Signs & Symptoms of Menopause: What to Expect

01/31/2023 | 6 min. read

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You have a sudden wave of heat and flushing, often at an inopportune time. You wake up at night, hot and drenched in sweat. Your emotions are all over the place, and you have zero interest in sex.

Welcome to the menopausal transition. These and other signs of menopause, which are caused by a decline in estrogen levels, are normal during this time of life. But if you don’t know what to expect—including less obvious symptoms of menopause—and when to expect them, this transition can be particularly distressing.

Let’s take a close look at the signs, symptoms, and phases of menopause.

Three Phases of Menopause

Menopause is a natural process that all women will go through. Although every woman’s experience is unique, the menopausal transition involves three distinct phases:

  • Perimenopause is the time leading up to menopause. It starts when estrogen production begins to fluctuate, most often when a woman is in her early to mid-40s. Menstrual periods become irregular and unpredictable—longer and heavier one month, shorter and lighter the next, or skipped altogether. Perimenopause typically lasts one to seven years, but it could begin earlier or last longer.
  • Menopause is diagnosed when a woman has gone 12 consecutive months without a menstrual period. It’s when the ovaries stop producing eggs and estrogen. Menopause usually happens between the ages of 45 and 55, with an average age of 51. For about 5% of women, it occurs in their early 40s. Fewer than 1% enter menopause before age 40 (due to ovarian failure).

  • Post-menopause officially begins a full year after the final menstrual period. Symptoms typically decline and eventually stop, although some women experience menopausal symptoms throughout their lives!

Hot Flashes & Night Sweats

Hot flashes, the quintessential sign of menopause, affect 75% of women. They may only last a few minutes, but when they recur several times a day, hot flashes can be quite disturbing. So can night sweats, which are hot flashes that cause such serious sweating that they drench your sheets and impair your sleep.

Both night sweats and hot flashes are classified as vasomotor symptoms. This means they are caused by constriction or dilation of blood vessels in response to the effects of fluctuating hormone levels on core body temperature.

When your body overheats, your blood vessels expand to increase blood flow to your skin, dissipate heat, and cool you down. This results in unpredictable and unpleasant flares of heat, flushing, and sweating.

Less Obvious Symptoms of Menopause

Changes in blood vessel dilation may cause other vasomotor symptoms that are not typically attributed to menopause:

  • Palpitations: A rapid, irregular, or pounding heartbeat may accompany hot flashes and night sweats. Palpitations can also occur on their own during menopause.

  • Chills: The profuse sweating of a hot flash can make you cold and trigger chills, which is your body’s way of warming you up.

  • Headaches: Migraines are vascular headaches, meaning they are caused in part by dilation of blood vessels. These headaches are also influenced by estrogen. For some women, headaches are more frequent during perimenopause. Others report that migraines improve in the postmenopausal stage.

Urogenital Symptoms of Menopause

The vagina and other tissues in the genital and urinary tracts are loaded with estrogen receptors, so it’s no surprise that menopause-related drops in estrogen have significant effects on these tissues.

These symptoms, which affect 60% of women, are referred to as the “genitourinary syndrome of menopause” and include:

  • Vaginal atrophy: As the walls of the vagina are no longer supported by estrogen, they thin and atrophy, resulting in dryness, itching, irritation, etc.
  • Sexual function: Vaginal atrophy and lack of lubrication can make intercourse uncomfortable, if not downright painful. This may translate into reductions in libido, sexual arousal, and overall sexual function.
  • Urinary problems: Painful urination, frequency, urgency, and recurrent urinary tract infections may arise as tissues in the urinary tract atrophy. Some women also develop stress incontinence.

Visible Changes Associated with Menopause

Some of the signs and symptoms of menopause are obvious. In fact, you can see them every time you look in the mirror!

  • Weight gain: Many women report gaining weight. Five extra pounds seems to be the average, and much of it is around the waist. This isn’t only about menopause, since muscle mass, metabolism, and activity levels tend to decline with age. However, hormones influence where we store fat, so hormonal changes linked with menopause may encourage belly fat.

  • Decreased height: Both men and women get a little shorter with age as cartilage wears out and bones settle. Yet, because of hormones’ central role in bone health, loss of bone—including the spine, which affects height—speeds up during menopause. Significant “shrinking” is a warning sign of osteoporosis and spinal fractures and must be checked out.

  • Other visible signs of menopause: Additional changes in estrogen-sensitive tissues that begin during perimenopause and increase in the postmenopausal years include dry, thinning, sagging skin; hair loss/ thinning; brittle nails; and decreased breast size.

NOT All in Your Head

Last but not least, menopause can mess with your mind and your emotions. It is not unusual for women to feel forgetful, unfocused, overly sensitive, irritable, tense, anxious, and stressed out, particularly during perimenopause.

Sleep is often affected, especially if you’re also dealing with night sweats, leaving you tired and grumpy. These symptoms may be so extreme that they interfere with work, relationships, family, and quality of life. They can also undermine your self-esteem and self-confidence. The likelihood of developing depression increases, and women with a history of depression or anxiety may have a recurrence.

These psychogenic symptoms affect about 45% of women to one degree or another, and they are among the most difficult of all aspects of menopause.

Postmenopausal Health Challenges

It is important to note that although hot flashes and other classic signs of menopause taper off as women move through the postmenopausal stage of life, other symptoms of low estrogen become pronounced.

Estrogen receptors are present in almost every organ system in the body, and once the ovaries cease production of estrogen, postmenopausal women lose estrogen’s protective effects.

For example, estrogen helps normalize cholesterol levels, dilates the arteries, and enhances blood flow. This is one reason why women have a lower risk of heart disease—until menopause. After around age 65, women’s risk is the same as men’s.

Bone health, as noted above, is also supported by estrogen, so bone density declines during the menopausal transition. Some 10 million older Americans have osteoporosis, and 80% of them are women.

Estrogen is also active in the brain and deficiencies may play a role in brain aging.

Menopause Recap: Enjoy the Journey

Menopause is on the horizon for all women, whether it’s around the corner or decades into the future. The “change of life” certainly has its challenges, but it’s coming, so you might as well enjoy the journey.

Rest assured that there are many treatments—lifestyle changes, herbal therapies, and bioidentical hormones—to help you deal with the symptoms of menopause. Working with an understanding healthcare practitioner can be a tremendous asset as you travel through the menopausal transition.

Dr. Briana Sinatra

Meet Dr. Briana Sinatra

Dr. Briana Sinatra is a board-certified naturopathic doctor with a vibrant practice in the Pacific Northwest. There she focuses on women’s and family health, taking a holistic approach to healthcare by empowering women with the knowledge and tools they need to live their best life now and protect their future wellness by looking at how all the systems in the body work together and how diet, lifestyle, and environment all influence health.

More About Dr. Briana Sinatra