The Main Symptoms of Menopause and What Really Causes Them

Almost all women will experience some symptoms during menopause, though the duration and severity vary. Here’s a look at some of the most common symptoms you may experience and insights into their causes.

Hot Flashes and Night Sweats

Hot flashes are among the most common menopause symptoms. They are increasingly recognized as serious due to links with inflammation, heart disease, and dementia risk. Hormone researcher Dr. Ray Peat suggests hot flashes may occur because estrogen is unopposed by progesterone in the body.

"Estrogen lowers body temperature by increasing blood flow to the skin, effectively lowering the body’s temperature set-point. It also decreases heat production. Progesterone has the opposite effect—increasing metabolic rate and body temperature, which causes the familiar temperature rise at ovulation. Hot flashes can occur when progesterone levels drop, such as during the luteal phase or menopause." — Dr. Ray Peat, PhD

Night sweats may be severe enough to drench bedsheets. To minimize symptoms, wear loose, light clothing and keep your environment cool.

Heart Palpitations

Hormonal changes can lead to heart palpitations. Dr. Peat attributes these to an imbalance between estrogen and progesterone.

By middle age, many women experience palpitations, orthostatic hypotension, tachycardia, and varicose veins. Excess estrogen weakens vein muscles, causing distension and reduced blood return to the heart, resulting in faster heartbeats and sometimes fainting. Over time, this may cause vein distortion. Similar effects occur in men with high estrogen.

Migraines and Headaches

If you’ve had migraines before, menopause may affect their frequency or severity. Some find migraines lessen if they were linked to the menstrual cycle, but others experience new, severe migraines. The cause is thought to be unopposed estrogen. Many women find that taking bioidentical progesterone helps relieve headaches.

Breast Swelling and Tenderness

Hormonal changes cause fluid retention in the breasts, making them feel tender and swollen, especially during perimenopause. Fibrocystic breasts indicate unopposed estrogen and often improve within 2-3 months of natural progesterone treatment.

Loss of Sexual Desire and Painful Intercourse

Many women notice a decrease in sexual desire during menopause, often accompanied by vaginal dryness that makes intercourse painful. This results from declining testosterone and estrogen levels.

Dr. John Lee, MD explains:

"Female libido often falls during anovulatory premenopausal periods, suggesting it is linked more to progesterone than estrogen. Paradoxically, libido may increase during menopause due to increased androgen synthesis secondary to progesterone deficiency, despite vaginal dryness and atrophy. Proper natural progesterone supplementation can maintain libido and restore vaginal health. Sometimes low-dose estriol (intravaginally) is needed for dryness. Enjoyment of sex should not be denied to postmenopausal women." — Dr. John Lee, MD

Urinary Symptoms

Some women experience urinary symptoms such as pain during urination or increased frequency, caused by estrogen-related changes that increase pressure around the urethra.

Changes to Your Skin

Menopause decreases collagen production, leading to reduced skin elasticity, loss of subcutaneous fat, and dryness.

Bone Loss

Progesterone plays a crucial role in bone formation. When progesterone drops, bone loss can occur.

Dr. John Lee, MD states:

"Bone formation in adult women is the function of progesterone, not estrogen. Osteoporosis can often be reversed by restoring natural progesterone alongside diet, supplements, and exercise. Synthetic progestins have modest effects and side effects, whereas natural progesterone is more effective and safe." — Dr. John Lee, MD

Mood Swings and Fuzzy Thinking

Mood swings and cognitive difficulties are common and challenging. Dr. Lee explains:

"Premenstrual syndrome (PMS) symptoms—depression, irritability, headaches, fatigue, weight gain, and loss of libido—occur when progesterone is absent and estrogen dominance prevails. This imbalance also disrupts hypothalamic-pituitary interplay. Adequate natural progesterone combined with diet low in caffeine, sugar, and stimulants, plus magnesium and vitamin B6 supplements, can greatly reduce these symptoms." — Dr. John Lee, MD

Insomnia

Insomnia is common, often worsened by nighttime hot flashes, making restful sleep difficult.

How Long Will These Symptoms Last?

Menopause symptoms usually begin during perimenopause, months or years before menstruation stops. For most women, symptoms last about three to four years after their last period; however, some may experience symptoms for up to a decade. Sudden menopause (e.g., after medical treatment) may cause more severe symptoms.

The symptoms of menopause vary widely from woman to woman, but understanding these common experiences can empower you to seek the support you need.