Please note these symptoms are not necessarily exclusive to perimenopause and menopause and in some cases can signify other potentially serious problems. If in doubt please speak to your doctor.
How long do perimenopause and menopause symptoms last?
The length of time that menopause symptoms last is different for everyone but they can start months or years before your period stops. The average length that they last for is about seven years. During this time, menopause symptoms can change. You may have some that come and go, while others linger. Lifestyle factors, such as age, weight and whether you smoke, can affect the duration and intensity of menopause symptoms.
Perimenopause is the time leading up to menopause where the amount of oestrogen produced by the ovaries fluctuates until a point of no further oestrogen production. This stage can last up to ten years, but its average duration is around four years.
You reach menopause when you have gone 12 consecutive months without a menstrual period. Many report their symptoms are at their worst during the 12 months after their final menstrual period.
Postmenopause is the stage of life after your periods have stopped. While some symptoms may disappear, others can last indefinitely.
Medications and other treatments can help you to manage and relieve symptoms. For example, Hormone Replacement Therapy (HRT) can help control hot flushes and night sweats, while vaginal moisturisers and lubricants can reduce day-to-day discomfort and pain during sex.
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The most common symptoms
Perimenopausal and menopausal symptoms include physical, emotional and psychological symptoms. These symptoms can vary in duration and intensity between individuals but some, including irregular periods, hot flashes, sleep issues, mood swings and vaginal discomfort are experienced by most women.
Most symptoms are a result of the steep drop in the amount of oestrogen produced by the ovaries. The most common symptoms of menopause include:
Bowel
Constipation
Changes in hormones can affect the digestive tract and slow digestion, causing constipation. Reduced muscle tone in the intestines can also contribute.
Diarrhoea
The gut’s normal function can be impacted by changing hormone levels, altering how quickly food moves through the intestines. This can lead to sudden bouts of diarrhoea.
Faecal incontinence
Faecal incontinence is common in postmenopausal women. Neuromuscular mechanisms that control continence can be affected by low oestrogen levels. In addition, a loss of muscle mass can cause the pelvic floor muscles to become thinner and weaker. This can result in urge incontinence, where there is a sudden need to have a bowel movement or passive incontinence, where you are passing stool without realising it.
Gastric reflux
Decreasing oestrogen can relax the oesophageal sphincter, leading to acid reflux and heartburn.
Breast
Breast changes
Oestrogen stimulates breast tissue growth so when levels decline during perimenopause, breasts can shrink. The distribution of fat within the breasts can also change, making them appear less full and softer. However, some women may find their breasts grow due to weight gain.
Breast tenderness
Fluctuating hormone levels can lead to water retention and breast tissue sensitivity, causing tenderness, burning, throbbing, or a stabbing sensation in the breasts.
Cardiovascular
Adrenaline surges
Menopause can disrupt the regulation of the adrenal glands, causing sudden spikes of adrenaline, leading to a rapid heartbeat and anxiety.
Chest pain
Chest pain can be a symptom of perimenopause and menopause but it’s important to rule out other causes, such as heart disease, especially if accompanied by other symptoms such as shortness of breath and neck pain.
Palpitations
There are oestrogen receptors throughout the body, including the heart, so declining levels can cause the heart to flutter or skip during menopause.
Ear, nose and throat
Globus
A sensation of a lump in the throat may occur due to changes in hormone levels, which can affect throat muscle relaxation.
Taste and smell changes
Falling oestrogen levels can reduce the flow of saliva, which can reduce or change how things smell and taste. You may also experience a metallic taste in the mouth.
Tinnitus
Lower oestrogen levels may affect the inner ear, leading to ringing, buzzing or whirring sounds. Hormone replacement therapy can decrease the risk of tinnitus in menopausal women.
Voice changes
Many women find their voice becomes huskier or deeper during menopause. This can be a result of the vocal cords becoming less supple and thinner, dryness in the larynx, or vocal fatigue.
Eyes
Dry eyes
Gritty, itchy or uncomfortable eyes are a common symptom of menopause, affecting more than 60% of menopausal women.
Watery eyes
As a result of dry eyes, you may actually find you experience watery eyes too. This is because the body tries to produce a lot of tears to alleviate the condition but this makes the eyes more irritated, causing further streaming.
Genital / Sexual
Arousal difficulty
Decreased blood flow and sensitivity in the genitals can make arousal more challenging. Low mood can further contribute to changes in sexual desire and arousal.
Bacterial vaginosis (BV)
The 'good' bacteria in the vagina thrive on oestrogen, so when this hormone drops, it can lead to imbalances in your vaginal flora, increasing your risk of bacterial vaginosis.
Difficulty achieving orgasm
Decreased oestrogen can lead to reduced sensitivity and lubrication, making it harder to reach orgasm. Feeling less confident due to body changes can also make it more difficult.
Discomfort during sex
Vaginal dryness and thinning of the vaginal walls can make intercourse uncomfortable or painful. Using a lubricant during sex can help.
High libido
While not as common as experiencing low libido, decreased oestrogen and progesterone can make the effects of testosterone more obvious, resulting in an increased sex drive.
Low libido
Lower sexual desire is a common symptom of menopause which can be driven by physical changes such as vaginal dryness, as well as emotional factors including reduced self-esteem and depression.
Perineal itch
Thinning skin in the perineal area (between the vagina and anus) due to hormone changes can cause itchiness.
Thrush
Hormonal imbalances can create an environment that increases the likelihood of yeast infections in both the mouth and vagina.
Vaginal discharge
Changes in oestrogen levels can cause shifts in the quantity and consistency of vaginal discharge. After menopause, your vagina tends to lose its moisture and you may produce smaller amounts of discharge.
Vaginal dryness
The main genitourinary symptom of menopause, vaginal dryness is caused by the lining of the vagina thinning due to low oestrogen levels. It can make sex uncomfortable, and lead to itching and occasional bleeding.
Vulval itch
Hormonal changes lead to thinning and dryness of the vulva, causing irritation and itchiness.
Immunological
Histamine sensitivity
Hormones and histamine are closely linked which is why during menopause, your body may find it more difficult to break down histamine in the body, resulting in hives, itching or other allergy-like symptoms.
New allergies
You may find you develop new intolerances or allergies to foods or other things, such as pollen or scented products, or that existing allergies become worse.
Menstrual
Irregular periods
Irregular periods are one of the main symptoms of perimenopause. Your cycle may become unpredictable, becoming short or longer or skipping periods intermittently. Your menstrual flow can also become heavier or lighter.
Periods stop
A key indicator that you have reached menopause is that you have gone 12 consecutive months without a menstrual period.
Mental health, mood and cognitive health
Anxiety
Anxiety is a common symptom of the menopausal transition. While hormonal changes play a part, anxiety can be further fuelled by life changes, sleep disturbance and other physiological and psychological factors.
Brain fog
Cognitive changes, including forgetfulness and difficulty concentrating, are common due to hormonal shifts.
Depression
Decreased oestrogen can affect neurotransmitters like serotonin, contributing to feelings of sadness or depression.
Difficulty concentrating
Difficulty concentrating is a direct result of fluctuations in hormones. It can make completing tasks at work or home feel much more challenging.
Dizziness
As the inner ear can be affected by hormone changes during menopause, you may experience dizziness, lightheadedness or a loss of balance.
Fatigue
Reduced oestrogen and progesterone can impact your metabolism and sleep cycle, making you feel like you have less energy. In addition, sleep issues during menopause can lead to tiredness during the day.
Headaches and migraines
Menopause headaches and migraines can be triggered by fluctuations in oestrogen which is why they may become more common and/or severe.
Insomnia
Hormonal shifts occur during menopause and sleep problems are common as a result. You may find it harder to fall or stay asleep.
Irritability
It’s not unusual to experience frequent mood swings during menopause due to hormone changes. Irritability can feel similar to PMS but may occur at different points throughout your menstrual cycle.
Low mood
The changes inside your body can affect neurotransmitters, directly affecting your mood. However, navigating the symptoms of menopause can be hard which can affect how you feel too.
Loss of confidence and self-esteem
The physical and emotional effects of menopause can lead to a reduction in self-confidence.
Stress
Hormonal shifts can heighten feelings of stress and overwhelm, impacting emotional well-being. Further, physical symptoms, such as hot flashes, can disrupt your everyday life, creating further stress.
Metabolic
Fat redistribution
Menopause often leads to fat being stored more around the abdomen and waist rather than the hips and thighs.
Glucose and lipid metabolic change
Oestrogen influences how the body processes glucose and fats, and its decline can lead to changes in cholesterol levels and insulin sensitivity.
Lower tolerance to alcohol
Hormonal changes during menopause can cause the liver to break down alcohol more slowly and reduce the enzymes that break down alcohol, lowering your tolerance.
Weight gain
The slowing metabolism and hormonal shifts during menopause often contribute to weight gain, particularly around the midsection.
Musculoskeletal
Muscle and joint aches and pain
Changing hormone levels can impact your bones, muscles, collagen and soft tissues, leading to increased inflammation, body aches and pain. Conditions like plantar fasciitis and tennis elbow can become more likely during the menopausal transition.
Restless legs
Characterised by an uncomfortable urge to move your legs and frequently accompanied by a throbbing or pulling sensation, restless leg syndrome is often worse in the evening or at night. This can lead to disrupted sleep which can result in further adverse effects like fatigue and low mood.
Oral / Dental
Burning mouth
Thought to affect between 18 – 33% of all menopausal women, burning mouth syndrome can create a burning, scalding, tingling or numbness of the mouth, lips and tongue.
Dry mouth
During menopause, saliva production decreases and moisture levels in the membrane of the mouth change. This can result in an unpleasant dry or sticky feeling in the mouth or throat as well as dry or cracked lips.
Sensitive teeth and gums
Lower oestrogen can impact oral health, making your teeth more sensitive to hot and cold foods. Gums can also be more sensitive, become inflamed, bleed and be more susceptible to disease.
Urinary
Bladder and urinary tract infections (UTIs)
Decreased oestrogen levels impact the urogenital microbiome, reduce vaginal pH and cause drying and thinning of genital tissue, making it more prone to infection. All of this makes menopausal women more susceptible to UTIs and bladder infections.
Nocturia
During menopause, the bladder can shrink, and kidney function can be impaired. In addition, women may find themselves drinking more water and waking during sleep, all of which can contribute to more frequent urination during the night.
Urinary frequency
Lower oestrogen can irritate the bladder and make its tissue more sensitive, leading to more frequent urges to urinate.
Urinary incontinence
Weakening of the pelvic floor muscles during menopause may cause loss of bladder control.
Urinary urgency
During the menopausal transition, you may feel that your need to urinate becomes much more sudden, even if your bladder isn’t full.
Skin, hair and nails
Acne
Hormonal fluctuations can cause increased oil production, leading to clogged pores and breakouts.
Body odour
Changing oestrogen levels can lead to increased sweating as well as more bacteria in your sweat. This can mean your body odour is stronger or smells different than it did before.
Brittle nails
Reduced moisture in the nails can lead to them becoming more brittle and make them more prone to cracking, splitting or peeling.
Collagen loss
Lower oestrogen levels reduce collagen production, affecting skin elasticity, firmness and thickness, making it more fragile.
Dry skin
Hormonal changes can reduce the skin's ability to retain moisture, causing dryness. Your skin may feel tight, itchy or sensitive. It may also appear dull and be prone to flaking.
Itchy skin
Thinning skin due to reduced oestrogen can lead to increased sensitivity and itchiness, also known as pruritus.
Pigmentation changes
As well as a loss of elasticity and tone, some women experience pigmentation changes to their skin during menopause. You may get darker spots of skin on your face, hand, neck or chest and signs of sun damage may become more visible.
Scalp hair loss
Hair loss during the menopausal transition is common due to a drop in oestrogen levels. As well as causing hair to shed, it can also cause hair to become thinner and drier.
Unwanted hair growth
Hormonal imbalances, particularly increased androgen levels, can lead to excess facial or body hair.
Temperature regulation
Cold flushes
Hormonal fluctuations can affect the body's ability to regulate temperature, causing cold sensations.
Hot flushes
Hot flashes or flushes are one of the most common symptoms of menopause, affecting more than 80% of all women. They cause periodic sudden yet brief increases in body temperature and sweating.
Night sweats
Night sweats in menopause are also incredibly common. They cause excessive sweating that can soak your pyjamas and bedsheets and lead you to wake up in the night.
Raynaud’s
Raynaud’s affect your circulation and can make areas of the body, particularly the extremities, feel sore, numb or cold. Reduced oestrogen can exacerbate poor circulation, causing your fingers and toes to change colour in response to cold temperatures.
Post menopause symptoms
Symptoms of menopause can persist even once your periods stop. Many will become less severe over time, but some can last indefinitely. Being postmenopausal can also make you more susceptible to other conditions.
Post menopause symptoms include:
Cardiovascular disease
After menopause, the decline in oestrogen levels can increase the risk of heart disease. It's important to maintain a heart-healthy lifestyle through regular exercise and a balanced diet.
Dry skin
A loss of skin elasticity and moisture can make postmenopausal women more prone to dry skin. Hydration and gentle skin care can help soothe these changes.
Hair loss
Hormonal shifts during menopause can result in thinning hair or hair loss, which can be distressing, but there are treatments available to support hair health.
Hot flushes
While 80% of women experience hot flushes for two years or less, many women experience them for longer.
Insomnia
35-60% of postmenopausal women have difficulty falling or staying asleep. Simple lifestyle changes, such as a consistent, calming bedtime routine, can support better sleep.
Lack of libido
Permanent changes in sexual desire aren’t uncommon after menopause but open communication with your partner and seeking medical advice can help navigate these changes and maintain intimacy.
Osteoporosis
Reduced oestrogen can result in bone thinning, increasing the risk of fractures. A diet rich in calcium, along with regular weight-bearing exercises, can help strengthen bones.
Urinary incontinence
Weakening of pelvic floor muscles post-menopause may lead to urinary leakage, but pelvic floor exercises and medical treatments can help manage this issue.
Vaginal dryness
Decreased oestrogen can cause vaginal dryness, which can result in discomfort or pain during intercourse. Lubricants and hormone therapy options can provide relief.
Weight changes
Shifts in metabolism and hormones often contribute to weight gain after menopause. Regular physical activity and mindful eating can help manage weight changes effectively.
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