Signs and Symptoms of Menopause

Hormonal changes that occur at menopause and the years preceding it can cause a variety of symptoms, such as hot flashes, irregular periods, and vaginal dryness and irritation. The severity of symptoms ranges considerably. Some women do not experience symptoms, others experience mild discomfort, and some experience severe symptoms that impact their quality of life.

Menstrual Changes

Many women experience irregular periods due to the changing hormone levels and the decreased frequency of ovulation (egg release). The changes may be subtle at first and then gradually become more noticeable. Common changes include the following:

  • Short cycles (less than 28 days)
  • Bleeding for fewer days than usual
  • Heavier than usual bleeding
  • Lighter than usual bleeding
  • Missed periods

Although menstrual irregularities are expected during menopause, menstrual changes can also be caused by conditions such as fibroids or pregnancy. Women who experience heavy bleeding (usually with clots), periods that come more often than every 3 weeks, spotting between periods, or bleeding after intercourse should see their physician or other health care provider.

After menopause, women no longer menstruate. Any woman who experiences vaginal bleeding after menopause should see her physician or other health care provider. Hormone treatments can sometimes cause vaginal bleeding to resume.

Menopause & Hot Flashes

As many as 85% of women experience hot flashes during menopause. Hot flashes are vasomotor symptoms that cause a warm or hot flushed sensation that usually begins in the head and face and then radiates down the neck to other parts of the body. There may be red blotches on the skin. Each hot flash averages 2.7 minutes and is characterized by:

  • Sudden increase in heart rate
  • Increase in peripheral bloodflow, which leads to a rise in skin temperature
  • Sudden onset of sweating, particularly on the upper body

Hot flashes can occur before, during, or after menopause. They can begin when a woman's cycles are still regular or, more commonly, as menopause approaches and her cycles become irregular. They usually last for less than a year following the last menstrual period, although some women continue to experience hot flashes 5 to 10 years after menopause.

Hot flashes can occur once a month, once a week, or several times an hour. They can happen any time of day or night. If they happen at night (i.e., night sweats), they can interrupt sleep and drench clothing and sheets. Loss of sleep can eventually lead to irritability and fatigue.

Self-care for Hot Flashes


According to The Boston Women's Health Book Collective's
Our Bodies, Ourselves for the New Century, women can do several things to prevent or reduce hot flashes:
  • Eat enough calcium and other nutrients necessary for calcium absorption.
  • Limit caffeine (coffee, tea, alcohol, chocolate), alcohol, sugar, hot drinks and soups, and spicy foods.
  • Every day eat at least one food rich in phytoestrogens, a form of estrogen that is found in soy products (soy milk, soy yogurt, soy nuts, tofu, miso, tempeh), legumes, and certain vegetables and fruits (squash, yams, carrots, papayas).
  • Some women find vitamin B-complex helpful.
  • Some women find vitamin E helpful (wheat germ, corn and soybean oil; brown rice and millet; legumes; corn; almonds). The evidence is inconclusive however, and some researchers warn that women who have breast cancer should NOT take vitamin E supplements.
  • Stay active: Physical activity can relieve hot flashes, stress, and depression, and can improve sleep.
  • Reduce stress: Hot flashes may increase in frequency and intensity during stressful times.

Menopause & Skin Changes

Estrogen keeps the skin smooth and moist. The loss of estrogen during menopause makes the skin dry, thin, lax, and transparent. The blood vessels are easier to see, and the skin bruises easily.

Menopause & Vaginal Changes

Women may experience vaginal changes. In particular, the tissues of the vagina and vulva may become thin and dry (called vaginal atrophy), which can lead to itching and discomfort during sexual intercourse. In some women, vaginal dryness is the first sign of menopause. In one study about 20% of the women reported experiencing vaginal dryness, and 15% found it "bothersome."

Vaginal dryness can be treated with hormone replacement therapy, vaginal lubricants and moisturizers, and by eating foods high in phytoestrogens (e.g., soy foods).

Menopause & Psychological Changes

Although many women think that depression and anxiety are inevitable consequences of menopause, there is no scientific evidence to support this. For example, studies have shown that women at midlife are less likely to be depressed than younger, menstruating women. Still, menopause may trigger psychological changes or make it more difficult to deal with psychological problems already present.

Menopausal women commonly seek medical advice for:

  • Night sweats
  • Hot flashes
  • Headaches
  • Tiredness
  • Lethargy
  • Irritability
  • Anxiety
  • Nervousness
  • Depression
  • Sleep difficulties (often associated with night sweats)
  • Inability to concentrate

Menopause & Urogenital Changes

As a woman approaches menopause, the lining of the urethra thins and the pelvic muscles weaken. As a result, women may

  • feel the need to urinate more frequently, even though the bladder may not be full (urinary frequency);
  • leak urine when coughing, sneezing, laughing, or lifting (urinary incontinence); 40% of postmenopausal women experience urinary incontinence);
  • need to get out of bed several times during the night to urinate (nocturia); or
  • feel painful urination.

Health Risks of Menopause

Menopause & Cardiovascular Disease

Heart disease is the leading cause of death in women over the age of 50. Twice as many women die from cardiovascular disease than from cancer, and more women than men die from cardiovascular disease. Menopause is believed to increase the risk for heart disease due to biochemical changes in the blood resulting from decreased estrogen levels. Preventative health care (e.g., regular exercise and healthy diet, moderate alcohol use, avoid tobacco products) can reduce the risk for heart disease.

Menopause & Osteoporosis

Postmenopausal women are at an increased risk for osteoporosis, a disease characterized by decreased bone density that causes bones to become porous and fragile. Bone loss is rapid during the first 4 to 5 years after menopause. Twenty-five percent of all women show radiologic evidence of osteoporosis (i.e., it can be seen on an x-ray even though it may not be symptomatic) by the age of 60.

Osteoporosis increases the risk for bone fractures, especially in the wrist, hip, and spine. Twenty-five percent of women who live to the age of 80 suffer a fractured hip. About 80% of all hip fractures in the United States are due to osteoporosis.

The risk for osteoporosis can be reduced through preventative health care. Adequate calcium and vitamin D intake and exercise are especially important.

Women can change their dietary and lifestyle habits to decrease their risk and should talk to their physician or health care provider about what steps they can take. Osteoporosis has been associated with the following risk factors:

  • Alcohol abuse
  • Cigarette smoking
  • High sodium intake
  • Sedentary lifestyle
  • High caffeine intake
  • High animal protein intake
  • Early menopause
  • Family history of osteoporosis
  • Caucasian or Asian ethnicity
  • Nulliparity (never having been pregnant)

Menopause Diagnosis

Menopause is usually diagnosed based on clinical symptoms.

A complete medical history and physical examination can help rule out other causes for menstrual irregularities and other symptoms that a menopausal woman is experiencing. The physical examination should include a Pap smear, mammogram, and lipid profile.

Publication Review By: Stanley J. Swierzewski, III, M.D.

Published: 01 Feb 2001

Last Modified: 13 Sep 2010