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20 Symptoms of Menopause

Have you been wondering about what happens in menopause? Are you looking for strategies for coping with menopause and its symptoms? Here is a guide to some of the most common menopause symptoms and suggestions for coping with them.

1. Changes in Periods

Changes in the menstrual cycle are among the most common and widely recognized symptoms of approaching menopause. Menstrual cycle changes may start several years before a woman’s periods ultimately stop. During this period of perimenopause, periods can be unpredictable. It is most common for periods to start coming closer together and be heavier than they had been before.

What causes menstrual changes? Fluctuations in estrogen levels.

What to do about it.

• Be prepared. Don’t let an “early” period catch you off guard. Always carry tampons or pads with you.
• Keep a menstrual calendar. Even though keeping a calendar won’t precisely predict when your next period will start, it may provide you with information to help you feel more secure. If you know you’re on day 12 of your cycle, you’ll know you probably don’t need to worry so much about your period starting. On the other hand, if you’re on day 23 and your periods have been coming every 25 to 28 days, you’ll know to be more vigilant.
• Get an app. There are several free apps available on iOS and Android platforms, geared toward tracking perimenopausal symptoms and periods. Some of them alert you that your period will be starting soon. Others provide a daily update as to where you are in your cycle.
• If your periods are completely out-of-control and having a significant impact on your life, seek care from your health care provider.

2. Hot Flashes

You find yourself sitting in an important meeting, in a comfortably air-conditioned room. Everyone around you is focused on the topic at hand when your chest and face start to feel flushed, and you break out in a sweat. Ugh. Hot flashes usually start during the last few years of perimenopause. It used to be thought that hot flashes stopped after a woman’s last period. We have since learned that many women continue to have hot flashes after menopause – sometimes for as long as 10 or more years after menopause.

What causes hot flashes? We aren’t entirely sure, but hope to have an answer soon.

What to do about it.

• Stop smoking. Smokers tend to have hot flashes for a longer period of time than non-smokers.
• Limit how much alcohol you drink, or, better yet, stop drinking entirely. Alcohol is a hot flash trigger for many women. The same goes for caffeine, hot drinks and spicy foods.
• Exercise. Women who exercise regularly tend to have fewer and less severe hot flashes.
• Dress in layers. A cardigan sweater worn over a blouse can easily be taken off during that meeting. A thick wool turtleneck worn with just a bra underneath – that’s going to have to stay on. Wearing layers, you’ll have more control over your body temperature in places where you may not be able to control the ambient temperature.
• Breathe deeply. Starting some deep breathing with the initial symptoms of a hot flash can minimize the severity of the hot flash.
• Seek help. Your healthcare provider can talk to you about the hormonal and non-hormonal medical therapies available to reduce the frequency and severity of hot flashes.

3. Night sweats

Night sweats are hot flashes that occur during sleep. It is not unusual to wake soaked in sweat, thinking that maybe there’s a water leak through your bedroom ceiling. Like hot flashes, some women will continue to experience night sweats for years after menopause.

What causes night sweats? As kin to hot flashes, we really aren’t sure.

What to do about it.

• Follow the suggestions for coping with hot flashes. Even though we don’t understand what causes these vasomotor symptoms, we are certain that hot flashes and nights sweats are similar in origin.
• Layers, again, are the key. Several light blankets will allow you to cover up or shed blankets throughout the night, whereas using one big, thick comforter won’t provide that flexibility.
• Keep an ice pack under your pillow. This way, when you feel yourself getting warm, all you have to do is flip your pillow over for refreshment.

4. Problems Sleeping

There’s a lot to be said about menopause and sleep. But does menopause cause insomnia? Maybe. As we age, our sleep patterns change. This is true for both women and men.

What causes sleeping problems? Menopause is not to blame for all of the factors that contribute to sleeping problems. On the other hand, menopausal symptoms, such as night sweats, can cause you to wake up in the middle of the night.

What to do about it.

• Adhere to a regular sleep schedule, regardless of the day of the week. Going to bed at the same time and waking up at the same time every day help your mind and body know when it’s time to sleep and when it’s time to be awake.
• Avoid alcohol and caffeine. Alcohol is a central nervous system depressant and caffeine is a central nervous system stimulant. It may sound logical to use alcohol and caffeine do get through your days and nights, but ultimately they do you no favors.
• Maintain a normal weight. People who are overweight have a higher incidence of sleep apnea which contributes to poor sleep.
• Exercise. Exercise in the morning or the afternoon. Exercising too close to bedtime can cause insomnia.

5. Painful Sex

Sex has so many health benefits. Sex reduces stress, helps regulate blood pressure, boosts immunity and helps improve sleep. It’s an important form of intimacy in many relationships, but when it hurts, it’s not going to happen.

What causes it? Painful intercourse after menopause may be due to structural changes in the vulva and vagina related to lower levels estrogen. The tissue can become thinner and more delicate. With lower levels of estrogen, menopausal women may not lubricate well enough for sexual activity to be comfortable.

What to do about it.

• Have more sex. Frequent sexual activity helps maintain good blood flow to the vagina and vulva, which helps prevent the tissue of the vagina and vulva from becoming thin and delicate.
• Use lube. There are so many personal lubricants on the market, you’re bound to find one that works for you.
• Experiment with different positions during sex, especially those in which you have more control over when and how any penetration might happen. Sometimes a different angle is all it takes.
• Communicate with your partner about what you do and do not like. Doing something you don’t like is not going to be stimulating.
• Consult a sex therapist or a health care provider who specializes in menopause or female sexual function.

6. Dry Vagina

Vaginal dryness is about more than not lubricating well during sexual activity. Vaginal dryness can be irritating and may distract from daily functioning Excessive itching can lead to more serious problems.

What causes vaginal dryness? Vaginal changes during menopause can be attributed to lower levels of estrogen in the body.

What to do about it.

• Have more sex, alone or with a partner. Sexual stimulation of any kind will increase blood flow to the area and help maintain moisture.
• Use a personal lubricant daily, but avoid products with fragrance and artificial coloring.
• Wash with warm water only. If you must use soap, avoid those with fragrance and artificial coloring. A pure castile soap or glycerin soap is your best bet.
• Avoid douching and using feminine powders and feminine sprays. They can alter the pH of your vagina and add to vaginal symptoms rather than resolve them.
• Consider vaginal estrogen treatment. Talk to your healthcare provider to learn if local estrogen therapy would be appropriate for you.

7. Urinary Problems

The urethra (the tube that carries urine out from the bladder) is situated inside the vagina. Changes in the tissue of the vagina have an effect on the tissue of the urethra. Perimenopausal women may involuntarily leak urine, especially when laughing, sneezing or coughing.

What causes urinary incontinence? Urinary incontinence may be caused by urinary tract infections, prolapse of the bladder (when the bladder starts to drop into the vagina), and overactive bladder syndrome for starters.

What to do about it.

• Work your Kegel muscles.
• Avoid alcohol and caffeine. Alcohol and caffeine are irritants to the bladder.
• Try pelvic floor physical therapy.
• Do not hide. Overcome any embarrassment you may have and bring any urinary issues to the attention of your health care provider.
• Once upon a time, surgery was a common approach to the treatment of urinary incontinence. Today, there are many effective, non-surgical treatments.

*See your healthcare provider to make sure you don’t have a urinary tract infection (UTI) or other medical condition. If you do have a urinary tract infection, or other condition, follow your provider’s recommendations for treatment.

8. Mood Changes

There are links between menopause and depression, and links between menopause and anxiety. The mood swings of menopause may rival those of adolescence and pregnancy.

What causes mood changes? Fluctuating hormones, poor sleep and stress all contribute to mood changes during menopause.

What to do about it.

• Find a menopause support group, or start one if there are none in your area. Talking about your experiences with other women going through it will lessen the isolation you may be feeling and help you gauge what is normal.
• Exercise. Exercise has an amazing effect on stress and anxiety, and is a mood stabilizer. Do what you like to do. If you prefer to walk, don’t try to talk yourself into swimming or running a marathon. Just get out there and do it.
• Spend time outdoors, during sunlight hours (while wearing sunscreen).
• Reduce stress and increase relaxation.
• Seek help. Psychotherapy and/or medication can help you through this time.

9. Hair Loss and Menopause

Hair loss in menopause is not uncommon. Female pattern baldness (hair loss or thinning on the crown of the head) and increased overall hair loss are associated with menopause. It would not be uncommon to find large clumps of hair in your brush.

What causes hair loss? There is a genetic predisposition to hair loss. If your parents had hair loss, there is a better chance that you will, too. Lower levels of estrogen, as well as the type of estrogen that predominates during menopause, contribute to hair loss.

What to do about it.

• Exercise.
• Reduce stress and increase relaxation.
• Follow a diet rich in fresh fruits and vegetables, lean proteins and whole grains.
• Avoid harsh hair treatments like permanent waves and hair coloring.
• While poor nutrition can cause hair loss, taking large amounts of vitamins/supplements will not reverse or slow hair loss.
• There are medications approved for use in the treatment of some types of hair loss.

10. Hair Gain in All the Wrong Places

During perimenopause, facial hair sprouts randomly, primarily on the chin and over the upper lip.

What causes facial hair? Changes in the type of estrogen that are highest in our bodies during and after menopause. This type of estrogen has more androgenic (promoting physical characteristics more commonly found in men) effects.

What to do about it.

• Tweezing, waxing, shaving, threading, and depilatory creams will remove hair temporarily.
• For permanent hair removal, consider prescription medication, laser treatment, or electrolysis.

11. Libido Changes

There is an association between menopause and sex drive. The popular thought is that women lose interest in sex with menopause. This is true for some, but many women experience an increase in their sex drive. Either way, change in libido is most distressing if it is opposite that of your partner.

What causes libido changes? Fluctuating hormones. Stress. Relationship challenges.

What to do about it.

• If partnered, talk about it. Talk about other factors or stressors in your life or relationship that might be affecting your interest in sex.
• Sometimes, just having more sex can increase libido.
• Review what medications you are taking with your health care provider. Some medications, like anti-depressants and opiate pain medications can decrease sex drive.
• Eat a healthy diet. Exercise. Get good sleep.
• Expand your sexual repertoire by trying something new.
• Both hormonal and non-hormonal treatments are available from your health care provider.

12. Headaches

There is an association between migraines and menopause. Women who had cyclic/premenstrual migraines are most likely to experience an increase in migraines during the perimenopausal period. There is usually an overall decrease in migraines post menopause as hormonal levels become and stay relatively stable.

What causes headaches? Fluctuating levels of estrogen; migraines most typically occur when estrogen levels drop.

What to do about it.

• Avoid common migraine triggers as much as possible. Red wine, hard cheeses, and other foods are migraine triggers for some people.
• Get regular sleep.
• Exercise may be a migraine trigger for some. Exercise will help reduce migraine frequency and severity in others.
• Stop smoking. Smokers are more likely to have migraines.
• NSAIDS – non-steroidal anti-inflammatory drugs like ibuprofen and naproxen, that are available over-the-counter.
• Prescription medications can be effective in treating migraines.

13. Cognitive Changes

Some people talk about a menopause brain fog. Others report forgetfulness, difficulty concentrating and slowed reflexes. The good (and interesting) news is that changes in cognition during perimenopause seem to resolve after menopause. Hormonal therapy is not recommended to address cognitive changes in menopause.

What cause cognitive changes? It is not clear if there are organic cognitive changes attributable to menopause so much as there are cognitive changes associated with menopausal symptoms like poor sleep quality, and stress, anxiety, and depression.

What to do about it.

• Get regular sleep.
• Reduce stress.
• Do something new. You don’t have to learn calculus or astrophysics unless you want to. Something as simple as taking a walk in a new neighborhood can stimulate cognitive function.
• Get help/support for anxiety and depression.

14. Weight

Weight gain is something that happens as we age. Weight gain, in and of itself, is not due to menopause. There are, however, menopause-related changes in the way that fat is distributed on the body, such that we tend to have more belly fat after menopause.

What causes changes in fat distribution? Lower levels of estrogen and a change in the type of estrogen that is predominant in the body after menopause.

What to do about it.

• Exercise. Recommendations for the minimum amount of exercise are for 150 minutes of moderate exercise (fast walking) per week.
• Diet is a lifestyle, not a passing fad. Take a walk to your local library and educate yourself about healthy eating and look into new cuisines. Mediterranean and Middle Eastern diets rely on fresh fruits and vegetables, lean proteins and whole grains, and use seasonings that make food interesting. Community hospitals often offer free nutrition classes.
• Consult a nutritionist.
• Make it a group effort. Exercise and make dietary changes with friends for support.

15. Skin changes

Some women experience acne during menopause. Skin may become dry and tissue paper like, and show more characteristics of aging, such as wrinkling.

What causes skin changes? Lower levels of estrogen.

What to do about it.

• Avoid prolonged sun exposure.
• Wear sunscreen daily, even during the winter. Many makeup lines have SPF foundation that works just as well.
• Consult a dermatologist.
• Consider hormone therapy.

16. Eye Changes

Menopausal women are more likely to have dry eye syndrome.

What causes eye changes? Probably lower levels of estrogen. We know that there are hormone receptors in parts of the eye. We know that dry eye syndrome happens with increasing age, and that women experience dry eye syndrome more often than men do. We make an inference that the increased incidence in women is hormonally mediated.

What to do about it.

• Use over-the-counter artificial tears to keep eyes moist.
• Consult an ophthalmologist.
• Hormone therapy may or may not be helpful.

17. Breast Pain and Tenderness

Breast pain and tenderness are most noticeable during the earlier states of perimenopause. Breast symptoms typically become less severe as perimenopause progresses.

What causes breast changes? Fluctuating hormone levels.

What to do about it.

• Wear a properly fitted, supportive bra.
• Invest in a supportive sports bra to wear while you exercise.
• For some women, warm compresses can provide temporary relief. For other, ice packs work better. You’ll have to experiment to figure out what works best for you.
• NSAIDS – non-steroidal anti-inflammatory drugs can provide temporary relief.
• Your health care provider can provide other recommendations.

18. Joint Pain

While joint pain can be related to arthritis, many women experience joint pain during menopause that has no known pathological basis.

What causes joint pain? It’s not entirely clear, but it is likely hormonal.

What to do about it.

• Maintain a healthy weight. Women who are overweight tend to have more joint pain throughout perimenopause.
• Get treatment for depression. For reasons not entirely understood, women who experience depression during perimenopause are more likely to experience joint pain.
• Hormonal therapy has been found to be effective in relieving joint pain.
• NSAIDs – non-steroidal anti-inflammatory drugs can provide temporary relief.

19. Irregular heartbeat

Palpitations and feeling “skipped beats” are common experiences during perimenopause, especially during hot flashes and night sweats. Much of the time, palpitations are benign; palpitations that are accompanied by chest pain, pain in the neck, arms, upper or mid- back, a feeling of severe heartburn or shortness of breath require immediate medical attention.

What causes an irregular heartbeat? It’s not entirely clear why perimenopausal women experience more palpitations.

What to do about it.

• First of all, make sure you do not have an underlying heart problem. A basic medical evaluation would include a physical exam and EKG. A more extensive workup may be recommended based on your symptoms and the exam findings.
• As palpitations are most often associated with vasomotor symptoms, follow the suggestions for reducing hot flashes and night sweats.

20. Dental changes

Osteoporosis (loss of bone density) is a common postmenopausal health condition. Osteoporosis can cause tooth loss.

What causes tooth loss? Tooth decay and gum disease are the most common culprits. Loss of bone density in the jaw, related to osteoporosis can also lead to tooth loss.

What to do about it.

• Eat well. Avoid starchy foods, especially those made with refined white flour and sugar.
• Make brushing and flossing a twice daily habit.
• Have regular dental cleanings and exams, and promptly address any dental problems.
• Prevent and treat osteoporosis.