What are the main menopause symptoms? Find out the signs and when to see your doctor

Understanding what menopause symptoms are can help to make the transition from perimenopause to post-menopause a little bit easier. If you think you could be approaching menopause, learning what to expect will enable you to determine whether any bodily changes are being caused by natural hormone fluctuations, and help you to make informed decisions about any treatments in advance.

Menopause affects all women differently, but a few of the most common symptoms include hot flushes, mood swings, vaginal dryness, headaches or migraines. Available treatment for these symptoms depends on the severity, but having a conversation with your doctor can certainly help you determine the best course of action.

To help you discover the sort of hormonal changes you can expect during your 40s and 50s, we’ve lined up a team of menopause specialists who will outline what you need to know about the difference between perimenopause symptoms and menopause, including the most common and uncommon ones to look out for, and the signs of early menopause. 

What is menopause?

“The menopause occurs in all women and it happens when a woman has not had a period for a year,” says menopause specialist Dr. Louise Newson. “It is caused by the ovaries no longer functioning properly which leads to a decline in hormone levels.” For most women, it occurs around the age of 51, but for some women menopause symptoms can occur much younger."

Many women go through menopause from the ages of 45 to 55, according to the NHS, however, symptoms of menopause can last up to five years after your last period. In a study conducted by menopause care website, Health & Her, out of 1000 women in the UK, 90% of women attributed menopause symptoms to aging, stress, anxiety, and depression, rather than to hormonal changes. 

“These hormones that decline during menopause are estrogen, testosterone, and progesterone, which are all produced by the ovaries and are important hormones for our bodies to function,” says Dr. Newson. “These low hormone levels are also associated with health risks. Women who have low hormone levels have an increased risk of diseases including heart disease, osteoporosis, diabetes, clinical depression, and dementia. Once women are menopausal then their low hormones last forever.”

Menopause symptoms

Menopause symptoms can often vary from person to person, but common symptoms include: 

• Hot flushes and night sweats
• Headaches
• Muscle and joint pain
• Fatigue
• Anxiety
• Menopausal weight gain
• Low mood
• Vaginal dryness
• Reduced libido

1. Hot flushes

One of the most well-known symptoms of menopause is hot flushes. These are characterized by intense feelings of heat and can feel quite uncomfortable.

“If you are experiencing random feelings of intense heat that come on suddenly, spread throughout your body and face, and leave you feeling overheated, sweaty, and flushed, where your skin takes on a red hue, you could be having hot flushes,” says Dr Burns, a GP with a special interest in menopause at Health & Her. 

“They can be caused by the declining levels of estrogen, which are seen around the perimenopause and menopause, which can leave the body unable to effectively regulate temperature.” The combination of factors, such as alcohol and menopause, can also make symptoms worse.

There are a variety of different treatments for hot flushes, but always consult your doctor to see what they’d recommend first. Treatments vary from hormone replacement therapy (HRT), to learning how to calm hot flushes by keeping cool, wearing light clothing, and avoiding spicy foods, as this can sometimes cause hot flushes to occur. 

2. Dizziness

A slightly less common symptom of menopause, but one that is still triggered by hormonal changes, is dizziness. For some women, this can occur suddenly or alongside other symptoms such as hot flushes or headaches.

“Feeling dizzy has been linked to menopause and women experience this because of fluctuations in hormone levels,” says Dr Burns. “However, this symptom has many different causes, some of which are serious, so it should always be reported to your GP so that other causes and conditions can be excluded.”

If you ever feel very dizzy, especially if this is accompanied by any other symptoms and/or you start to feel unwell, you should seek urgent same-day medical attention.

3. Digestive issues

Many women also experience digestive issues during menopause, as the hormonal changes happening in the body often disrupt the gut.

“Hormone changes during menopause have been linked to a range of digestive issues such as nausea, diarrhea, and cramping, alongside bloating,” says Dr Burns. “If you’re experiencing stomach changes that are out of the ordinary for you, it might be a result of menopause. However, it is important to exclude other, potentially more serious causes of such changes, so these symptoms should always be discussed with your GP.”

4. Weight gain

Some women also gain weight during menopause. It's perfectly natural and comes down to the decline in estrogen levels and the rise of the stress hormone cortisol, which leads to many women storing fat around their middle. 

If it's something that bothers you, it's worth consulting your doctor to see if menopause might be a contributing factor. You can manage the change through diet and exercise, with programs like walking for weight loss or going into a calorie deficit to lose weight.

Otherwise, it's a totally normal part of menopause and nothing to be concerned about. 

5. Sleep difficulties

According to the National Sleep Foundation, approximately 61% of menopausal women suffer from sleep issues, including overheating, insomnia and drowsiness. 

“Hot flushes can also occur at night, so some women experience night sweats as a result,” says Miss Tania Adib, consultant gynecologist at The Lister Hospital, part of HCA Healthcare UK. “Alongside this, women report experiencing insomnia or changes to their sleep pattern.”

There are steps you can take if you’re suffering from sleep issues during menopause, such as learning how to sleep better by implementing a sleep schedule, creating a sleep hygiene-focused wind-down routine in the evening, wearing cool, loose and comfy clothing to bed, and avoiding caffeine and alcohol. 

However, if this is a menopause symptom you're dealing with, it’s worth consulting your doctor to see whether HRT might be a good option for you.

6. Vaginal dryness

Caused by the natural decline of estrogen in the body as menopause takes place, vaginal dryness affects a lot of women who've been through menopause. According to a study by the University of California Davis, around 19% of women experience the symptom in the first few years of perimenopause. This increases to 34% of women aged between 57 and 69 years old, so it's a common sign that the menopause transition is taking place or already has taken place.

Although it's another perfectly natural menopause symptom, it can cause irritation, pain during sex, and burning sensations. To combat vaginal dryness, some women try and have success with vaginal lubricants and moisturizers, but other times estrogen creams can be more effective.  

7. Depression

Another common symptom of the menopause includes mood changes with some menopausal women experiencing a lower mood, anxiety, and depression.

“Psychological symptoms such as low mood, reduced energy, intrusive thoughts, feelings of reduced self-worth and low self-esteem, loss of confidence, and irritability can take place during menopause,” says Dr Newson. “Some women even have suicidal thoughts during this time. These all often improve with the right dose and type of HRT which will replace the missing hormones.”

Discovering menopause support groups can also be really beneficial if you’re struggling with your mental health during this time.  

8. Brain fog

“Brain fog is used to describe concentration and memory issues that are commonly reported around the time of menopause,” says Dr Burns. “Women may struggle to remember why they came into a room, forget about routine tasks and simple activities, find it difficult to find the correct words, remember people’s names, and just generally feel a bit mentally out of kilter. It may also be difficult to concentrate or focus on a task at hand.”

Brain fog in menopause can often knock your confidence, so if you feel like you’re experiencing it regularly, then get in touch with your doctor.

Perimenopause versus menopause: what’s the difference? 

The difference between being perimenopausal and menopausal simply comes down to where your hormone levels are currently at, although menopause terminology can sometimes be confusing when we speak about the different stages of menopause. 

“The perimenopause is the time before the menopause when menopausal symptoms start occurring and hormone levels start to decline and periods often change in frequency or nature,” explains Dr Newson. “This can occur for many years, sometimes a decade, before menopause.” This means that the majority of women in their 40s will be perimenopausal and they may experience the symptoms above.

“As many women do not have periods, for example, if they have had a hysterectomy or are on contraception such as the Mirena coil, it is really important to monitor any health changes regularly. If there are changes in symptoms, then women should consider the perimenopause as a cause,” says Dr. Newson. 

What is early menopause?

Early menopause often occurs in women under the age of 45. It’s unusual, but it can happen, as Dr Newson explains. “Early menopause is known as premature ovarian insufficiency and it occurs in women under the age of 40,” she says. “It’s very common and can affect around one in a hundred women under the age of 40 and one in a thousand women under the age of 30."

Dr Newson explains, "Sometimes early menopause can occur without any unknown triggers, whereas for some women it is because their ovaries are removed due to an operation or damaged for example by medication or radiotherapy. Women of any age can become menopausal, even as young as a teenager.”

It’s important that early menopause is diagnosed and treated as these women are susceptible to greater health risks than older women who are menopausal.