What Are the Most Common Signs of Menopause?

Technically, menopause is the cessation of periods for 12 months. Because estrogen plays a role in keeping many of the body’s systems running smoothly, its decline can contribute to many of the irksome symptoms of the menopausal transition.

1. Weight Gain

Many women notice that their clothes begin to fit differently after age 40, even if their diet and exercise habits remain the same. According to functional-medicine physician Sara Gottfried, MD, author of The Hormone Cure, this is because the rate of fat gain increases as estrogen declines, and much of this fat will be stored at the waist, as fat-distribution patterns also change. When hormones level out after menopause, the weight gain typically stops.

While the weight itself is not a health issue, Gottfried notes that it can correlate with metabolic-health challenges, including a greater risk for heart disease, high blood pressure, and problems with insulin regulation.

Try this: Gottfried suggests a modified ketogenic protocol (unlike strict keto, her approach includes a modest amount of carbohydrates) and intermittent fasting (IF) to help her patients manage their hormones, including insulin and cortisol, and stabilize their weight.

Romm, meanwhile, suggests a cautious approach to IF. “For some women it can help,” she says, but she’s concerned that effects may diminish after six to eight weeks. Fasting can also have rebound effects on blood sugar and weight, she adds, “so maybe do it a couple of days a week instead of all the time.” (For more on fasting, see “Everything You Need to Know About Intermittent Fasting“.)

2. Sleeplessness

With or without night sweats, disrupted sleep is a problem for many women during perimenopause. Again, this has to do with hormonal changes. Melatonin, the hormone that regulates sleep timing, decreases naturally with age, explains Aviva Romm, MD, an integrative-medicine physician, women’s-health specialist, and author of Hormone Intelligence.

What’s more, melatonin is produced from serotonin, which is also related to estrogen production; some research suggests that as estrogen declines, so does melatonin. These shifts are normal, she emphasizes, but they do set up a “triple hormonal whammy.”

Try this: Romm, a trained herbalist, recommends a sleep-supporting cocktail of three herbal tinctures: passionflower, valerian root, and lemon balm. During a phase of rough sleep, take 20 to 45 drops of any or all of these a half-hour before bed, and then again 15 minutes before lights out.

Place a third dose on the night­stand in case you wake up in the middle of the night.

3. Hot Flashes

Vasomotor symptoms, colloquially known as hot flashes, are the signature symptom of perimenopause and menopause. They can be triggered by a warm room, a stressful situation, or nothing at all, and typically they last from one to five minutes. They may feel like a warm flush or a full-blown conflagration, which makes you want to immediately strip down to your tank top in a room full of people in sweaters.

Sixty to 85 percent of women experience hot flashes, and frequency may be correlated with race, with African American women reporting the greatest number of episodes. Researchers remain at a loss for why this is so.

Try this: For immediate relief during a hot flash, Gottfried recommends this breathing exercise: Take a five-second inhale, 10-second hold, and five-second exhale. Repeat until you cool down.

Other strategies include wearing layers you can remove as needed, keeping the bedroom cool at night, and avoiding spicy foods and alcohol if these are triggers for you. (Red wine, notes Romm, can be one of the worst culprits.)

Severe or chronic hot flashes can signal a greater risk for cardiovascular disease. If this is the case, work with your healthcare provider on heart-health protective strategies, such as smoking cessation and dietary changes. (For more on heart health, see “Rethinking Heart Health“.)

4. Anxiety and Mood Swings

These are familiar PMS symptoms as well as routine features of the menopausal transition. In both cases, the abrupt shift in hormone levels can tank mood. Like estrogen, progesterone also drops (though more gradually); this hormone typically has a calming effect. When progesterone goes down, it can be “harder to soothe yourself,” explains Gottfried.

Try this: You know better than anyone else what helps you manage your mood in a healthy way. Is it a yoga practice? Playing guitar? Long solo walks? Start there.

At a minimum, consider adopting a nonnegotiable daily movement practice, and keep a few calming herbal interventions on hand, such as kava, ashwagandha, or CBD.

5. Memory Loss

As hormones begin to shift, many women find themselves struggling with word recall and other short-term memory tasks. This may be caused by the hormonal switch from the more potent estradiol, which plays a role in brain function, to estrone, the less-potent form of estrogen.

Happily, this effect seems to be temporary, according to one study that followed 2,362 perimenopausal women for four years. Once the menopausal transition concluded, these cognitive issues disappeared.

Try this: Rhodiola, an adaptogenic herb, can help with mental clarity and focus. A sense of humor is also handy.

6. Declining Libido and Changes in Vaginal Health

Throughout the reproductive phase, estrogen helps foster interest in sex, and when estrogen declines, so can libido. Estrogen also plays a prominent role in keeping the tissues of the vagina healthy, and accordingly, they can become drier and thinner as the hormone declines.

These changes also involve structures beyond the vagina, including the bladder, urethra, and vulva; medically, this is known as genitourinary syndrome of menopause, or GUSM. It can make intercourse uncomfortable or painful and bring on a more frequent need to pee. As symptoms go, this group may get the Biggest Bummer award. (There are many reasons why women chronically experience pain during intercourse. See “14 Reasons Why Sex Might Be Painful for Women” for more.)

Try this: Regular walks support blood flow. Adding flaxseeds and soy foods (for the phytoestrogens) can help relieve vaginal dryness. Regular sexual activity (using additional lubrication as needed) may be the best way to maintain elasticity.

Be willing to experi­ment. “Sometimes a small adjustment creates big changes,” notes Gottfried. “I love it when a patient realizes that she can alter her presumed life-sentence of low sex drive with a particular form of meditation, like orgasmic meditation.”

This was excerpted from “What You Should Know About Menopause” which was published in the October 2022 issue of Experience Life.