Each person experiences different symptoms with their menopause journey.

Find out what you need to know about the physical and psychological symptoms of the menopause, from hot flushes, night sweats, and difficulty sleeping to brain fog, anxiety, and depression and longer-term health issues.

Menopause HQ recommends that you see your primary GP for help with your menopause symptoms.

Hot flushes and night sweats

Some of the most common symptoms are hot flushes and night sweats. You might experience sudden feelings of heat when drinking hot drinks or walking into a warm room, making your internal thermostat shoot right up. On average, women experience hot flushes for around seven years but they can last for much longer.

Our hormones play a significant role in how our brain and nervous system communicate with our bodies. During perimenopause, hormonal fluctuations can disrupt the vasomotor system, leading to symptoms such as hot flashes and night sweats.

Estrogen plays an important part in the thermoregulatory system, which controls core body temperature. 

Progesterone also plays a role in our body’s maintenance system. It alters our core temperature at key points of our menstrual cycle to encourage egg fertilization and fetal growth in pregnancy.

Pulses in Luteinising Hormone (LH)—the hormone that triggers ovulation—are also known to promote an increase in temperature.  

Our hormones also contribute to a cell’s health. They keep our blood vessel walls smooth and flexible to aid blood flow. The rate of blood flow and its direction influence our feeling of warmth. If we are too warm, sweating occurs to cool our skin and the blood that flows beneath.  

When our hormones fluctuate, you may find that your body temperature also fluctuates, making you feel too hot or too cold.  

Anxiety

Anxiety can creep up and leave you feeling irritable and stressed in a way you never were before. Many women don’t realise that anxiety is a symptom of the menopause and instead think they’re suffering from stress. They may start antidepressants when Hormone Replacement Therapy (HRT) can be more effective.

Cortisol, Stress, and Anxiety 

Stress is both natural and necessary for survival. It is how the brain recognizes that we are under threat and prompts actions that can protect us.

When we experience stress, the levels of the hormones epinephrine and norepinephrine rise, producing cortisol.

Cortisol gives us the energy to confront or avoid the stress, contributing to our ‘fight or flight’ response.

Heart rate, breathing, and blood flow increase to prepare our muscles for action, and our thoughts quicken. Physically, we are prepared to deal with the threat, after which the stress reaction can shut down and return our body systems to normal.

We know that stress these days is rarely caused by a threat that we need to fight off or run away from. But by not fighting or running—and completing the process as our body expects—we do not physically discharge these chemicals as we should.

They linger in the body, making us feel jittery, tingly, breathless, and lightheaded. Our thoughts race, and we feel a sense of watchful anticipation or trepidation.

In other words, we experience mild panic.

Not shutting this stress response down effectively will keep cortisol levels higher than necessary. This, in turn, can shut down the production of other chemicals that the body needs to return to a calmer state. We remain in a vicious cycle called a negative feedback loop.

For menopausal individuals, this is compounded by cortisol levels being more erratic and higher than usual. So it’s not surprising that many of us feel locked into seemingly never-ending stress and emotional turbulence during this phase of our lives!

The role that cortisol plays in the stress reaction can be disruptive, as higher cortisol levels can cause our reaction to be excessive and out-of-proportion to the stressor.

Perceiving things as stressful will elicit anxiety, which in itself becomes stressful, as we remain alert and anxious about it happening again. This may leave us vulnerable to getting more easily stressed in situations where we perceive we might feel stressed.

The psychological effects of such symptoms are wide-ranging. Our ability to perform tasks may be affected, and our capacity to do our jobs effectively may diminish. As a result, our confidence suffers as our stress increases.

Our relationships may also suffer, compounded by a possible loss of libido and the psychological confusion of, “Who am I? Why can’t I do or feel like I used to? What is happening to me?!”

Depression

You might feel generally low, lethargic and have little interest in activities you would usually love.

Many women struggle on for years and, as with anxiety, thinking they are depressed or unhappy in their life, not realising that menopause could be the root of the problem. The menopause can also increase the likelihood of depression if you’ve had it before.

Some women may give up jobs or relationships, thinking they’re the cause rather than the result of being impacted by the effects of low oestrogen in the brain. They may start taking antidepressants, but HRT may be more effective.

An endocrine or hormonal cause is suggested by the observation that low mood occurs at times of hormonal change, such as:

• The days before a period, known as premenstrual syndrome (PMS) or premenstrual dysphoric disorder (PMDD). PMDD is similar to PMS but more severe, manifesting as extreme irritability, depression, or anxiety in a week or two before a period starts. Symptoms usually go away two to three days after the period starts.

• The weeks after giving birth, which many parents experience and is known as postnatal depression (PND)

• The few years before the cessation of periods during the menopause transition, known as climacteric depression (CD)

This subgroup of depressive disorders is called reproductive depression (RD). This labeling is important because it highlights that the cause is endocrine rather than psychiatric. Thus, the most effective and logical treatment is to prescribe hormones rather than antidepressants.

The brain is a brilliant organ. Although our menopausal hormonal decline can cause a state of flux and imbalance, the evidence suggests that over time, the brain adjusts. Symptoms of depression, anxiety, or low mood, therefore, become less. This adjustment can be helped and sped up by making lifestyle changes to reduce stress.

Clinical depression is different from reproductive depression because the former is often triggered by difficult events and consequent stress and strain, disrupting brain chemistry. The consequences may be further reaching than the brain needing to rebalance, with trauma requiring adjustments to thought, behavior, and lifestyle.

Addressing the cause of symptoms may require combinations of specialist therapy and medical intervention over a long period of time.

Brain fog

The dropping oestrogen levels that are behind so many menopause symptoms affect brain function too. Lots of us start to experience brain fog, memory issues, and difficulty with remembering words and names. We’ve heard women tell us they think they have early dementia, and getting stressed and anxious about these symptoms can make some of us fear that we can’t carry on at work or in other vital areas of life.

Sleep

Lack of sleep can be caused by physical and psychological symptoms linked to the menopause, such as night sweats, anxiety or middle-of-the-night toilet visits. Sleep patterns also change as we grow older, so not all poor sleep is down to the menopause.

For many women, this is one of the most challenging symptoms. Getting this sorted with proper treatment can have a positive impact on other symptoms too, such as anxiety and brain fog.

Sleep can even help us lose weight. Evidence shows that those who experience weight gain issues are normally poor sleepers.

Also, common sense tells us that the longer we are awake, the more energy we need. We also face the temptation to eat, bringing about the tendency to consume more calories than we need to and letting the extra weight creep in.

Sleep is also good for turning back the clock on our appearance. Tiredness often makes us look older than we are because the body is trying to conserve its energy, and the skin cells are deprived of the time to renew as they normally would during sleep.

Sleep is also great for libido! Your sex drive might be diminished during menopause, but how much less is it when you are tired?

Sleep has an impact on our happiness, too. Happy people are typically full of energy and always ready to get up and go.

All these reasons are why you should take your sleep seriously and give your brain everything it needs to shut down for eight hours or more each night.

How Does Menopause Affect Sleep?

Hormone Levels

During menopause, hormone levels, especially estrogen, interact with other hormones like melatonin, which regulates sleep patterns.

Melatonin levels decline with age, affecting sleep as we get older. Additionally, the decline in progesterone and estrogen can disrupt the secretion levels of melatonin, further impacting our sleep cycles.

Progesterone has a naturally calming effect on the brain, so its reduction may make our brains more active during times when rest is expected.

Progesterone also influences breathing stimulation and muscle relaxation, which can contribute to sleep apnea, a condition where the throat’s walls relax and narrow during sleep, disrupting normal breathing. However, other factors like obesity or heart defects can also contribute to sleep apnea.

Aches and pains

Many women start to get aches and pains in their joints, and this is sometimes misdiagnosed as arthritis. To make matters worse, these symptoms can leave us feeling less than enthusiastic about exercise, which means we lose muscle mass and condition, and can put on weight.

Weight gain

Weight gain is another common issue in the menopause. The causes are complex – it’s not all about hormones, genetic factors can be important too.

Many women find that fat is redistributed to their middle area, so you may feel that you have gained weight, but it’s actually a change of shape as you turn from a ‘pear’ to an ‘apple.’ You are also more prone to lose muscle in the menopause – particularly if you stop exercising – meaning you need fewer calories than you did before.

On top of all this, it’s easy to start eating and snacking for emotional reasons. Some women also drink more alcohol – which is full of empty calories – in the menopause to try to sleep or to deal with stress.

Changing hormone levels can affect the way we store fat. During menopause, many individuals may notice changes in their fat distribution, leading to fat being stored around the abdomen rather than the hips. This change in shape from a pear to an apple can have implications for health, as carrying fat around the abdomen is associated with a higher risk of conditions such as type 2 diabetes and heart disease. Therefore, it is essential to take action to address these changes and maintain a healthy weight.

Another aspect affected by hormonal changes during menopause is the digestive system. Hormonal fluctuations can influence the delicate balance of the gut’s microbiome, which comprises millions of microorganisms that support digestive and immune health. When this balance is disrupted, it can lead to various digestive symptoms, including:

• Bloating

• Wind

• Constipation

• Changes in bowel habits

• Abdominal pain.

While many individuals experience weight gain during menopause, academic studies have not yet established a clear link between hormonal changes and weight gain. It is important to recognize that various factors, such as the aging process and lifestyle choices, can also contribute to weight changes during this phase of life.

The Effects of Declining Estrogen Levels on Metabolism  

During perimenopause, the declining levels of circulating estrogen can cause rapid changes in the body’s metabolism, fat distribution, and insulin resistance.

Estrogen plays a crucial role in regulating metabolism and weight, particularly the primary form of estrogen called estradiol. It interacts with other hormones that control metabolism, such as leptin, which regulates hunger and body fat formation. The decline in estrogen levels can affect appetite and fat distribution in the body.

Another hormone affected by estrogen is cortisol, which is involved in the body’s stress response. As estrogen levels fall, cortisol levels may rise, leading to increased blood pressure, blood sugar levels, and digestive issues like bloating, gas, and constipation.

Estrogen also optimizes the action of insulin, a hormone that controls blood sugar levels. High blood sugar levels can have adverse effects on various body systems, and estrogen’s decline may impact insulin efficiency and glucose levels.

Changes in sensation

The menopause can result in your body experiencing strange sensations. For some, it’s tingling and numbness of hands and feet, for others it’s the sensation of insects crawling on the skin. Changes to your nervous system can also result in dizziness of varying degrees. It’s not uncommon for you to experience changes to taste and smell too.

Changes in appearance

Some women experience a thinning of hair caused by a change in the balance of male and female hormones in the body. Dental issues can also be a problem for some.

The menopause can also cause a decrease in the quality of collagen in the body, which means skin can start to look ‘saggy’ and result in more wrinkles.

The skin can also be affected in other ways. Some women get a second wave of acne (it’s not just teenagers), and some develop a condition called hirsutism, where hairs begin to grow on the face, breasts and chest.

Dryness is a fairly common symptom and can be experienced in many areas of the body. The most common are the eyes, skin and mouth. Dry skin can be itchy and irritable. The transition can even cause changes to your nails.

Vaginal, vulval and bladder symptoms

Your body uses oestrogen to keep the tissues of the vulva, vagina and bladder healthy, so fluctuations in hormone levels can cause symptoms in these areas. As with the eyes, mouth and skin, the tissue of the vulva and vagina becomes dry and more delicate. This can make sex painful for some.

Again, you might not be surprised to hear that it’s a loss of oestrogen in the tissue of the bladder that causes less-than-pleasant symptoms. These include pain passing urine and needing to go more often (especially in the middle of the night). Infections are also more likely during the menopause.

Lower sex drive

During this sensitive time in our lives, our sexual function can be affected. Loss of libido is common and can be a direct result of discomfort in the vaginal area, which may lead to pain during intercourse and subsequent avoidance.

Lifestyle and psychological factors, such as stress, relationships, and work-life balance, can also impact libido. The challenges of caregiving responsibilities for children and aging parents can add to the stress. A recently published survey of women aged between 45 and 65 found that up to 40-50% lose interest in sex as they pass through the perimenopause, menopause and beyond[1]. For some, the desire for sex and the experience of pleasure during sexual intercourse can diminish. There are a few reasons for this:

• Drop in hormones with their physical and psychological impact

• Vaginal dryness and discomfort

• Rise in urine infections after sex

Throw in juggling a busy life along with these menopause symptoms and it’s not surprising that low libido is experienced by many.

But, as ever, it’s important to remember that we all experience the menopause differently and some women say that their menopause improves their sex drive – as children leave home and they have more time for themselves and their relationship.

Breast tenderness

Breast tissue is sensitive to hormones, and you may experience breast tenderness, pain, burning or soreness as you transition through the perimenopause and the menopause. It’s likely to be the changes in the hormones oestrogen and progestogens (for example, progesterone) that are responsible for symptoms.

Breast pain and tenderness are not common signs of breast cancer but always speak to a doctor about any breast changes.

Please see a doctor if you notice any of the symptoms of breast cancer:

• A breast lump

• An area of thickened breast tissue that is new

• Breast skin changes like dimpling

• Nipple changes or nipple discharge

• A lump or swelling in either of your armpits

Fatigue

Fatigue and tiredness are common symptoms of the menopause. You may find that you feel exhausted and worn out or unable to do what you used to. Fatigue in itself can make you feel low and set up a vicious cycle of lack of energy.

You may not not be sleeping, leaving you feeling tired in the day. This might be due to physical symptoms like hot flushes and night sweats, muscle aches and pains and needing to go to the toilet at night.

Stress and anxiety can also keep you awake at night making it difficult to switch off. The menopause hormone changes can also interfere with sleep.

Fertility issues

For most of us, our fertility starts to decline around the time we turn 30, decreasing more significantly over the age of 35.

In the perimenopause, fertility drops again, but the chance of pregnancy is not zero – so you still need to use contraception if you don’t want to get pregnant.

In your 50s, fertility continues to decrease, and at the age of 55, you can stop using contraception even if you are still bleeding.

Some women with POI do conceive naturally as there is a small chance that the ovaries will start working again, particularly if no cause of premature menopause has been found.

Headaches

Headaches can become more common in the perimenopause and the menopause. If you have experienced headaches relating to your monthly cycle throughout your life, you may find that you have more of them during the perimenopause. It is likely to be linked to swings of hormones.

Migraines can also start out of the blue in the perimenopause. If you suffer from migraines – and again, particularly if they are related to monthly cycles, they can get worse in the perimenopause.

After the menopause, when hormone levels settle, migraines can get better – although this can take several years. If the migraine triggers are not hormones, they can persist after the menopause.

Heart palpitations

Palpitations, where you feel your heart skipping beats, are common for some women during the menopause. They usually last just a few seconds and settle by themselves. You may experience them during hot flushes, and it won’t be a surprise to learn that it’s the changing hormone levels that are responsible for them.

Changes to periods

In terms of periods and bleeding, our advice is to expect the unexpected.

For some women, periods continue as normal and then suddenly stop. For most women, however, periods become more irregular as they pass through their 40s in the perimenopause.

Periods can become more spaced out, and you may miss the odd one or two, then suddenly have one again. You may notice that instead of four-weekly cycles, you change to five- or six-weekly cycles – and this can change too.

Your periods can become more problematic – closer together or heavier. Speak to a doctor if they are bothering you, and always speak to a doctor if you have bleeding in between periods, if periods become significantly heavier, or if there is bleeding after sex.