What are the symptoms of menopause?
The most common are hot flashes and night sweats, sleep problems, mood changes, vaginal dryness and more urinary infections, joint and muscle aches, and lower sex drive. Hot flashes usually fade over several years, with a median total of 7.4 years in a large US study. Vaginal and urinary symptoms tend to stay or worsen unless treated. Menopause also brings changes you do not feel, such as faster bone loss and muscle loss, which training, protein and calcium help counter.
Key takeaways
- Hot flashes and night sweats are the best known symptom, and often the longest lasting.
- In the SWAN study, frequent hot flashes lasted a median of 7.4 years, and 4.5 years after the final period.
- Vaginal dryness and urinary symptoms usually do not fade on their own, but they respond well to treatment.
- Joint and muscle aches are a recognized menopause symptom in the NICE guideline.
- Silent changes matter as much: bone is lost quickly for 4 to 8 years after menopause, and muscle declines.
- Lists of 50 symptoms are not official. They split the same few groups into smaller items.
- Hormone therapy is the most effective treatment for many symptoms. Your clinician can weigh it with you.
Menopause symptoms are not one thing that starts and stops together. Some fade within a few years, some stay unless treated, and some never make themselves felt at all. Knowing which is which helps you decide what to treat and what to plan for. What menopause is covers the stages and timing.
The main menopause symptoms
NICE, the UK guideline body, lists the recognized symptoms of menopause as changes in the menstrual cycle, hot flushes and sweats, genitourinary symptoms such as vaginal dryness, effects on mood such as low mood, joint and muscle pain, and sexual difficulties such as low desire. It also notes that symptoms range from minor to severe and can last a short or a long time.1 ACOG adds sleep problems, including trouble falling asleep and waking early.2
The SWAN study, which followed thousands of US women through the transition, studied the same set: hot flashes, sleep complaints, psychological symptoms, cognitive performance, and urogenital and sexual health.4
Which symptoms fade and which stay
| Usual course | What helps most | |
|---|---|---|
| Hot flashes and night sweats | Median 7.4 years in total, then fade | Hormone therapy, non-hormone medicines, CBT |
| Sleep problems | Often tied to night sweats | Treating night sweats, then sleep itself |
| Mood changes | Varies from woman to woman | Talk to a doctor if new or worsening |
| Joint and muscle aches | Variable | Staying active, strength training |
| Vaginal dryness, urinary symptoms | Tend to stay or worsen | Local estrogen and other treatments |
| Bone and muscle loss | Silent, ongoing | Training, protein, calcium, vitamin D |
Hot flashes and night sweats
A hot flash is a sudden feeling of heat rushing to the face and upper body, lasting seconds to minutes. Night sweats are the same thing during sleep.2 In SWAN, frequent hot flashes lasted a median of 7.4 years in total and a median of 4.5 years after the final period. Women whose flashes began before or early in perimenopause had them longest, over 11.8 years.3 Hot flashes covers causes and treatment.
Vaginal and urinary symptoms
As estrogen falls, the vaginal lining becomes thinner, drier and less elastic, which can make sex painful. The urethra can become irritated too, which means needing to urinate more often and more urinary infections.2 Unlike hot flashes, these usually do not fade on their own, but treatment works well, so it is worth raising with your clinician.
Joint pain and brain fog
Joint and muscle pain is on NICE's list of menopause symptoms.1 Brain fog, meaning trouble focusing or finding words, is common enough that SWAN studied cognitive performance as one of its core areas.4 Broken sleep from night sweats makes both worse. Menopause insomnia covers the treatment, and menopause fatigue the daytime side.
Why some lists say 50 symptoms
Lists of 50 menopause symptoms take the six groups above and divide them into small pieces. They are not an official list. They are useful if you are wondering whether something odd is related to menopause, but they can also make the transition sound worse than it is for most women, who have a handful of symptoms rather than dozens.
The symptoms you cannot feel
Two changes go on without any symptom at all.
Bone. Women lose bone faster in the first 4 to 8 years after menopause, which raises the risk of osteoporosis.2 What osteoporosis is explains why this matters.
Muscle. In SWAN, lean mass began to fall during the transition while fat gain sped up.5 NICE advises explaining to everyone going through menopause the importance of keeping muscle mass and strength through physical activity.1
Muscle is kept by two things together: strength training and enough protein. Protein Buddy works out a daily protein target from a short quiz on your weight, age, activity and goal, and Home shows how many grams are left today as you log. Typing meals in by hand is free with no limit. Protein through the menopause transition has the numbers.
Vitamins for menopause fatigue covers the deficiencies worth testing for.
Treatment
Hormone therapy is the most effective treatment for hot flashes and night sweats and also relieves vaginal dryness.2 For women who cannot or do not want to use it, the Menopause Society recommends cognitive behavioral therapy, clinical hypnosis and several prescription medicines for hot flashes, and does not recommend supplements or herbal remedies.6 Natural menopause treatments lists the non-drug options that work.
Which treatment fits depends on your symptoms, age and health history, so it is a decision to make with your clinician. See a doctor promptly about:
- any bleeding after menopause
- low mood or anxiety that is new or getting worse
- any symptom that stops you sleeping or working
More questions about Women over 40
What are the 50 symptoms of menopause?
There is no official list of 50. Long lists break the main groups (temperature, sleep, mood and thinking, joints and muscles, vaginal and urinary, sexual) into many smaller items. They can help you recognize that a symptom is related to menopause, but most women have only a handful.
How long do menopause symptoms last?
It depends on the symptom. In the SWAN study, frequent hot flashes and night sweats lasted a median of 7.4 years in total, and longer in women whose flashes started early in perimenopause. Vaginal dryness and urinary symptoms often continue for years after menopause unless they are treated.
Can menopause cause joint pain?
Yes. NICE lists joint and muscle pain among the recognized symptoms of menopause. Staying active, strength training and keeping a healthy weight often help. New joint swelling, redness or pain that is severe should be checked by a doctor.
Is brain fog a symptom of menopause?
Many women notice trouble concentrating or finding words during the transition. SWAN studied cognitive performance through the menopause transition as one of its main areas. Poor sleep from night sweats can make it worse. If memory problems are severe or getting worse, see your doctor.
What symptoms continue after menopause?
Hot flashes can continue for several years after the final period. Vaginal dryness, discomfort during sex and more frequent urinary infections are common after menopause and often need treatment to improve. Bone and muscle loss also continue without symptoms.
References
- Menopause: identification and management (NG23)
- The Menopause Years
- Duration of menopausal vasomotor symptoms over the menopause transition
- The menopause transition and women's health at midlife: a progress report from the Study of Women's Health Across the Nation (SWAN)
- Changes in body composition and weight during the menopause transition
- The 2023 nonhormone therapy position statement of The North American Menopause Society
