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Guide To Menopause Symptoms

Our complete guide to menopause symptoms - from hot flushes, night sweats and irregular periods, to fatigue, anxiety and depression.

The menopause can be a very distressing time for women, with so many changes going on in their body’s due to fluctuating hormone levels. 

It is actually the transition phase to menopause, called the perimenopause, when most women experience the disruptive symptoms of hot flushes, night sweats and irregular periods.

The menopause is the term used to describe the phase in a woman’s life where the ovaries become less responsive and oestrogen and progesterone levels decline.

As a woman gets older and her ovaries become unresponsive the two main female hormones produced by the ovaries - oestrogen and progesterone – fluctuate and gradually decline over time causing a hormone imbalance.

As the ovaries are no longer responding, the control hormones FSH and LH increase to try and get the ovaries to respond.  So, you have declining oestrogen and progesterone levels and increased FSH and LH levels.

chart showing how female hormones fluctuate over time

As there are oestrogen and progesterone receptors throughout the body, these declining hormone levels have effects throughout the body.

In women, oestrogen plays a vital role in helping to regulate body fat, reproductive function, cardiovascular health, bone health and brain function. Declining levels, therefore, impact all these areas of the body and can lead to increased risk of developing cardiovascular disease and osteoporosis as oestrogen levels decline.

We explore these symptoms in detail and outline the hormone changes that cause them.

What are the most common symptoms of the menopause?

The most common symptoms of the menopause (or more accurately perimenopause) are:

  • Irregular periods
  • Hot flushes & night sweats
  • Trouble sleeping
  • Vaginal dryness
  • Reduced sex drive (low libido)
  • Mood swings

But women often experience other symptoms and do not realise it’s related to the perimenopause, these include:

  • Memory lapses, trouble concentrating and ‘brain fog’
  • Anxiety and depression
  • Fatigue and tiredness
  • Headaches, vertigo, and dizzy spells
  • Breast soreness
  • Weight gain
  • Digestive issues and bloating
  • Joint pain and muscle tension
  • Hair loss, dry, itchy skin, and brittle nails

Let’s take a look at each of these symptoms in turn and which hormones cause them.

Menopause Symptoms Guide

  1. Irregular periods
  2. Vaginal dryness
  3. Increase in urination frequency & UTIs
  4. Breast soreness
  5. Reduced sex drive (low libido)
  6. Digestive problems and bloating
  7. Weight gain
  8. Hot flushes & night sweats
  9. Insomnia, trouble sleeping and sleep disruption
  10. Fatigue and tiredness
  11. Anxiety, depression and mood swings
  12. Memory loss and trouble concentrating (brain fog)
  13. Headaches, dizzy spells, and vertigo
  14. Joint pain and muscle tension
  15. Hair loss and brittle nails
  16. Dry, itchy skin and acne

1. Irregular Periods

As the responsiveness of the ovaries starts to decrease, the hormones that are produced declines. Furthermore, oestrogen and progesterone can become unbalanced. For example, intermittent anovulatory cycles (missed periods) results in lower levels of progesterone over a cycle. So in the early stages of the transition to the menopause, periods may become irregular and change in nature. You may find your periods:

  • Last longer or may only last a couple of days
  • May be heavier or lighter than normal
  • Are more frequent – every 2 weeks - or less frequent

Some months you may not notice any changes, and other months you may notice that your periods are different. It is worth keeping a diary of your periods to see if they are changing as this is a clear indication that you may be entering the perimenopause.

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2. Vaginal Dryness

It is estimated that up to 60% of women experience moderate to severe vaginal dryness because of menopause.

Vaginal dryness is caused by a reduction in oestradiol, a type of oestrogen, during the perimenopause and menopause.  Vaginal dryness can cause an itchy or sore vagina, pain or discomfort during sex, a need to pee more often and can make you more susceptible to urinary tract infections.

Read more about vaginal dryness.

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3. Increased Need To Urinate And UTIs

Women may experience the need to go to the toilet more often, or in some cases lose control of their bladder during the perimenopause.  This is because the vagina and urethra lose their elasticity and the pelvic muscles become weaker.  In addition, women may experience more urinary tract infections (UTIs) due to lower levels of oestrogen.

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4. Breast Soreness

The unpredictable spikes and falls in both oestrogen and progesterone during the perimenopause can cause breast soreness.

Breast pain as a symptom of the perimenopause feels different from the type of pain experienced just before your period.  Breast pain during the perimenopause feels like a burning sensation or soreness, it can also feel like a sharp, stabbing or throbbing pain.  It may be felt in both breasts or just one breast.

Once women have reached the menopause and their periods have stopped, breast pain should ease off and no longer cause any discomfort.

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5. Reduced Sex Drive (low libido)

Reduced sex drive or a loss of libido is common during and after the menopause affecting 20-40% of women.

“It can be one of the most difficult symptoms to manage. This is often because the woman doesn’t understand why it’s is happening and what to do about it,” says Trudy Hannington, a psychosexual therapist at the Leger Clinic.

Vaginal dryness along with other symptoms such as sore breasts, fatigue, hot flushes can all impact a woman’s desire to have sex.

Read more on loss of libido.

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6. Digestive Problems and Bloating

Low oestrogen levels can result in less fluctuating cortisol levels which increases blood sugars and slows down digestion.  As oestrogen plays a role in the function of the gastrointestinal system, low levels can cause bloating, indigestion, acid reflux, stomach cramps along with nausea, flatulence, constipation, and diarrhoea.

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7. Weight Gain

Hormonal changes during the perimenopause often mean women gain weight, particularly around their abdomen.  On average women gain 4-7lbs in weight during the menopause.

menopause and weight gain

Due to the declining levels of oestrogen, the body tries to produce more of this hormone from elsewhere in the body.  It does this via the fat cells (adipose cells), as such, the female body may need to be fatter for this to happen.

Read more about weight gain and diet during the menopause.

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8. Hot Flushes/Night Sweats and Body Odour

Hot flushes and night sweats are the same, the only difference is that night sweats are hot flushes that happen at night!

Hot flushes and night sweats are caused by declining oestrogen levels, this impacts your brains' ability to regulate body temperature.  Your body thinks it is overheating when it isn’t and your brain triggers the body to cool down by sweating and increasing blood flow through the skin’s blood vessels which causes the flush.

Hot flushes and night sweats are common menopausal symptoms and can vary in severity and duration. For about 20% of women, they can be quite severe and cause a lot of distress impacting work, sleep, and overall quality of life.  However, for most women going through the menopause, they only occur occasionally.

Experiencing hot flushes and night sweats can also increase body odour.  In addition, symptoms such as anxiety create sweat produced in the apocrine glands. Anxiety sweat is fatty and breeds and feeds on bacteria which creates a more pungent smell.

Read more about hot flushes

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9. Insomnia, Trouble Sleeping and Sleep Disruption

During the perimenopause, levels of the hormones oestrogen and progesterone fluctuate and gradually decline as a woman nears the menopause.  These hormone changes can have a drastic impact on sleep.

“Estimates are that between 40 and 60 per cent of women will be affected by insomnia or another sleep disruption,” says Dr Heather Currie, founder of Menopause Matters.

Oestrogen is important for managing the level of magnesium in the body.  Magnesium is used by the body to help muscles relax and low levels can make it more difficult to fall asleep.  In addition, falling oestrogen levels cause hot flushes and night sweats which can also impact the natural sleep cycle.

Woman awake in bed

Progesterone also plays a key role in as it helps you fall asleep and stay asleep.  Fluctuating and declining levels of this hormone will make it more difficult to slip into a deep sleep. It can also impact the quality of sleep, making you feel tired in the morning.

Read more about menopause and sleep 

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10. Fatigue and Tiredness

Other perimenopause symptoms such as night sweats, joint aches, and the need to urinate more frequently all impact a good night’s sleep, resulting in fatigue and tiredness during the day.

Tiredness and fatigue have an impact on being able to carry out and cope with day to day tasks and life events.  This can result in stress which in turn increases levels of the stress hormone cortisol in the body – raised cortisol levels, particularly at night will impact your ability to fall asleep and stay asleep.

In addition, low levels of oestrogen can also result in a feeling of fatigue.

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11. Anxiety, Depression & Mood Swings

Research indicated that 61% of perimenopausal women experienced low mood.

Sleep problems caused by perimenopause symptoms such as night sweats, lead to sleep deprivation which in turn can cause anxiety and/or depression.  

"Neuroscientists have found that sleep deprivation fires up areas of the brain associated with emotional processing. The resulting pattern mimics the abnormal neural activity seen in anxiety disorders" according to PsychCentral.com,

In addition to poor sleep quality, anxiety, and depression, along with low mood are associated with low levels of serotonin.  Oestrogen influences the production and breakdown of serotonin, so lower levels of oestrogen will impact serotonin levels in women going through the menopause.

Menopause and anxiety

Poor sleep can also have an impact on your levels of the stress hormone cortisol.  Your cortisol levels rise and fall throughout the day, with levels being higher first thing in the morning.  But a lack of sleep can cause your cortisol levels to rise and stay high which can impact mood, including feelings of anxiety and depression.

Read more about menopause, anxiety, and depression.

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12. Memory Issues and Trouble Concentrating (brain fog)

Memory loss or lapses, trouble concentrating and the feeling of ‘brain fog’ can be worrying but are natural symptoms of the perimenopause and menopause.  Up to 47% of the women we surveyed experienced ‘brain fog’, reduced memory and concentration during the menopause.

It’s a symptom many women do not often associate with the early stages of the menopause – instead of putting it down to being too busy or stressed with work or life in general.

Our own research looking at women in the workplace has shown that 43% of menopausal women experience memory issues while at work.

Across all cultures, 34-62% of women experience menopause-related memory changes which often mimic the symptoms associated with early signs of dementia.

A drop in oestrogen levels can result in a lack of focus and concentration, but other symptoms associated with the menopause can also cause memory and concentration issues.

Sleep deprivation as a result of poor sleep caused by night sweats and other symptoms; anxiety and increased stress levels due to a lack of sleep can all impact cognitive function and could be the cause of memory issues, trouble concentrating and ‘brain fog’.

Read more on menopause and memory loss.

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13. Headaches, Dizzy Spells or Vertigo

Have you ever woken up first thing in the morning to the room spinning as if you’ve had one too many the night before?  This feeling is known as vertigo and, along with dizziness, is another symptom of the perimenopause caused by a drop in oestrogen levels.

Declining oestrogen levels can impact blood circulation, the nervous system and blood pressure by reducing the reactivity of the artery walls.  This, in turn, affects the brain resulting in dizzy spells.

Falling oestrogen and progesterone levels are also the cause of headaches in menopausal women and some women may even experience migraines for the first time during perimenopause.  Women who suffer from headaches around their period due to low oestrogen levels may find headaches increase as they transition to the menopause.  But after menopause, some women find that headaches, in particular, migraines lessen.

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14. Joint Pain and Muscle Tension

Oestrogen and progesterone level fluctuations can be responsible for the aches and pains women feel as they transition through the menopause. There are oestrogen and progesterone receptors all over our bodies including joints, and as oestrogen and progesterone levels fall, this can cause joint inflammation.

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15. Hair Loss and Brittle Nails

Women may notice their hair becoming thinner or even hair loss during the perimenopause, as well as brittle nails and dry, itchy skin or acne breakouts.

This is due to the declining levels of oestrogen and progesterone which can affect hair growth, causing it to grow more slowly, become thinner and even fall out.

In addition, as oestrogen and progesterone levels fall, this triggers a group of hormones called androgens to increase.  Androgens are known as male hormones and include testosterone and androstenedione and are present in both men and women.  In women, an increase in these hormones can shrink hair follicles causing hair loss, but excess levels can also result in hair growth in unwanted places such as on the face.

Brittle nails are caused by weakening keratin layers. Keratin is a protein that nails are made up of but drops in oestrogen weaken the keratin layer of the nail causing it to break more easily.  Dehydration can also cause nails to become dry and break more easily.

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16. Dry, Itchy Skin and Acne

Oestrogen is associated with the production of collagen, as well as the production of natural oils that keep our skin supple and prevents it from drying out.  As oestrogen levels drop, this impacts the creation of collagen and natural oils in our skin causing it to become dry and itchy.

Some women even experience acne during the menopause caused by a decrease in oestrogen and an increase in testosterone.

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How To Manage Menopause Symptoms

There are a number of ways to manage the symptoms of the menopause.  These include:

  • Ensuring you have a healthy, balanced diet with plenty of fresh fruit and vegetables, lean meat, and unsaturated fat
  • Reducing your intake of caffeine, alcohol and sugary foods
  • Getting regular exercise which can help with symptoms such as hot flushes and low mood. 
  • Hormone replacement therapy (HRT) is used to help relieve menopause symptoms
  • Non-hormonal remedies such as Black Cohosh, St John's Wort and Rhodiola Rosea can also help with some of the symptoms such as hot flushes and low mood.

Summary

It can be difficult to know what is going on in your body as you transition through to the menopause.  Fluctuations in oestrogen and progesterone have an impact on all aspects of your mind and body, lasting anywhere between 4-8 years.

This can leave you feeling confused, overwhelmed and out of control – and just not feeling like your normal self.

The first step is to understand whether the symptoms you are experiencing are due to the perimenopause.  One way to do this is by measuring and tracking your hormone levels over time.

Our perimenopause check is a simple finger prick blood test which checks the key hormones associated with the menopause. By tracking hormone changes over time, you will be able to establish if you are perimenopausal.  

All our tests are carried out by UKAS accredited labs here in the UK and results are reviewed by a GP and returned within 2 working days.

Once you understand whether your symptoms are being caused by hormone fluctuations, you will be able to make the necessary lifestyle changes and live well with the menopause.

Perimenopause

Our perimenopause test is for women who believe they may be starting to transition through the menopause. It tests three key female hormones – FSH, LH and oestrogen which change when entering the menopause.
Perimenopause
£59
3 Biomarkers Included
A test to confirm you are transitioning through the menopause.
Medically Reviewed
Dr Nicky Keay
Chief Medical Officer, BA, MA (Cantab), MB, BChir, MRCP.​
This article has been medically reviewed by Forth's Chief Medical Officer, Dr Nicky Keay.
Nicky has extensive clinical and research experience in the fields of endocrinology and sport and exercise medicine. Nicky is a member of the Royal College of Physicians, Honorary Fellow in the Department of Sport and Exercise Sciences at Durham University and former Research Fellow at St. Thomas’ Hospital.

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