While menopausal experience varies widely among women, those in rural areas seem to suffer more, says a US study.
Indeed menopause is a time of hot flashes, poor sleep and mood shifts.
It's estimated that about 75 percent of women experience hot flashes, ranging from mild to severe.
But many women report debilitating symptoms that interfere with family life, relationships and work. The impact of menopause often depends on where a woman is in her life, says Tara Parker-Hope, writing in the New York Times.
A woman who works in a relaxed office with other middle-aged women may be less troubled by menopausal symptoms than a woman who is caring for an elderly parent and can't afford the heart-pounding, sweaty distraction of a hot flash.
Living in a rural environment can add extra pressures to coping with menopause, notes a report in the latest issue of The Journal of Advanced Nursing. Menopausal women in rural areas have less access to medical care and may have more stress due to multiple care-giving roles and lower income. And menopause in a small town is less anonymous, the study notes.
Researchers interviewed 25 menopausal women in rural Nova Scotia, a Canadian province where many people live in remote areas. They found that women were often surprised by the intensity of the psychological, physical and social consequences of menopause.
While this is likely a common response for most women, lack of access to health care and support groups made the experience especially stressful for women living in rural areas.
Memory loss, which is common during the hormonal surges of menopause, for instance, caused considerable concern, and many women were scared that it was due to the early onset of Alzheimer's.
The women said they found it difficult to obtain information from local health services and often relied on the Internet, books, magazines and television shows, but they were frustrated by conflicting information.
The women also said having other women to talk to helped, and they lamented the lack of female rural doctors.
"Scarce health care resources are a problem in rural areas, and many of the women we spoke to struggled to get the medical information and support they needed, especially if they preferred to talk to a female doctor,'' said Sheri L Price, a nurse researcher who specializes in women's health at the IWK Health Centre in Halifax.
Meanwhile Wayne State University researchers say hot flashes do awaken some women, but only if the flashes occur in the first part of the night, before the women settled into deep REM sleep.
The real surprise in their study was that more than half of the women showed signs of sleep apnea, restless legs syndrome or both.
Whether a woman scored high on anxiety tests was also a predictor of poor sleep, according to the report, which was published this month in the medical journal Menopause.
The results are all the more disturbing because both sleep apnea and restless legs may lead to more than a poor night's sleep.
Sleep apnea, a breathing disorder, increases the risk for heart disease and stroke.
Restless legs syndrome, which affects more women than men and causes uncomfortable crawling sensations in the legs and a nearly irresistible urge to move them, raises the chances of developing sleep apnea, anxiety, depression and impaired concentration.
The findings suggest that menopausal women ought to pay closer attention to how they feel when they wake up at night. If you are hot, sweaty and flushed, it's pretty obvious a hot flash woke you up. But if the reasons behind your disturbed sleep aren't clear, talk to your doctor about undergoing a sleep study. It means spending the night hooked up to wires and monitors, but the answer might finally lead to a good night's sleep.