The top 12 symptoms of menopause

Here's the good news: Technically, menopause is only one day long. It's the point when you haven't had a period for a year, and after that, you're considered postmenopausal. But the time leading up to that day, perimenopause, can last for years and come with a range of issues that affect your physical, mental, and emotional health. Some of these changes are mildly uncomfortable or annoying — like dry eyes or having to pee more often — while others can be more serious, creating a ripple effect on your health and quality of life. Here, find info on the most common signs of menopause, some of which may be a bit surprising, along with what’s causing them and how treatments may help.

What is menopause?

Menopause is a natural transition for women that occurs when the ovaries wind down from their reproductive years and, as a result, stop producing two key hormones: estrogen and progesterone. For some women, this change may happen quickly over the course of a few months — or abruptly if ovaries are removed surgically — but for most women, it’s a gradual development over years. Estrogen, particularly, plays a big role in numerous functions within the body, which is why having less of the hormone can cause such wide-reaching symptoms.

What causes menopause symptoms?

The main culprit for many menopause symptoms is decreased estrogen, says Ruiz. Because that hormone plays so many different roles in the body, having less of it can lead to profound changes. “Those symptoms can be more profound if there are lifestyle changes that happen at the same time that tend to worsen what’s going on,” he adds. “That could be feeling more stress, experiencing weight gain, and becoming more sedentary.”

Common symptoms of menopause

Some women will have very mild symptoms, while others can experience more severe issues. Here’s what to expect:

Irregular periods

Not only is this a symptom of perimenopause, it’s often the symptoms women notice first. Periods may be shorter or last longer than they have before, they may happen more or less frequently, or you might experience heavier or lighter bleeding. That’s because estrogen levels determine your menstrual schedule and rate of bleeding — when you have your period, estrogen levels are at their lowest, and then the hormone naturally fluctuates throughout the month until your next period. Rapidly changing estrogen levels makes that schedule a lot less reliable.

Hot flashes and night sweats

Hot flashes during menopause? Sounds cliche, but they’re just that common. Up to 80% of women will experience hot flashes at some point during menopause, and 10% will have them very frequently (think: more than seven a day). Also known as vasomotor symptoms, hot flashes and their partner night sweats occur because estrogen is involved in the body’s temperature regulation. When hormone levels change wildly, as they do during the menopause transition, that can lead to sudden and intense temperature shifts.

Hot flashes often start in perimenopause and they can significantly impact your quality of life — making it difficult to concentrate, reducing energy levels, and affecting mood. “It’s very common for hot flashes to occur throughout the night, and that can lead to significant sleep disruption,” says Dr. G. Thomas Ruiz, M.D., lead OB/GYN at MemorialCare Orange Coast Medical Center in Fountain Valley, CA. “Unfortunately, that can create a ripple effect.” Some factors can make hot flashes more frequent and intense, he adds, like drinking alcohol, smoking, feeling stressed, and having excess weight or obesity.

Vaginal dryness

Estrogen helps maintain the elasticity and thickness of the vaginal lining and promotes lubrication, in addition to prompting a healthy balance of bacteria within the vagina. So when estrogen levels drop during menopause, your vaginal tissue may lose moisture — and this dryness can make sex uncomfortable. You may also experience itching and burning in the vaginal area, since this dryness can cause irritation.

Mood changes

Emotions like stress, anxiety, tearfulness, and irritability can become more intense during menopause — partly due to there being estrogen receptors in your brain affected by the lower hormone levels and partly due to other factors like disrupted sleep. Unlike the PMS-related mood changes you may have dealt with for decades, the emotional upheaval during perimenopause can come and go for years without any kind of pattern, which can make you feel blindsided, says Ruiz.

"Handling different emotions during this time can feel overwhelming, especially as you address the physical effects happening at the same time," he notes. "However, awareness that this is tied to menopause is helpful, and being more proactive with healthy behaviors may ease some of those emotional impacts."

Sleep problems

With night sweats causing you to lurch awake at 3 a.m. in soaked pajamas, it’s no wonder many women report poor sleep during menopause. Sleep difficulties may be prompted by other issues as well, such as stress, anxiety, and depression. Menopause also impacts melatonin production, which then can cause changes to your sleep/wake cycle.

Urinary problems

Estrogen helps maintain the strength of the bladder and its surrounding tissue, so when levels decline, it can lead to bladder weakness. The result: feeling like you suddenly need to urinate or having leakage while exercising, laughing, or sneezing (something called stress incontinence). You may also notice you have to use the bathroom more often, including waking up at night to pee. Additionally, reduced estrogen levels can contribute to changes in the urethral tissues, which can make you more susceptible to urinary tract infections.

Other symptoms of menopause

In addition to the above common symptoms, there are others you may experience as well. It's helpful to know these since you may not immediately connect them to menopause even though they may be part of what's going on.

Weight gain

File this under: things you don’t want to hear. "Menopause presents a marked change in a woman's body, and one of the most notable changes can be weight gain, particularly in the abdominal area," says Dr. Kecia Gaither, M.D., an OB/GYN and director of perinatal services and maternal fetal medicine at NYC Health + Hospitals in New York City.

This happens, in part, because aging prompts a downshift in the metabolism — that's true for men as well as women — and that slowdown allows for more fat to accumulate. Why the belly, though? It's mainly about the hormones, Gaither adds. Reduction in your estrogen and progesterone production causes fat to be stored around the waist more frequently compared to other body areas like the hips or thighs, she says.

Not only can this type of fat cause frustration, it can present major health challenges, says Gaither. "The fat that accumulates around the abdomen — known as visceral fat — increases one's risk of cardiovascular disease, because it comes with an increase in inflammation, insulin resistance, elevated blood pressure, and high cholesterol," she says. Visceral fat also raises your risk for type 2 diabetes, certain cancers, and dementia.

"These are often women who are surprised by weight gain because they're eating the same amount of calories they have for a long time, but the way the metabolism slows in menopause is causing that abdominal fat accumulation," Ruiz says. "The sooner you can address that, the more likely you are to slow the momentum of that weight creeping on."

Decreased libido

Mood changes, vaginal dryness, poor sleep, and other menopause symptoms can do a number on your sex drive. Research suggests more than a third of women in perimenopause or menopause report sexual challenges, from lack of interest in intimacy to trouble climaxing. In part, this is physical, since you’re experiencing reduced blood flow to your genitals while lower estrogen levels in the brain affect release of dopamine — the hormone connected to reward and pleasure. There can be a psychological component as well, since mood changes and bodily changes might make you feel less desirable.

Brain fog

You walk into a room to get something and then forget why. Or it takes you longer to remember the name of a childhood friend or the title of a movie you saw last week. Or you neglect to write an important meeting on your calendar. All of these can be indicative of "brain fog," which is characterized by challenges with concentration, recall, and problem-solving. Menopause can prompt this issue since some parts of the brain that are involved with verbal memory rely on estrogen receptors.

Hair loss or thinning

Hormonal changes don't just affect what's going on inside your head — they can also affect what's happening on the outside of it. Research suggests your hair follicles can be impacted by menopause, which can lead to thinning, loss of volume, and changes in hair texture. This is because estrogen is involved in maintaining hair follicle stimulation. When that hormone declines, growth of new hair can slow down.

Joint and muscle aches and pains

You may notice your joints and muscles feel aching even if you haven't worked out, or you could experience stiffness or weakness you haven't had before. Much like other menopause symptoms, issues with joints and muscles are often tied to declining estrogen, according to Dr. Natasha Trentacosta, M.D., sports medicine specialist and orthopedic surgeon at Cedars-Sinai Orthopaedics in Los Angeles, CA. That's because estrogen plays a role in protecting the cartilage in joints and keeping inflammation in check. When estrogen drops, the joints lose some of their "shock absorber" protection, which can affect muscles as well, Trentacosta says.

Heart palpitations

Estrogen helps to regulate heart rhythm, so you may feel a sensation like a fluttering or pounding in the chest, or that your heartbeat feels more noticeable than it has before. These palpitations can also be brought on by anxiety or the temperature spikes of hot flashes. Research suggests about 42% of women in perimenopause and 54% of postmenopausal women experience heart palpitations.

“On their own, palpitations are not considered dangerous, especially if they happen only occasionally or are connected to a symptom like hot flashes, which tend to last for only a few minutes each,” says Ruiz. “However, if they’re happening frequently or seem to be getting worse, it's important to check in with your doctor.”

Treatments for menopause symptoms

While some menopausal symptoms may seem inevitable, you aren’t just stuck with suffering through them. There are many options for helping you feel better, including both lifestyle changes and, possibly, medications.

Lifestyle changes

Your daily habits are crucial to how you feel — and this is very true during menopause. Being more active, including strength training, can build muscle mass, increase bone density, and reduce the stress hormone cortisol, says Gaither. This can lead to improvements in your weight, sleep, energy, and mood. And a shift toward a healthier diet — like increasing protein, fiber, and hydration and decreasing alcohol — can also help reduce body fat and lower risks for chronic conditions like type 2 diabetes.

Hormone treatments

Hormone replacement treatment (HRT) — also known as menopause hormone therapy (MHT) — is one way to address many common menopause symptoms, says Gaither. This prescription medication is usually delivered through pills or patches and supplements your body with extra estrogen and progesterone. Since many symptoms, like hot flashes, are linked to changes in these hormones, particularly estrogen, bringing those levels back up can often help alleviate those issues, she says. For vaginal dryness, there are prescription low-dose estrogen creams, rings, or tablets that can be inserted directly into the vagina as a way to restore elasticity and moisture.

Non-hormone treatments

In addition to HRT, your provider may prescribe other medications. There is a non-hormonal medication approved for hot flashes and other drugs, like some antidepressants, that may also improve certain menopause symptoms. And if you’re dealing with weight gain, your doctor might talk about a GLP-1 like Wegovy (semaglutide) or Zepbound (tirzepatide). GLP-1s mimic a natural hormone in the body that regulates blood sugar levels and appetite, and slows digestion. This can help you lose weight by making you feel full for longer, and reducing or eliminating food cravings, which can lead to weight loss.

"We're seeing that GLP-1s play really well with HRT, particularly in addressing weight gain that comes as a result of menopause," Ruiz says. "Overall, the changes that come at this time can be disheartening for many women, but it helps to have a sense of control and the understanding that you can do something about these menopause-related effects."

The bottom line

Throughout the entire menopause transition, estrogen and progesterone levels fluctuate wildly and ultimately drop to very low levels. Because these hormones, especially estrogen, are involved in many different bodily functions, these changes can cause many different symptoms. These include hot flashes, abdominal weight gain, sleep disturbances, weight gain, mood shifts, decreased libido, brain fog, and more. Healthy habits like physical activity and a nutrient-dense diet, along with certain medications like HRT, can help manage symptoms while supporting overall health.