31 Symptoms of Menopause

Menopause is often called “the change of life” and is a natural biological process women experience as they age. It brings about various physiological and hormonal transformations within the body. This article aims to provide a comprehensive understanding of the most common symptoms associated with menopause and shed light on some lesser-known symptoms.

1. Vasomotor Symptoms

Vasomotor symptoms, otherwise known as hot flashes, are one of the hallmark symptoms of menopause. When a hot flash comes on, you’ll feel a sudden warmth in the upper body, usually most intense on the face, neck, and chest. Your skin can become red, and you may even start sweating. Research suggests that hormonal changes, especially estrogen changes, are to blame for hot flashes and night sweats. A decrease in estrogen levels causes your body’s hypothalamus (think of this as your body’s thermostat) to become even more sensitive to slight changes in body temperature. When your hypothalamus thinks your body is too warm, it sets off a reaction (a hot flash) to help cool your body (1).

2. Cognitive Impairment

Menopause can bring about cognitive challenges often referred to as “brain fog.” Working memory, attention, reduced processing speed, and reduced verbal memory can occur due to hormonal changes. Estrogen elicits a neuroprotective effect on the brain, and while it previously facilitated efficient neurological connections, due to declining estrogen levels, you may experience cognitive difficulties (2).

3. Cardiovascular Irregularities

As hormones fluctuate, women may experience palpitations which can be described as rapid, irregular, or exaggerated heartbeats. It’s reported that up to 42% of perimenopausal women and 54% of postmenopausal women have palpitations (3). If you are experiencing cardiovascular irregularities, it’s important to talk to your doctor.

4. Sleep Disturbances

Insomnia or disrupted sleep patterns are prevalent during menopause. Hot flashes are usually the culprit for sleepiness in menopause, and nighttime hot flashes are commonly coupled with unexpected awakenings. Research shows that many women wake just before a hot flash occurs versus the hot flash causing the waking (4). Melatonin, a vital hormone for sleep, decreases as we age (5). And if you look at your phone or watch TV when you can’t sleep, the blue light can keep you from getting back to sleep (6).

5. Fatigue

Menopause often brings about persistent tiredness and exhaustion. Various factors contribute to this symptom, including night sweats that lead to sleep disturbances, increased irritability, and hormonal changes. Addressing the underlying causes of fatigue, particularly focusing on improving sleep quality, can significantly ease this symptom.

6. Mood Changes

Around 4 in 10 women have mood symptoms during perimenopause. They’re similar to PMS, but unlike PMS, these symptoms are often unrelated to your menstrual cycle. These mood changes are related to hormonal changes. On top of that, women in their 40s and 50s may also be experiencing many pressures: demanding jobs, raising children, and caring for aging parents. These can increase stress levels and add to mental health challenges, affecting mood (7).

7. Unexpected tears

Women experiencing fluctuating hormone levels during menopause may encounter sudden unexplained crying episodes. Crying spells (among other symptoms) can be a sign of perimenopausal depression (8).

8. Psychological Changes

In addition to crying spells, menopause can bring about feelings of guilt, anxiety, and emotional hypersensitivity. The collection of these symptoms is typically due to perimenopausal depression (8). Studies have shown a higher likelihood of clinically significant depressive symptoms among women entering perimenopause compared to those who remain premenopausal (9). If you’re experiencing signs of perimenopausal depression, talk to your doctor, multiple treatment options are available.

9. Irregular Menstrual Cycles

Due to declining estrogen levels, menopause disrupts the regularity of menstrual cycles. You may experience shortened or lengthened cycles, lighter or heavier flows, or unexpected cycles (10).

10. Decreased Libido

Some women can experience a decline in libido. The physiological changes that impact sexual responses are largely influenced by estrogen. One of the notable effects of lower estrogen is a delayed or absent orgasmic response. This effect, in conjunction with decreased vaginal secretions and painful uterine contractions seen in some postmenopausal women, can further affect the sexual experience (11).

11. Vaginal Dryness

Vaginal dryness, burning, itching, spotting, pain with sex, frequent urination, and urinary tract infections are some of the symptoms experienced in genitourinary syndrome of menopause. This frequently affects people transitioning to menopause and is due to the lining of your vagina becoming drier and thinner due to a lack of estrogen (12).

12. Muscle Aches

Muscle and joint pain affects over half the female population in middle age (13). Estrogen receptors are present in muscle tissue, and studies suggest that, with decreasing estrogen levels, muscles are more prone to injury, and regrowth of muscle tissue is limited (14).

13. Joint Pain

Estrogen receptors are also in our joints, and declining estrogen levels can contribute to the pain caused by inflammation in the joints. This can translate into the joints feeling more stiff, causing pain (15). Research has demonstrated that there are fluctuations in how stiff our joints are depending on our body’s estrogen levels, due to estrogen’s effects on ligaments and tendons (14).

14. Dry Eyes

Postmenopausal women have a higher incidence of dry eye disease, resulting in visual disturbances. Sex hormones, including estrogen, are involved in components of eye health. In the US, the rate of dry eye disease in women over 50 is almost double that in men over 50 (16).

15. Balance problems

You may notice feeling dizzy or faint as you move towards menopause, and while the exact cause is unknown, there may be some ethnic differences in the prevalence of this symptom. One study showed that 25.1% of Australian women reported “feeling dizzy or faint” versus 41.8% of Japanese women suffering from dizziness (17).

16. Urinary Incontinence

As estrogen levels begin to decline, the lining of the urethra (the tube that transports urine from the bladder to the outside of the body) thins. In addition, you may experience “pelvic relaxation” when the surrounding pelvic muscles weaken with age. As a result, women in mid-life are at a higher risk of urinary incontinence (the involuntary leakage of urine). Despite urinary incontinence being common, it’s not an inevitable result of aging and should not be passively accepted if it proves bothersome (18).

17. Urinary Tract Infections

Decreased estrogen can increase the risk of urinary tract infections. Changes in vaginal microflora related to declining estrogen can lead to decreased levels of good bacteria in the vagina and increase the incidence of UTIs (19). In addition, as you age, your vaginal tissue thins, and you may have trouble fully emptying your bladder. Both can increase the chance of a urinary tract infection (20).

18. Skin Changes

Skin is significantly affected during menopause. Sweat production decreases, leading to dry skin, and with declining estrogen comes a change in collagen metabolism. Skin becomes less resilient and pliable, and intense tingling can occur. Skin thickness decreases by 1.13% annually in the postmenopausal period, and collagen decreases by 2.1% every postmenopausal year (21).

19. Breast Changes

Estrogen plays a role in the connective tissue of your breasts and helps keep your skin hydrated and elastic. With less estrogen, your breasts decrease in size due to shrinking of the ducts and mammary glands. Your breasts lose their firmness and shape as well (22). On the flip side, some women report having to buy a larger bra; in one study, 1 in 5 women experience an increase in breast size after menopause. The most important factor connected to increased breast size was weight gain (23).

20. Headaches

Hormonal fluctuations can contribute to various types of headaches, including migraines, tension headaches, and cluster headaches. Hormone replacement therapy may intensify these headaches. On the bright side, headaches in menopause are less common than headaches in earlier ages (24).

21. Weight Gain

Fat accumulation, particularly around the waist, is common during menopause. Hormonal changes alone aren’t solely responsible for menopausal weight gain. Age-related muscle loss and slower metabolism can also contribute to the climbing numbers on the scale. Other factors include lack of exercise, unhealthy eating, and lack of sleep. It’s important to monitor your weight, as being overweight can increase your risk of type 2 diabetes and cardiovascular disease. Adopting a healthy and balanced diet, engaging in regular physical activity, and reducing sugar and alcohol intake are beneficial for managing weight during menopause (25).

22. Hair Changes

Estrogen supports hair growth, density, and fullness. Hair on the head may become thin, fall out more easily, turn gray, or change texture. Conversely, facial hair may increase, particularly on the chin (26).

23. Alterations in Body Odor

Sweat itself does not smell bad; rather, the combination of bacteria on your skin and sweat causes body odor. Hormonal changes, specifically fluctuating estrogen experienced during menopause, can cause excessive sweating, especially when experiencing a hot flash (27). Increased perspiration from hot flashes and night sweats can breed underarm bacteria and lead to a stronger body odor. The decrease in estrogen levels can leave your body with higher levels of testosterone and therefore attracts more bacteria to sweat, changing how you smell. Bathing regularly and using a high-quality deodorant or antiperspirant is your best defense (28).

24. Electric Shock Sensations

The feeling of an electric shock under the skin can occur during menopause. This sensation is believed to be associated with disruptions in the body’s nervous system, influenced by changing hormones during menopause (29).

25. Prickly Sensations

Estrogen greatly affects the central nervous system, and when levels are off balance it can produce a tingling sensation or “pins and needles” feeling in your extremities (30). However, these symptoms can also indicate other conditions, including vitamin B deficiency, diabetes, or nerve damage. Persistent or concerning symptoms should be discussed with a healthcare professional (31).

26. Gum Problems

Menopause can also bring about oral health problems. Teeth and gums are extremely sensitive to hormonal changes that take place before reaching menopause. Your gums become more susceptible to plaque, leading to a higher risk of developing gingivitis and advanced periodontitis (32). Periodontitis is a serious gum infection that damages the soft tissue surrounding the teeth (33). Regular dental care, including early diagnosis and treatment, is essential for maintaining healthy teeth and gums.

27. Dry Mouth

Another common manifestation of menopause is dry mouth, caused by decreased saliva. Interestingly, lower salivary progesterone levels appear to be associated with feelings of oral dryness in menopause (34).

28. Burning Mouth Syndrome

This condition can cause various uncomfortable sensations such as burning, tingling, tenderness, numbness, or an unsavory taste in the mouth. Seeking professional dental advice can help manage and alleviate these symptoms (35).

29. Decreasing Height

Estrogen plays a crucial role in maintaining bone density, and a decline in estrogen levels can accelerate bone density loss. Osteoporosis, a condition characterized by weakened and brittle bones, becomes more prevalent during menopause (36). One in two postmenopausal women has osteoporosis, and many will suffer a fracture in their lifetime. Hormone therapy and lifestyle changes, such as regular exercise and adequate calcium and vitamin D intake, can help mitigate the risks of osteoporosis and associated height loss (37).

30. Weakened Nails

Your nails may break more easily during menopause. Keratin strengthens your nails, and estrogen is a key player in keeping the keratin layer of your nails strong. When estrogen declines, the keratin layer weakens, and, as a result, your nails can become brittle (38).

31. Tinnitus

Tinnitus, characterized by ringing, buzzing, or humming in the ears, can be experienced during menopause (39). During menopause, estrogen and progesterone levels decline, affecting the auditory system and potentially contributing to tinnitus. Estrogen plays a large role in developing and maintaining the auditory pathway in the brain. Other symptoms of menopause, such as sleep disturbances, anxiety, and depression, may worsen tinnitus (40).