Disclaimer: This information isn’t a substitute for professional medical advice, diagnosis, or treatment. You should never rely upon this article for specific medical advice. If you have any questions or concerns, please talk to your doctor.
Hot flashes are the most common sign, but every woman experiences different symptoms. Here are ten to look out for.
It can be a little confusing to understand whether or not you’re actually in menopause, so let’s clear up a couple of things.
- Prior to reaching menopause, you’re in perimenopause. This transition phase can start up to 10 years before your last menstrual period. A lot of the signs and symptoms we typically associate with menopause start during perimenopause.
- You “reach” or are “in” menopause when it’s been 12 months since you’ve had your last period. If your period has been disrupted or has stopped due to other causes, namely medication, surgery, pregnancy, breastfeeding, or illness, this is not menopause.
- Menopause itself is just a brief moment — starting the next day, you are in postmenopause.
“We tend to think about being ‘in’ menopause as this long phase in midlife, when we’re actually mostly talking about being in perimenopause and postmenopause. In the time before your last period, your hormones are fluctuating, which causes these signs and symptoms. After you’ve reached menopause, your estrogen and progesterone levels have dropped, so you may still experience some issues. Remember, it’s different for every woman, so be open with your doctor to ensure you’re being treated properly,” says Melynda Barnes, M.D., Clinical Director at Rory.
Every woman experiences natural menopause differently, but there are signs that indicate you might be close to reaching menopause.
They’re the most well-known sign of menopause, and for good reason— hot flashes affect an estimated 75 percent of women. A hot flash is when you suddenly feel a rush of heat in your body anywhere from a few seconds to several minutes or even longer. You might experience them multiple times in a single day, or a few times a month.
They tend to be most intense in the face, neck, and chest. During a hot flash, your skin may look red and blotchy and your heart rate may speed up. You might even break out into a sweat that turns into a chill if you lose too much body heat.
Hot flashes usually start before your last period (during perimenopause) and typically last 5 to 7 years, but can last up to 10 to 15 years (1).
Night sweats are hot flashes that happen while you’re sleeping and make you sweat so intensely that your pajamas and sheets are soaked through. They may wake you up, which can make you groggy the next day.
Absence of menstrual cycles
When you reach menopause, your period stops because you’re no longer ovulating and your uterine lining no longer grows and sheds. You reach menopause when it’s been 12 months since your last period.
A lot of women gain weight during this time in their lives, which is mostly a factor of a slowing metabolism and a decrease in lean body mass due to aging, according to The North American Menopause Society (2).
Perimenopause, however, may be related to changes in body shape. Some women who carried more of their weight below their waist (“pear-shaped”) start to carry more weight above their waist (“apple-shaped”).
Vaginal dryness and vaginal atrophy
When your body loses estrogen, the lining of the vagina becomes thin, pale, and dry. This change in the vaginal walls is called vaginal atrophy. The lining can become so thin that the once abundant folds of extra skin disappear and the vagina loses much of its capacity to expand when needed. The vagina opening becomes more narrow and the vaginal canal narrows and shortens.
One of the most frustrating sign of this is that penetrative sex may become painful or cause bleeding, which can make some women feel embarrassed, isolated, and even confused — why is it hurting if it’s never hurt before? Why does it hurt when you’re aroused? You’re not alone.
Between 17 and 45 percent of postmenopausal women say they find sex to be painful, according to The North American Menopause Society (3). While the statistics tend to look at women after they’ve reached menopause, a small HealthyWomen survey (4) found that 62 percent of women aged 45 and older experienced pain during or after sex. In other words, it’s definitely a common issue for women in midlife.
Vaginal atrophy can also make gynecologic exams feel painful.
In addition to vaginal atrophy, you may also be dealing with vaginal dryness. Normally, when you’re aroused, your glands release lubrication, to ready your body for sex. But when you reach perimenopause and menopause, you might find it takes more time, even when you’re stimulated, and you might be more dry than usual, which causes friction and makes penetration uncomfortable.
Loss of libido
While vaginal dryness and vaginal atrophy can turn you off from sex, even without those physical changes loss of sexual desire is something many women experience during midlife.
The stats say that women in midlife have less sexual desire (5), have sex less frequently, and have higher rates of sexual discomfort (6). You might find it reassuring that it’s not just you, but it can still be extremely frustrating, embarrassing, and a serious stressor on your relationship.
Your libido is a complex blend of your physical, psychological, and emotional health. Talking to a doctor and your partner can help you find a solution that’s right for you.
Changes in your mood, including irritability, fatigue, or even anxiety and depression, can start during perimenopause because of hormonal fluctuations. Up to 23 percent of women notice mood changes at this time, according to The North American Menopause Society (7).
In a large 10-year study, researchers found that a woman’s risk for high depressive symptoms (including fatigue, feelings of worthlessness, and significant weight loss/gain) and disorder is greater during and possibly after reaching the menopausal transition (8).
Sleep issues and insomnia
With your estrogen and progesterone levels fluctuating and eventually lowering, you’re losing tools that help you get sound sleep. Estrogen is not only related to temperature regulation (see: night sweats), but it also helps stabilize sleep and increase sleep time (9). Progesterone helps you fall asleep.
Anxiety, stress, and depression can also mess with sleep. Even if you haven’t dealt with sleep problems before, insomnia may interfere with your ability to rest.
Problems with urinary function
With the drop in estrogen comes a reduction in the urinary tract’s ability to control urination. You might feel the sudden need to urinate, experience frequent urination, or pain on urination — not unlike symptoms of a urinary tract infection (UTI).
The rapid drop in estrogen levels may explain why you may experience two of the more common hair changes: thinning hair on the top and crown of your head and facial hair. When estrogen drops, androgen (a male hormone) increases, which is what can turn peach fuzz on your chin and upper lip into darker, courser hair. Androgen may also make your hair thin out and become finer.
1. Avis N, Crawford S, Greendale G. Duration of menopausal vasomotor symptoms over the menopause transition. Jama Intern Med. 2015;175(4):531-539.
2. Changes in Weight and Fat Distribution. Changes in Weight and Fat Distribution, Sexual Side Effects of Menopause | The North American Menopause Society, NAMS. Accessed February 22, 2019.
3. Pain with Penetration. Pain with Penetration, Sexual Side Effects of Menopause | The North American Menopause Society, NAMS. Accessed February 22, 2019.
4. Menopause and Painful Sex: What You Need to Know. HealthyWomen. Accessed February 22, 2019.
5. Shifren JL, Monz BU, Russo PA, Segreti A, Johannes CB. Sexual problems and distress in United States women: prevalence and correlates. Obstet Gynecol. 2008;112(5):970-8.
6. Lonnèe-Hoffmann RA, Dennerstein L, Lehert P, Szoeke C. Sexual function in the late postmenopause: a decade of follow-up in a population-based cohort of Australian women. J Sex Med. 2014;11(8):2029-38.
7. Depression, Mood Swings, Anxiety. Depression, Mood Swings, Anxiety, Sexual Side Effects of Menopause | The North American Menopause Society, NAMS. Accessed February 22, 2019.
8. Bromberger JT, Kravitz HM. Mood and menopause: findings from the Study of Women’s Health Across the Nation (SWAN) over 10 years. Obstet Gynecol Clin North Am. 2011;38(3):609-25.
9. Eichling PS, Sahni J. Menopause related sleep disorders. J Clin Sleep Med. 2005;1(3):291-300.