12 most common signs of menopause

Period changes, brain fog, hair loss, low libido, poor sleep, weight gain and joint pain are among the most common symptoms of menopause. Menopause expert Dr Katie Hodgkinson explains these and the 12 most common symptoms and what to look out for. 

What is menopause?

The menopause is defined as 12 months without a period in the absence of any other physiological or biological cause. The average age of menopause is 51 however hormonal changes associated with the menopause often start several years before this, in some cases over 10 years before and in your late 30s. Learn more in our blog ‘Get menopause ready in your 30s’. The transition time is known as the 'perimenopause'. 

Some women may experience surgically induced menopause, often prompted by a hysterectomy (removal of the uterus) or oophorectomy (removal of the ovaries). This can happen to women at any age and can sometimes be more intense than menopause as the body doesn't have time to gradually adjust to declining hormonal levels. Learn more about surgical-induced menopause.

Whilst some will sail through the menopause without any symptoms, 80-85% of women will experience at least one symptom in the perimenopause and menopause, and around 25% of women can suffer from debilitating symptoms that can affect their quality of life. 

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What happens in menopause?

One of the first changes during menopause is a gradual decline in progesterone levels and then fluctuations and a decline in oestrogen.

Testosterone is an important hormone in women, albeit in lower amounts than in men. Testosterone levels gradually decline with age, and some women may experience symptoms as a result of lower levels. You can learn more in our blog ‘Why is testosterone important for women’.

Thyroid and menopause

The thyroid is a gland in the neck that produces hormones whose main role is to regulate your metabolism. Changes in the levels of oestrogen, progesterone and testosterone during menopause can impact on the thyroid hormones and vice versa, and this can cause the development of symptoms of menopause or be a factor in them. (You may be interested in our blog: Best foods for thyroid health).

Common symptoms of menopause

There are over 30 different symptoms of the perimenopause and menopause and every woman will be different in terms of which symptoms (if any) they present with. While there are many lesser known and more unusual symptoms of menopause, here are 12 of the common symptoms of menopause. 

1. Period changes

A more obvious symptom that may alert you to hormonal changes is an alteration in your menstrual cycle. Periods can become heavier or lighter, or they can become more or less frequent as a result of changes and fluctuations in hormones, and eventually menstruation will stop. You can learn more about Nutrition for PMS symptoms here.

2. Pre-menstrual symptoms

PMS often occurs a few days before a period and symptoms usually settle soon after a period arrives. Symptoms vary and include headaches, mood changes, breast tenderness, bloating, poor sleep and more. Some women will also experience symptoms when ovulation occurs.  

Women who experience PMS may find that their symptoms worsen in the perimenopause, and others may experience PMS for the first time during menopause. Discover the best foods for PMS in our blog ‘Nutrition for PMS’. 

3. Brain fog

One of the most troubling symptoms that women report is the inability to focus, often with confusion, poor memory and a lack of mental clarity. Often described like 'living in a cloud', brain fog, coupled with mood changes, can really make you feel like you’re not yourself anymore. This can be a result of factors such as hormone changes and exacerbated by a lack of sleep, stress, and diet. Discover 5 foods to improve your mood.

4. Poor sleep

Difficulty in getting to sleep or experiencing interrupted sleep can occur as a result of hormonal changes that affect your thermoregulation. This can lead to night sweats or feeling hot at night, and increased frequency of needing to pee which gets you up in the night. 

In addition, stress can increase cortisol levels. Cortisol is an inhibitor to melatonin (your sleep hormone), which can impact on the ability to get to sleep or stay asleep.  

5. Weight gain

It is not uncommon for weight gain to occur, particularly around the middle. This can be difficult to shift even when making sensible dietary changes and exercising.

Insulin resistance can occur during menopause as a result of factors such as lower oestrogen levels and stress on our body from emotions, diet, lifestyle and poor sleep, resulting in what's called 'central obesity'. Other hormones can play a role in weight gain such as low or high testosterone, low progesterone or an under-active thyroid.  Learn more why testosterone is important for women. You may also be interested in reading 'Exploring the link between diabetes & early menopause'.

6. Mood swings and anxiety

Mood swings and anxiety can present themselves in the days before a period, although it can feel like emotions are all over the place at different times, especially if menstrual cycles start to become irregular.

Oestrogen, progesterone and testosterone can impact on the levels of your neurotransmitters, serotonin and dopamine. Serotonin helps to stabilise our mood and promote feelings of wellbeing and dopamine plays a role in pleasure and motivation.

Alterations in our hormone levels, as well as sleep, stress, poor diet and lifestyle can therefore influence regulation of our emotions. Check out our blog '5 foods to improve your mood'. 

Discover our Menopause Hub | Resources to help support women through all stages of menopause.

7. Low libido

A lower libido can result from a drop in oestrogen and testosterone, which can decrease sexual desire and lead to vaginal dryness (vaginal atrophy) which may cause pain during sex.

Other factors affecting libido include fatigue, mood swings, stress or psychological causes such as low self-esteem from weight gain during menopause.

8. Fatigue

Oestrogen and progesterone interact with the adrenal glands and thyroid hormones which are associated with energy.

The instability arising from changing hormone levels can have a big effect on the body and lead to feelings of crushing fatigue, which can come and go or be more persistent. Other factors such as lack of quality sleep, stress, brain fog, low mood, diet, dehydration or nutrient deficiencies can also contribute to feelings of fatigue. 

9. Urinary symptoms

Low levels of oestrogen can lead to changes in the pH and natural microbes in the urinary tract. This can make your urinary tract more susceptible to infections and lead to thinning of the lining of the urethra, and weakness of the pelvic floor muscles which support the bladder and urethra. This may lead to an increased frequency of needing to pee or even incontinence.

10. Hair loss or thinning

Many women during menopause and perimenopause notice thinning of the hair, either all over the head or on the front or sides rather than bald patches.

Hair loss during menopause is almost always related to hormones, which can lead to shrinking of hair follicles and slower hair growth. Other factors such as nutrient deficiencies, stress and illness can contribute to thinning of the hair.  You may enjoy our blog ‘5 key nutrients for healthy hair’ and 'How menopause affects your skin and hair'.

11. Hot flushes and night sweats

A classic menopause symptom which affects most women, hot flushes are a sudden and often intense feeling of warmth and sometimes sweating, usually on the chest and face. They are a result of altered control of the body temperature from changing hormones, in particular from changes in oestrogen and progesterone levels.

Night sweats are hot flushes which occur at night and can affect sleep. Other factors that can contribute to hot flushes include alcohol, spicy foods and caffeine. 

While hot flushes are a common symptom, cold flushes are among more unusual symptoms, also arising from a change in the functioning of the hypothalamus and often after a hot flush.

12. Joint aches 

The most common joints affected during menopause are the knees and hips, which can present with pain and stiffness.

Oestrogen, testosterone and progesterone all contribute to maintaining healthy bones and joints. When hormone levels drop during the menopause, inflammation can increase, painful joints can occur and the risk of osteoporosis and osteoarthritis can increase.  

Managing menopausal symptoms

Stress on the body from emotions, diet and lifestyle can have a huge impact on our hormones which can result in menopause symptoms or impact on them.  

Whilst we can't stop the menopause, making positive lifestyle changes can help to support how we feel at this time. Read the most effective changes in diet during menopause and the best foods that can help you through menopause. Wondering if menopause causes gut health issues? Read the latest research on menopause and gut health to uncover the 8 common gut health issues that happen during the menopause.

Having a healthy balanced diet with minimal processed foods or drinks, refined sugar or unhealthy fats is really important. Trying to reduce emotional stress, doing adequate exercise, and promoting relaxation and quality sleep are also very important. There is also a role for menopause supplements and hormone replacement therapy (HRT) for menopausal symptom relief. 

Dr. Katie Hodgkinson is a GP specialising in lifestyle medicine and in particular the effects on hormones on the body.

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