Menopause Symptoms

Menopause occurs when your ovaries stop producing estrogen. When this happens, you stop ovulating and you stop having your period. Typically, this doesn't happen abruptly because your ovaries slowly decrease their production of estrogen over several years. This time of changing ovarian function is called the menopausal transition. The most common symptom of the menopausal transition is irregular bleeding.

Most women will notice some changes in their periods in the five to seven years before menopause.

The symptoms of menopause are all the result of the changes in your body caused by the lack of estrogen. You may start to notice some of the symptoms of menopause during the menopausal transition. 

The Terrible Twos of Menopause

Not all women experience menopause in the same way. In fact, not all women will have symptoms or, if they have symptoms, they will not be bothered by them. On the other hand, some women will be significantly affected by the lack of estrogen in their bodies. Considering the many symptoms of menopause, these are the two most common or classic symptoms of menopause:

Hot Flashes/Night Sweats

Are you waking up in the middle of the night because you are cold, drenched in sweat, and lying on wet bedding? Or have you been sitting in a meeting when all of a sudden you feel an intense heat rise up from your chest to the top of your head?

You know your face and neck are now bright red and maybe you may even start to drip perspiration from your brow. Welcome to menopause.

By the time you get to menopause you will likely have already experienced one of these issues, known as vasomotor symptoms. As many as 80 percent of women will have hot flashes (hot flushes) or night sweats during menopause.

We don't know exactly how vasomotor symptoms develop, but we do know that declining estrogen levels likely trigger changes in the body temperature control center in the brain. 

Some women experience vasomotor symptoms more intensely than others. Although the good news is that these symptoms tend to peak one year after menopause, they may not completely go away for several years. Hot flashes which typically last between one and five minutes can also be accompanied by feelings of anxiety or heart palpitations

Women who experience night sweats will often have chronic sleep disruption. Lack of adequate sleep can have a significant negative impact on your health and wellness, including weight gain and depression. 

Vaginal Dryness

The symptom of vaginal dryness in menopause is a direct result of a lack of estrogen. Your vagina and vulva are very sensitive to estrogen, and your vagina actually begins to atrophy when it's not exposed to the hormone. Related changes that cause this include:

  • Vaginal tissues thinning
  • Normal vaginal secretions decreasing
  • Vaginal tissues losing elasticity (the vagina becomes shorter and narrower over time)
  • The labia majora losing fat, so it appears that your vulva is getting smaller
  • The environment in the vagina changing, so you are more prone to vaginal infections

This is a big deal, and these changes can have a big impact on your quality of life. The changes that happen in your vagina are too often overlooked and under-explained.  

At the time of menopause, about 40 percent of women will have some symptoms of vaginal atrophy. Symptoms include:

  • Vaginal dryness
  • Vulvar dryness
  • Vagina discharge
  • Itching
  • Painful sex

If you are sexually active or you plan to be in your post-menopausal years, don't be embarrassed to discuss your vaginal health with your doctor.

Other Common Signs and Symptoms of Menopause

Again, it is important to remember that every woman experiences menopause differently. There are many different menopausal symptoms. This list includes some of the more common symptoms of menopause. 


Sleep disturbances are a common problem in menopause. The changing hormone levels of menopause likely have some direct impact on sleep centers in your brain. Night sweats interrupt sleep, and for some women, it is very difficult to fall back to sleep. Many women will also have significant social stressors during menopause juggling work, kids, marriage, finances, and perhaps aging parents. 

Memory Changes/Mood Swings

Menopause can negatively affect your mood, your memory, and your ability to think clearly. This is not only because of a lack of adequate sleep. The low estrogen levels in menopause interact with certain brain chemicals called neurotransmitters. These neurotransmitters, specifically dopamine, serotonin, and GABA, help you deal with stress, regulate your mood, and think clearly. Low estrogen levels impact the regular function of these neurotransmitters and can cause mood swings, anxiety, depression, short-term memory problems, and sluggish thinking.

Urinary Problems

Just like the vagina, the bladder contains a lot of estrogen receptors, making it very susceptible to changing estrogen levels. The lack of estrogen in menopause causes the bladder to lose its elasticity. As the bladder becomes more rigid, it is less able to hold your normal amount of urine. You may notice that you have to urinate more frequently. You may also notice that you start to leak urine when you finish urinating. In menopause, the lining of the urethra (the short tube that carries urine out of the bladder) becomes very thin and loses its ability to help you stop dribbling urine at the end of your pee.

Decreased Sex Drive

Many of the unpleasant symptoms of menopause are caused by low estrogen, and decreased libido is no exception. The vaginal changes of menopause can make sex painful, indirectly decreasing your desire. However, estrogen isn't the only hormone level that drops in menopause. Declining levels of progesterone and testosterone, also produced by the ovaries, have a direct negative impact on your libido as well.

Weight Gain

Though menopause can play a role in weight gain, it is not inevitable because there are several factors that contribute to gaining extra pounds.

Don't underestimate the effects of poor sleep and stress on your weight. Both of these things increase your cortisol levels which can lead to weight gain. Lack of sleep also often results in a lack of exercise because of chronic exhaustion.

Thyroid dysfunction is common in women in their 40s and 50s. So, it is possible that you may also have an under active thyroid. Low thyroid hormone levels can cause weight gain. Consider checking your thyroid hormone levels if an appropriate diet and exercise are not controlling your weight.

Your body composition is changing. You have been losing lean body mass or muscle since age 40. It is harder to build muscle now. Also, the low estrogen in menopause shifts fat stores from your hips and bottom to your midsection. Don't be discouraged. With a proper diet and exercise routine, you can maintain your fitness. 


Fatigue is a real problem for some menopausal women. As your body adjusts to the very low estrogen levels of menopause, you may experience some fatigue. If this fatigue doesn't improve in a few months it could be a sign of an underlying condition, such as an underactive thyroid.

The change in hormone levels during menopause can also disrupt sleep and alter mood, which can result in fatigue.  

Conditions That Might Be Confused With Menopause

It is important that you or your doctor don't just blame your symptoms on menopause, especially if they are not typical. Some illnesses share similar symptoms with menopause, which could lead to overlooking an important diagnosis. This is why it is important to see your doctor for a thorough physical exam and screening tests on a regular basis—especially during menopause.

Although it is likely that a new symptom that you develop around menopause is probably menopause-related, there are some potential clues to suggest otherwise.

  • Your symptoms are not getting better with hormone replacement therapy
  • Your symptoms are getting worse with hormone replacement therapy
  • Your symptoms are not typical of menopause

It is also important to remember that some underlying medical conditions can become more symptomatic during the menopausal transition. For example, it is common for migraine headaches, depression, and anxiety to become more intense in the menopausal transition, and you may need to start or adjust your medications.

A Word From Verywell

Yes, in most cases menopause is a normal aging process that doesn't need to be treated. However, for some women, the symptoms caused by a lack of estrogen in menopause are very unpleasant and have a significant impact on quality of life.

If you are struggling with the changes in your body and the symptoms of menopause, don't suffer silently. Talk with your doctor. There are many options to help you manage your symptoms and live very well in menopause.


North American Menopause Society. (2014). Menopause Practice A Clinician's Guideline. Mayfield Heights, Ohio.

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