8 Changes That Come With Menopause

Are you having sleeping problems? Hot flashes? Mood swings? Here’s what you need to know.

Medically reviewed in December 2020

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You know those ambitious, entrepreneur types who like to dabble in just about everything? Well, your hormones are kind of like them. Sure, they're known for their reproductive prowess, but that's not their only role. They influence everything from your brain to your bones, even your heart. So, when estrogen levels start to fall during menopause, your entire body is affected.

Whether your midlife change is smooth sailing or a wild, rollicking ride, menopause can have a wide-ranging effect on both your mental and physical health. Here are eight common signs that signal you're probably going through "the change."

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Hot flashes and night sweats

For about three in four women, menopause can really heat things up. The exact cause of hot flashes is unknown, but some experts think low estrogen triggers a malfunction in the area of the brain that controls body temperature. So, the brain thinks the body is overheating and tells the nervous system to release body heat ASAP. The result is intense hot spells that can turn you red and drench you in sweat. The quicker you go through menopause, the more intense symptoms may be.

Smoking and stress can raise your risk of hot flashes and night sweats. About 20 percent of women will have hot flashes that impair their quality of life, says JoAnn Manson, DrPH, MD, chief of preventive medicine at Brigham and Women's Hospital in Boston.

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Getting a good night's sleep can be a major challenge for menopausal people, for multiple reasons:

  • During the menopause transition, production of estrogen and progesterone (a sleep-promoting hormone) decline, which can make falling and staying asleep tougher.
  • Hot flashes can jolt you awake. Then, the physical discomfort and sheet-drenching that often accompany night sweats can keep you from getting back to sleep.
  • Urinary symptoms are common to women going through menopause, so you may get up during the night to pee.
  • People going through menopause have a higher risk of sleep apnea, or interrupted breathing during sleep.

Add the usual midlife stresses, such as work and family, and you can see why sleep may so often evade menopausal people.

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Mood swings

Just as PMS can trigger cravings and crankiness, fluctuating hormone levels can cause emotional symptoms, too. Sadness, irritability, fatigue, anxiety and aggressiveness are some of the feelings that can crop up along your journey.

“Women may cry at the drop of a hat over something that on a different day wouldn’t bother them,” says Judith Volkar, MD, of the Center for Specialized Women’s Health at Cleveland Clinic.

While most people go through menopause without serious emotional health issues, many will experience depression. Depression differs from mood swings, and is often characterized by prolonged sadness, fatigue and loss of interest in things you formerly enjoyed. If you have a personal history of mood disorders or other psychiatric conditions, you may be more prone to depression during menopause.

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Sexual Changes

Menopause does not mean your sex life is over. Still, midlife changes can pose new challenges. Lower levels of estrogen can cause your vulva and vaginal walls to become dry, thin and fragile, and sex may feel less comfortable. Called genitourinary syndrome of menopause (GSM), the condition affects between 27 and 84 percent of women, according to the North American Menopause Society.

Prescription vaginal estrogen may ease symptoms, including discomfort during intercourse. Lubes and moisturizers may help, as well. Speak with a healthcare provider about treatments that could work for you.

Remember that as you age, other people’s bodies change, too. The ways in which you express intimacy and affection may not be the same as when you were 21, but they can still be satisfying.

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Urinary trouble

Feel like you're taking more trips to the bathroom than you used to? GSM affects your ability to urinate, too.

Pelvic floor muscles, which are responsible for bladder control, may weaken as you get older. In addition, the ovaries begin to stop manufacturing estrogen, which helps protect the lining of the bladder and urethra (the tube that empties your urine). When the body’s production of estrogen slows down, some women may become more prone to urinary tract infections or incontinence. That means you may have a tough time holding your bladder long enough to get to the bathroom (urinary urge incontinence), or you might experience a trickle when you cough, laugh or sneeze (urinary stress incontinence).

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Cardiovascular Changes

Total cholesterol, LDL (bad) cholesterol and triglycerides often increase during menopause, while HDL (good) cholesterol decreases. That said, although a woman's risk for heart disease rises after age 50, it may have less to do with her midlife change and more to do with getting older, explains Margery Gass, MD, former executive director of The North American Menopause Society. "It's really a product of age and lifestyle," she says. Still, hormonal changes during menopause can lead to weight gain and may contribute to increased blood pressure—both of which are risk factors for heart disease.

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Bone loss

Bone density doesn’t change much between age 30 and menopause. (It may decline slightly.) After that, lower levels of hormones such as estrogen tend to weaken bones, which is why from the onset of menopause to about 10 years later, women lose an average of 25 percent of their bone mass. As your bones become weaker and more porous, your risk of fractures and osteoporosis goes up.

The more bone you have at the time of peak bone mass, the better protected you'll be once bone loss begins. Eating foods rich in bone-building nutrients can help—especially protein, calcium, potassium and vitamin D.

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Brain fog

Feeling a little hazy lately? The so-called brain fog of menopause is real for some women, Dr. Gass says. During the change, between one- and two-thirds of women report forgetfulness and other mental hiccups. Starting during perimenopause, women may have a tougher time staying focused, solving difficult tasks or retaining new information. But don't despair. According to Gass, some studies suggest that these memory lapses last only as long as menopause. Think of it as pregnancy brain for the menopause set.

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Going forward

While menopause can be a challenging rite of passage, if you are like many women, you may find there is an upside to this time of life. It’s often marked by a greater sense of confidence, control and personal direction. There are many things you can do to make navigating menopause easier. Adopting healthy habits and taking care of your physical and mental health—including paying attention to and getting help for symptoms—can make all the difference in how smoothly you pass through this time of change.


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