The 48 Symptoms of Menopause

It’s essential to remember that if any of these symptoms become severe, a member of our healthcare team is here to support you. Hormone therapy (HT), lifestyle modifications, and dietary changes can offer relief. There might not be a one-size-fits-all solution, but you don’t have to endure discomfort needlessly.

Running Hot and Cold:

The exact cause of cold and hot flashes, and night sweats is not fully understood. Researchers believe that a part of the brain called the hypothalamus is involved. The hypothalamus is responsible for maintaining the body’s core temperature between an upper threshold (at which you’ll sweat) and a lower threshold (at which you’ll shiver). As estrogen declines, the zone seems to narrow, and the hypothalamus becomes more sensitive to slight changes in the body’s temperature. (North American Menopause Society (NAMS), 2023)

1. Cold Flashes: The lesser-known menopausal symptom of experiencing sudden shivers and chills is a thing. As estrogen levels decline throughout the menopausal phase, the hypothalamus, responsible for maintaining body temperature, becomes more sensitive, resulting in erratic temperature regulation. Cold flashes can also be triggered by panic attacks or anxiety. During a panic attack, the body releases adrenaline and other stress hormones, which can disrupt its ability to effectively regulate body temperature. (NAMS)

2. Hot Flashes: Menopause-related hot flashes are the most common menopause symptom, but the pattern differs greatly from woman to woman. “Some hot flashes are easily tolerated, some can be annoying or embarrassing, and others can be debilitating”. (NAMS)

3. Night Sweats: Nighttime hot flashes can lead to night sweats. Research suggests that night sweats can induce higher levels of stress compared to experiencing hot flashes alone. Additionally, women who experienced more nighttime hot flashes, as opposed to daytime ones, faced a higher risk of developing depression. Notably, night sweats tend to persist for longer durations and result in more substantial sweating. (University of Massachusetts, 2022)

Weight:

4. Weight Gain: Excess fat around the belly can sometimes be attributed to hormonal factors. The thyroid plays a crucial role by releasing hormones that regulate various bodily functions, such as metabolism, stress response, appetite, and sexual desire. When certain hormones are deficient, it can lead to weight gain in the abdominal region, often referred to as a hormonal belly. (National Institute of Diabetes and Digestive and Kidney Diseases)

Mood and Emotion:

5. Anxiety and Stress: 30% of individuals suffer from increased anxiety and stress during menopause, don’t think it is just your mental health. (Freeman et Sammel, 2016).

6. Depression: Studies have linked hormonal changes to a low mood and feelings of depression. Additionally, women who have previously experienced depression may see a resurgence in symptoms. Research indicates that women in the perimenopausal transition are particularly vulnerable to these mood-related challenges. (Harvard Study of Moods and Cycles, 2018)

7. Irritability: The primary mood complaint for up to 70% of women during the perimenopause is irritability, a phenomenon that has been observed cross-culturally. (Journal of Psychiatry & Neuroscience, 2008)

8. Lack of Motivation: Both progesterone and testosterone are linked to energy levels and motivation. Women do also have testosterone, which is produced in the ovaries and in smaller amounts the adrenal glands.

9. Loss of Confidence: As our bodies change, our appearance and how we perceive ourselves change. Loss of skin elasticity, weight gain, thinning hair and low moods can all affect our self-confidence. Lack of confidence during menopause, along hot flashes, disrupted sleep, aches and pains, and irritability may result from the decline of estrogen.

10. Mood Swings: Studies report that 4 in 10 women have mood symptoms during perimenopause, that are like premenstrual syndrome. Sometimes referred to as ‘meno-rage’. (American College of Obstetricians and Gynecologists)

11. Panic Attacks: Estrogen and progesterone work together to regulate mood, as they fluctuate during perimenopause women are at more risk of developing anxiety. When anxiety becomes overwhelming it can develop into panic attacks.

Skin, Hair, Nails and Body:

Estrogen is important for skin, hair and nail health.

12. Acne: During menopause, acne can often occur because of hormonal fluctuations. As estrogen levels drop, the influence of male sex hormones known as androgens tends to rise. These androgens can stimulate the skin to produce more sebum, the skin’s natural oil, which can contribute to acne breakouts.

13. Altered Skin Sensation: Electric shock sensations can occur during menopause, affecting areas such as the head and inner layers of the skin. Although ongoing research aims to provide a deeper understanding of this menopausal symptom, some evidence points to hormone fluctuations as a potential cause. Estrogen, which plays a significant role in the nervous and cardiovascular systems, may be linked to these electrical sensations.

14. Breathing Difficulties: While not as prevalent as many other menopausal symptoms, some women may encounter breathing difficulties during this phase. The decline in estrogen levels due to menopause can result in diminished lung capacity, with up to a liter of lung capacity being lost as individuals progress into post-menopause. This reduction in capacity can contribute to a sensation of breathlessness. (American Journal of Respiratory & Critical Care Medicine)

15. Burning Mouth: Pain and discomfort in the mouth, lips and tongue described as a tingling, scalding, numbness or burning sensation has been reported in 18-33% of menopausal women. Other symptoms may include a dry mouth, a bitter or metallic taste and loss of taste. (BMC Women’s Health, 2021)

16. Body Odor: Estrogen plays a crucial role in regulating body temperature and controlling sweat gland activity. As estrogen levels decrease, the production and composition of sweat changes, leading to alterations in body odor. This decline in estrogen particularly affects the apocrine glands, located in the scalp, armpits, and groin, responsible for producing sweat containing proteins and fats that interact with skin bacteria, resulting in distinct odors. In contrast, eccrine glands, found throughout the body, secrete clear, thin, watery sweat that lacks the nourishment for odor-causing bacteria. Consequently, menopausal sweating may emit a stronger, more pungent odor than before.

17. Bone and Teeth Strength: Menopause can bring oral health problems. The same processes that lead to loss of bone density can also lead to loss of the alveolar bone of the jaws, resulting in periodontal disease, loose teeth, and tooth loss (Cleveland Clinic Journal of Medicine, 2021)

18. Brittle Nails: When estrogen levels start to decline in perimenopause, one of the outcomes is that the body’s ability to manage fluids becomes less efficient. This can often lead to dehydration, impacting the production of keratin. As a consequence of insufficient keratin, the layers of our nails can weaken, causing them to become brittle and prone to chipping, flaking, or splitting.

19. Changes in Skin Texture: Studies report that collagen decreases about 30% during the first five years of menopause, and it continues declining about 2% with each additional year. This change in the appearance and quality of a woman’s skin is linked to a decrease in estrogen, leading to less collagen. This results in the skin becoming drier and noticeable lines, with less firmness. (American Academy of Dermatology, 2022)

20. Dry Eyes: Sixty-two percent of menopausal women and perimenopausal women reported dry eye symptoms”. The reduction in estrogen during the menopause transition impacts the eyelids’ oil and fluid-producing glands which make up tears that keep your eyes moist and comfortable. (Society for Women’s Health Research, 2006)

21. Dry Mouth: The decrease in estrogen levels can lead to a reduction in mucus production in the mouth and nose, resulting in a dry sensation. This dryness can impact saliva production, causing difficulties with eating, chewing, speaking, swallowing, and even a good night’s sleep. Many women experiencing dry mouth during menopause wake up several times at night to sip water and maintain moisture in their mouths. Furthermore, menopausal dry mouth can contribute to various oral health problems, including gum disease, tooth decay, a metallic taste, and unpleasant breath.

22. Itchy Skin: As estrogen drops so does the production of natural oils and collagen. A decrease in natural oils and collagen can cause the skin to become drier and thinner than it was before menopause, which can make it feel itchy.

23. Heart Palpitations: Palpitations, skipped, missed, irregular, and/or exaggerated heartbeats or heart pounding are reported by women around the time of menopause. There is less known about palpitations than other physical menopausal symptoms. Yet, research does show the prevalence of heart palpitations is significantly higher among perimenopausal and surgically post-menopausal women in comparison to premenopausal or post-menopausal women. (Women’s Midlife Health Journal)

24. Smell and Taste Changes: Menopausal women report signs of dysgeusia, which is a condition of altered taste sensation, in addition reporting changes in their sense of smell. Despite these reports the underlying mechanism remains largely unknown. Estrogen receptors have been identified within the oral mucosa, salivary glands, and olfactory function. As estrogen levels fluctuate, these can influence the capacity to perceive, sense and recognize smells. (Ciesielska et al,2022 and Savovic et al, 2002)

25. Thinning Hair: A drop in progesterone and estrogen levels also triggers a rise in androgens, which are male hormones present in women, albeit in smaller quantities compared to men. Androgens can lead to the contraction of hair follicles on the scalp, leading to a form of hair loss referred to as androgenic alopecia.

Aches and Pains:

26. Headaches: Women are three times more prone to experiencing migraines compared to men. For certain individuals, these headaches are triggered by the drop in estrogen and progesterone levels. During perimenopause, when hormones are fluctuating and diminishing, the intensity of these headaches tends to increase. (American Migraine Foundation, 2022)

27. Joint Pain: Joint pain affects many people as they age and is also common during menopause. Many women in menopause experience joint aches, stiffness and swelling. Estrogen receptors within the joints play a role in safeguarding bone health and maintaining low levels of inflammation. As estrogen levels decrease during perimenopause, joint swelling and discomfort often increase. When left unaddressed, this inflammation can lead to the development of osteoarthritis linked to menopause.

28. Loss of Bone Density: Menopause markedly accelerates bone loss and heightens the susceptibility to osteoporosis. Research indicates that up to 20% of bone loss can happen during these stages and approximately 1 in 10 women over the age of 60 are affected by osteoporosis worldwide. Shockingly, one in two post-menopausal women will develop osteoporosis, and the majority will endure a fracture at some point in their lives. (Endocrine Society, 2022)

29. Muscle Tension: Musculoskeletal pain (MSP) is one of the most severe complaints in women undergoing menopause. Research suggests that menopausal women, especially those in the perimenopausal phase, may have a higher risk of experiencing MSP. The chances of developing MSP increase as women transition from premenopause to perimenopause, but this risk doesn’t seem to change significantly from perimenopause to post-menopause. Nevertheless, more studies are needed to establish strong connections between menopausal states and MSP and to pinpoint specific risk factors during perimenopause. (Lu et al, 2020)

30. Tingling Extremities: The menopause symptom of tingling extremities, formally called paresthesia, involves sensations of numbness, pins and needles in the arms, legs, hands, feet, fingers, and toes. While uncomfortable, most cases of tingling extremities during menopause and post-menopause do not signal a more serious underlying issue. Some women may experience balance issues while walking due to the numbness and may lose their dexterity for delicate tasks. In other instances, a burning sensation can take over as nerves are pinched or joints compressed.

Sleep:

31. Insomnia: Sleep disruptions like insomnia are highly prevalent, particularly among women post-menopause. The prevalence of sleep disturbances ranges from 16% to 42% before menopause, 39% to 47% during perimenopause, and 35% to 60% after menopause. (National Institutes of Health, 2005)

32. Tiredness and Fatigue: Fatigue is common across all phases of menopause. Research found that it was increasingly common in the later phases: 19.7% of women not yet in perimenopause, 46.5% of women in perimenopause, and 85.3% of women in post-menopause. (Swanson et al, 2018)

Brain and Memory:

33. Brain Fog: In 1996, it was discovered women’s brains are rich with estrogen receptors, particularly in regions that control mood, memory, sleep and body temperature.  The decreased estrogen levels during the menopause transition alter the functioning of these brain areas, believed to be responsible for the reduced cognitive performance and brain fog.

The good news: it’s not permanent.  Clarity, memory and critical thinking improves during post-menopause.

34. Dizziness and Tinnitus: Tinnitus can be a distressing complaint for menopausal women. Some find it starts or becomes worse as they enter perimenopause. The relationship between tinnitus and menopause has rarely been researched. Although, it has long been known that receptors of different types of hormones, such as adrenaline, thyroid hormones, insulin, cortisol, testosterone, progesterone, and estrogens are expressed at the level of the inner ear sensors. (: Khiati et al, 2023).

35. Lapses in Memory: Research shows that the hormone estradiol impacts memory and how our memory-related brain circuits function. During perimenopause the ovaries are producing less estradiol which can lead to increased forgetfulness. (Konishi et al, 2019)

36. Trouble Concentrating: Women experience more cognitive changes than men, likely due to hormonal factors. Cognitive issues are more common during menopause, linked to hormone decline, especially estrogen. Post-menopausal women face cognitive challenges due to declining estrogen levels, alongside other menopausal symptoms. (Conde et al, 2021)

Reproductive Health:

Changes in Breasts

37. Breast Size: As estrogen levels decrease during the menopause transition, the body no longer supports the system responsible for producing breast milk. This leads to a shrinkage of the mammary glands, resulting in smaller and less voluminous breasts for many women. Interestingly, about one in five women may experience an increase in breast size after menopause. This can occur when there is an accumulation of fat within the breasts, particularly in cases of weight gain. (Maturitas, 2004)

38. Sagging Breasts: During menopause, declining estrogen levels cause breast connective tissue to lose hydration and elasticity, leading to breast sagging, a condition known as ptosis. Fat may then fill this space, resulting in a softer, less full appearance. Additionally, the reduction in collagen and elastin, crucial structural proteins, impacts the ligaments supporting the breasts, contributing to tissue laxity. Ultimately, this process leads to the development of the “saggy” breasts commonly seen in women during this stage of life.

39. Sore/Tender Breasts: Many women experience breast pain, also known as mastalgia at some point in her life. Often breast soreness is felt around the time of a woman’s menstrual period or while taking hormone therapy (HT). This happens when the tissue in their breasts responds to hormones. The most common hormonal breast soreness comes from an increase in the level of estrogen before a period. This causes milk ducts and glands to swell, trapping fluid in the breasts. Many women have tenderness or pain in the lead-up to a period, and sometimes right through it. Hormonal breast soreness usually stops when a woman’s periods stop, although it might continue if she is taking HT. (British Journal of General Practice, 2020)

40. Decreasing Fertility: Throughout a woman’s reproductive years, key hormones are produced including estrogen, progesterone, luteinizing hormone (LH), and follicle stimulating hormone (FSH). Mid-cycle, LH, FSH, and estrogen work in sync, triggering egg release during ovulation. For successful ovulation, hormone levels must be optimal. Perimenopause marks the transition when ovaries begin producing less estrogen and progesterone. Simultaneously, LH and FSH levels rise because ovaries become less responsive. This hormonal shift causes symptoms like hot flashes, irregular periods, and inconsistent ovulation. Once menopause sets in, typically between ages 40 and 55 (average 51), LH and FSH remain high, while estrogen and progesterone stay low, ending fertility. Although fertility falls during perimenopause, women are not fully protected from an unplanned pregnancy until they have reached menopause, which means 12 straight months without a period.

41. Irregular Periods: The regular menstrual cycle relies on estrogen and progesterone hormones. Variations in these hormones can cause irregular periods. In the years before menopause, women often experience shifts in their menstrual cycle, including varying time between periods, duration, and flow. Skipping a cycle is common during this phase. Hormonal imbalance is the main cause of irregular periods in menopause, but other factors like health conditions and lifestyle can also play a role.

42. Worsening PMS: Premenstrual syndrome (PMS) involves mood, behavioral, and physical symptoms that cyclically appear before menstruation. While most women experience mild discomfort, around 5% suffer from a severe form called premenstrual dysphoric disorder (PMDD). Though the precise causes remain uncertain, they are believed to be linked to hormonal fluctuations in the luteal phase of the menstrual cycle. Symptoms tend to intensify during periods of hormonal change, such as perimenopause. (Mishra et al, 2023)

Bladder Health:

43. Bladder Weakness: Reduced estrogen levels during menopause can lead to thinning of the urethral lining and weakening of pelvic muscles, known as pelvic relaxation. This increases the risk of urinary incontinence in midlife and beyond, including stress and urge incontinence. Stress incontinence results from weak pelvic floor muscles, causing urine leakage during activities like coughing or sneezing. It’s common during perimenopause and doesn’t typically worsen with menopause. Urge incontinence, or “overactive bladder,” is caused by hyperactive or irritated bladder muscles, leading to frequent, sudden urges to urinate with occasional leakage. While incontinence is common, it’s not an inevitable part of aging and can be managed. (NAMS)

44. Recurring Urinary Tract Infections (RUTIs) Estrogen encourages the growth of beneficial vaginal lactobacillus, which acts as a probiotic. Insufficient lactobacilli in women elevate infection risks. Post-menopause, declining estrogen and lactobacilli create a favorable environment for bacteria, increasing UTI susceptibility. Vaginal estrogen lowers recurrent UTI risk by 36-75% with minimal systemic absorption, whereas oral estrogen lacks this effect. (Al-Badr et Al-Shaikh, 2013)

Digestive Health:

45. Bloating/Water Retention: Menopause-related belly bloat can be partly linked to hormonal shifts, including a decline in estrogen levels, which are associated with alterations in the gut microbiome. This microbiome is composed of beneficial bacteria vital for digestive processes within the intestines. Among their essential functions is the effective processing and elimination of hormones such as estrogen. A reduction in the diversity of these gut bacteria can have adverse effects on your digestive well-being, leading to uncomfortable symptoms like bloating, excessive gas, or constipation. (Santoro et Kaplan, 2022)

46. Nausea and Digestive Problems: Progesterone, produced regularly during reproductive years, regulates menstrual cycles. As menopause approaches, the ovaries produce less progesterone, potentially causing nausea through gastrointestinal issues like bloating, indigestion, and heartburn. Menopause, accompanied by heightened stress and fatigue, can further contribute to nausea. (Lee et Saha, 2011)

Sexual Health:

47. Low Libido: Sexual desire, also known as libido, is primarily controlled by the brain and serves as the biological impetus for thinking about and engaging in sexual activities. Typically, both men and women experience a gradual decline in sex drive as they age. However, women are more likely to be affected by a decline in sex drive as they get older, with a significant increase in their late 40s and 50s. It’s worth noting that the impact of age on sexual desire varies widely; some individuals notice no change, while a few report an increased interest in sex during midlife. (NAMS and Currie et Moger, 2019)

48. Vaginal Dryness: The decline in estrogen levels that starts in perimenopause and carries through post-menopause causes the vaginal walls to become thinner, which is responsible for moisture. This also leads to the vagina becoming less stretchable and may even shorten and narrow at the vagina opening. Consequently, this results in a drier vaginal environment. This dryness and thinning, known as vaginal atrophy, are the most common causes of painful sex during and after menopause. (NAMS)