Here’s everything you can expect, with advice straight from OB/GYNs on how to cope. By Emily Laurence
With the exception of childbirth, menopause is the biggest physical change a woman will experience after puberty. Menopause is the permanent end of menses, which is completely natural and caused by a decrease in estrogen. Women spend roughly 40% of their life in the postmenopausal years.
The onset of perimenopause typically begins around 45, with the average age of being in full-blown menopause between 50 and 52. If you're around this age, you may be wondering what exactly to expect. Sure, you've heard of hot flashes, but what about the less talked about symptoms? Or perhaps you are all too familiar with menopause symptoms and you just want to know how to make them more bearable.
With renewed research around hormone replacement therapy, many women are wondering if HRT might be a possible solution. "Hormone replacement therapy is traditionally used when a patient is experiencing menopausal changes that are distracting, distressing or making life complicated," says Dr. Brian Tesler, MD, FACOG, the System Chief Medical Director for Women's Health and Perinatal Services at McLaran Health Care. He explains that hormone replacement therapy is when the body is supplemented with hormones the ovaries decrease or stop producing to help the body better adjust to the changes happening during menopause. "It's important to know there are different types of hormone replacement therapy and the ways you take them," he says.
Dr. Tesler says it's important to talk to your doctor about your particular symptoms, medical history and get a comprehensive lab panel to know if HRT is necessary. "Each patient's journey through perimenopause and menopause is different. Some patients can manage concerns by changing their lifestyle and environment, such as sleeping in lighter clothing to help with night sweats or using fans during the day for hot flush feelings. Other patients can take non-hormonal medications or supplements and see reasonable control of symptoms," he says. Most experts recommend starting hormone replacement therapy before the age of 60 and sticking with it for a maximum of 10 years, he says.
Included here is a comprehensive list of every single menopause symptom as well as how to make all of them easier to endure.
Hot flashes
You’ve probably heard of hot flashes, but what exactly are they? They happen spontaneously and suddenly, a feeling of warmth that is felt on the chest, neck and face. Often, hot flashes make you sweat.
“Hot flashes can be uncomfortable, but there are several strategies you can try to make them more manageable through lifestyle change,” says Dr. Anna Cabeca, DO, OBGYN, FACOG. Dr. Cabeca recommends dressing in layers, which makes it easier to adjust when a hot flash strikes. She adds that certain foods and drinks can trigger hot flashes, including spicy foods, caffeine and alcohol, so it can help to minimize consumption of them.
“Stress can contribute to hot flashes. Practice relaxation techniques like yoga, meditation or deep breathing,” Dr. Cabeca added, noting that getting enough sleep also helps minimize hot flashes. If you try all of this and hot flashes are still making you miserable, Dr. Cabeca says it may be beneficial to consider hormone therapy, which can be discussed with your doctor. “There are also medications specifically approved for hot flashes that don't contain hormones,” she adds.
Dr. Tesler says that breast tenderness often happens during perimenopause and goes away when menopause sets in. "Breast tenderness is related most to the fluctuation or changes of hormones like progesterone and estrogen. Often during perimenopause, or the period around menopause when the ovaries start to shut off gradually, is when most people experience breast tenderness," he says. Dr. Tesler says that, for some people, caffeine can make breast tenderness worse, so it may be beneficial to minimize how much you're consuming. He says that making sure your bras fit correctly can help too, as well as hormone therapy if it's really inhibiting you from enjoying life.
Dry mouth
Something else that can happen due to a drop in estrogen, Dr. Tesler says, is your mouth feeling extra dry. "There have been studies that show the amount and consistency of saliva change in menopausal patients. This can be as severe as what is known as 'burning mouth syndrome,' where some experience a feeling that their tongue and mouth are on fire," he says, adding that if it's something you are experiencing, you should tell your doctor and dentist because it can impact the teeth and gums. To manage dry mouth, Dr. Tesler suggests using sugar-free, natural lozenges such as ginger, known to stimulate saliva production, or special mouthwashes.
Vaginal dryness
If you are experiencing vaginal dryness, don’t be afraid to talk to your doctor about it! Dr. Cabeca says this is an extremely common menopause symptom.
“Vaginal dryness during menopause can be such a frustrating experience, but there are definitely ways to manage it and feel more comfortable. You want to keep it moisturized, using gentle, natural moisturizers like coconut oil, shea butter, aloe vera gel, hyaluronic acid or vitamin E. These can help soothe and hydrate the skin down there without any harsh chemicals,” she says. (Be sure to speak with your OB/GYN before using anything topical inside your vagina, or you may risk irritation and infections, not to mention wrecking latex condoms if you're sexually active, putting you at risk of STIs.) Dr. Cabeca adds that eating a nutritious diet can help as well. If those don't help, you can consider prescription medications, according to Cleveland Clinic, so be sure to speak to your OB/GYN.
Sleep disturbances
Trouble sleeping is one of the primary symptoms of menopause and can mean trouble falling asleep or waking up in the middle of the night. “Sleep disturbances are common during menopause due to hormonal fluctuations. Estrogen levels decline, which can disrupt the body's natural sleep-wake cycle. Additionally, hot flashes and night sweats can wake women up throughout the night,” Dr. Cabeca says.
Dr. Cabeca recommends making your bedroom as conducive to a good sleep environment as possible. That means making sure it’s cool and dark and having bedding that feels good to you. She also says it’s important to stick to a regular sleep schedule, which helps support circadian rhythms.
Mood swings
It’s not your imagination if you find yourself moodier than usual. This is yet another common symptom of menopause. “Hormonal fluctuations, specifically the decline of estrogen and progesterone levels, can lead to significant emotional symptoms such as irritability, anxiety, depression and feeling overwhelmed,” Dr. Cabeca explains. The fix here? Dr. Cabeca says to prioritize self-care and do what you can to support balance in the body by eating a nutritious diet, which is less likely to spike blood sugar levels than one that primarily consists of sugary, ultra-processed foods, which can make mood swings more likely.
And don’t be afraid to see a therapist if you are really struggling. “You can always look for help. Talk to someone that can help you as you’re processing these changes in life and within your body,” Dr. Cabeca says This may also be an area where hormone therapy can be useful, so if nothing else is helping, definitely talk to your OB/GYN or a psychiatrist, who will be able to prescribe hormonal replacements or medications to help you feel like your best self again..
Weight gain
It’s natural to gain weight during menopause, especially around the abdomen. “The hormonal changes we experience during menopause, especially the drop in estrogen, has a direct impact on our metabolism which in turn, will impact your weight,” Dr. Cabeca told us. While she says that maintaining a healthy diet and regular exercise can help, she says it can be especially beneficial to maintain a low-carb diet and eat lots of leafy greens. “This approach not only helps with weight loss, but also supports overall hormone balance,” she says. Dr. Cabeca added that doing what you can to minimize stress can be helpful too, because it keeps cortisol levels from rising. This is key since high cortisol makes weight gain easier.
Itchy skin
Dr. Tesler explains that as estrogen decreases, skin loses collagen (a connecting tissue that gives it elasticity) and natural oils that keep it hydrated. This can make the skin feel dry and itchy. "Other than hormone replacement, successful remedies include decreasing hot shower temperature, moisturizer, avoiding skin irritants and wearing looser non-synthetic clothing," he says.
Dry eyes
Dr. Abby Flannagan, DO, an OB/GYN at UnityPoint Health, says it isn't unusual to experience dry eyes during menopause. To manage it, she suggests using lubricating eye drops, which provide moisture. Dr. Flannagan says that taking an omega-3 fatty acid supplement may help too because it helps balance hormones. She adds that it's also a good idea to stay on top of your yearly eye exams to make sure nothing else is contributing to the dryness.
Brain fog
“Another symptom that often flies under the radar is brain fog,” Dr. Cabeca says, describing brain fog as a feeling of forgetfulness or trouble concentrating. Some ways to minimize brain fog include taking regular breaks from activities that require a lot of focus, getting consistent, good quality sleep, minimizing stress, exercising regularly and eating a balanced diet. Brain fog can also be a symptom of long COVID, so if you're concerned, definitely talk to your doctor to determine the root cause of the problem.
Ringing in the ears
While Dr. Flannagan says that menopause can cause ringing in the ears, she says this symptom could also stem from a change in hearing due to age. For this reason, she suggests seeing an audiologist to make sure there are no underlying health issues and for treatment. "Estrogen is believed to play a role in the connections between the hearing mechanisms of the ear and the brain that processes the sounds. Research states both progesterone and estrogen are to blame when it comes to hearing and ringing problems during menopause," Dr. Tesler says, adding that aspirin, ibuprofen, caffeine and alcohol can all exacerbate symptoms. "Some studies have shown success with distraction techniques such as yoga and deep breathing to 'block out' the ringing," he adds.
Heart palpitations
Heart palpitations is another symptom Dr. Cabeca says many people don’t realize is connected to menopause, but it’s something more than half of menopausal women experience. Scientific research shows that hormone replacement therapy may help with heart palpitations, so if it’s something you are experiencing regularly and it’s impacting your ability to function or enjoy life, it may be beneficial to talk to your doctor about it.
Frozen shoulder
Dr. Cabeca says that another symptom of menopause many people don’t know is frozen shoulder, which is experiencing pain or stiffness in one or both shoulders. While hormone replacement therapy can help decrease this, it can also be treated by taking an over-the-counter painkiller or applying a heating pad.
Restless legs
Ever experience an uncomfortable feeling in your legs that feels like the urge to move them? This restless leg symptom can be due to menopause, Dr. Cabeca says. Medications like gabapentin and pregabalin can help decrease symptoms, so if it’s something you’re experiencing regularly, talk to your doctor.
Alcohol intolerance
You may find that alcohol affects you more during menopause. "Alcohol causes a lot of changes in the menopausal person. People may notice it makes them have to use the restroom more often, hangovers are worse and the amount they can drink is significantly less," Dr. Tesler says.
Dr. Tesler explains that this is likely due to the liver losing the ability to process alcohol as well, so alcohol stays concentrated for longer. "It is also known that the body loses water more quickly during menopause, and this is thought to reduce the ability to dilute alcohol and its effects," he adds. He recommends minimizing intake—especially before bed as it can disrupt sleep. “It's important to remember that menopause is a unique experience for every woman,” Dr. Cabeca says. “Some might sail through with minimal symptoms, while others might face a mix of these challenges. If you're noticing any changes that feel ‘off,’ it's always a good idea to chat with your healthcare provider.”
Remember, if any symptom is getting in the way of your daily functioning or is making you feel depressed, talk to your doctor. Together, you can find a way to decrease your symptoms so you can go back to feeling like yourself again.
