoms as well as individual risk factors and the woman’s preferences.

Hormone replacement therapy (HRT)

Hormone replacement therapy (HRT) with estrogen – possibly combined with progesterone – is considered the most effective option for severe vasomotor symptoms (hot flashes, sweating). It is recommended when severe symptoms significantly reduce quality of life and no medical contraindications exist. Forms of administration: tablets, patches, gel, locally acting preparations.

Non-hormonal systemic therapies

• Lifestyle measures: regular exercise, balanced diet, stress management
• Herbal preparations with phytoestrogens (e.g., red clover, soy)
• Behavioral strategies to improve sleep (sleep hygiene, cognitive behavioral therapy)
• Non-hormonal medications for hot flashes (e.g., SSRIs/SNRIs, Fezolinetant)

Local therapies for urogenital symptoms (GSM)

Local therapies target the vaginal mucosa directly and are especially relevant for women who do not want or cannot use systemic hormone therapy.

• Moisturizing vaginal gels and creams
• Vaginal suppositories to support mucosal regeneration
• Locally acting estrogen preparations (low dose)

Modern non-hormonal local therapies combine several active ingredients:

Hyaluronic acid: Naturally occurs in the human body and can bind large amounts of water. This improves hydration and elasticity of the vaginal mucosa.

Cannabidiol (CBD): Has antioxidant and cell-protective properties; can reduce mucosal irritation and support tissue balance.

What clinical studies exist on non-hormonal therapies during menopause?

The effectiveness of local therapies is increasingly studied in clinical trials. Standardized measurement tools used include:

MRS (Menopause Rating Scale): 11 questions, scale 0–4 per item; total score: lower = fewer complaints.

MANSA (Manchester Short Assessment of Quality of Life): 16 questions, scale 1–7; higher = better quality of life.

CANNEFF® VAG SUP – Pilot Study & RCT

Two clinical studies examined vaginal suppositories with CBD and hyaluronic acid (CANNEFF® VAG SUP) in menopausal and postmenopausal women over 30 days each.

Pilot study (n = 30)

The pilot study with 30 women showed improvement in menopausal and postmenopausal symptoms as well as a positive impact on quality of life in social and sexual areas.

Randomized, double-blind, placebo-controlled study (n = 50)

The RCT (25 verum, 25 placebo) yielded statistically significant results:

• MRS median: decrease from 16 to 8 in the CANNEFF group (mean change: −10.60 points vs. −1.96 points placebo; p < 0.0001)
• MRS comparison after treatment: significant difference between groups (p = 0.005)
• MANSA median: increase from 62 to 67 (change: +5.68 vs. +1.32 placebo; p = 0.0003)

Improved symptoms according to study conclusions: 

Hot flashes, sweating, insomnia, depressive moods, nervousness, concentration and memory problems, as well as pain in the intimate area. Notably, the improvement was not limited to urogenital complaints but affected several typical menopausal symptoms simultaneously.

When should women seek medical advice for menopausal symptoms?

Many menopausal symptoms are part of a normal physiological process. However, the following symptoms warrant a gynecological evaluation:

• Bleeding after menopause (always get checked!)
• Very intense or sudden hot flashes
• Ongoing sleep disturbances with significant exhaustion
• Severe pain in the lower abdomen or intimate area
• Frequent recurring urinary tract or vaginal infections
• Persistent depressive moods or feelings of anxiety

Individual medical advice is the best way to find a therapy tailored to the personal situation—whether HRT, non-hormonal options, or combined approaches.

FAQ – Frequently Asked Questions about Menopause

Menopausal symptoms mainly arise from the decline of female sex hormones and can cause numerous physical and psychological symptoms. While some women experience only mild discomfort, others suffer significant limitations in daily life. In addition to hormone replacement therapy, various non-hormonal treatment options are now available, especially for urogenital complaints. Modern local therapies can help relieve both mucosal symptoms and other typical menopausal symptoms, improving quality of life.

How long does menopause last?

The entire transition phase (perimenopause to postmenopause) lasts between 5 and 10 years for most women. Perimenopause often begins in the mid-40s, and the final menstrual period (menopause) occurs on average at age 51.

What helps best against hot flashes?

The most effective medical treatment for severe hot flashes is hormone replacement therapy (HRT). Non-hormonal alternatives include SSRIs/SNRIs, fezolinetant, and lifestyle measures (stress reduction, layering clothing, avoiding alcohol and spicy foods).

What is genitourinary syndrome of menopause (GSM)?

Genitourinary syndrome of menopause (GSM) is the medical term for symptoms caused by estrogen deficiency affecting the vaginal mucosa and urinary tract: vaginal dryness, burning, itching, dyspareunia (pain during sex), and urinary symptoms. GSM typically does not improve without treatment.

Can a local vaginal therapy improve systemic menopausal symptoms?

Clinical studies (including a randomized, double-blind, placebo-controlled study with CANNEFF® VAG SUP) show that local vaginal therapies with CBD and hyaluronic acid can significantly improve not only urogenital symptoms but also general complaints such as hot flashes, sleep disturbances, and mood swings (MRS reduction from median 16 to 8 in 30 days; p < 0.0001).

What does CANNEFF® VAG SUP contain and how does it work?

CANNEFF® VAG SUP are vaginal suppositories with two main active ingredients: hyaluronic acid (hydrates the mucous membrane, improves elasticity) and cannabidiol/CBD (antioxidant, cell-protective, anti-inflammatory). They act locally without systemic hormone exposure and are especially suitable for women who do not want or cannot use hormone therapy.

When can hormone replacement therapy be started?

HRT can generally be started as soon as bothersome menopausal symptoms appear – usually from perimenopause onwards. The optimal timing and suitability are individually assessed by the doctor, considering factors such as pre-existing conditions, risk profile, and symptom pattern.

Are menopausal symptoms the same for all women?

No. The severity varies significantly: About 20–25% of women experience hardly any symptoms, while 25% suffer from severely limiting symptoms. The type, intensity, and combination of symptoms differ individually and are influenced by genetic, lifestyle-related, and health factors.