Menopausal symptoms: symptoms before and after the menopause

Menopause is a natural stage in life that usually begins between the ages of 45 and 55 in women. While menopause—the permanent cessation of menstruation—is often seen as the key event, hormonal changes begin before that and can affect the body in many ways. Even after menopause, symptoms may persist as the body adjusts to the new hormonal situation. In this article, you’ll learn about the symptoms that can occur during the different phases of menopause and which strategies can best support your health during this stage of life.

Table of Contents

• What is meant by menopause?
• Menopausal symptoms – what signs can occur?
• How long do hot flashes last during menopause?
• Treatment and tips for menopause – finding the right strategy
• Summary

What is meant by menopause?

Menopause, also known as the climacteric, is a natural phase in a woman’s life in which fertility gradually declines. It usually begins between the ages of 45 and 55 and lasts several years. During this time, hormonal changes take place, especially a decrease in the production of the female sex hormones estrogen and progesterone. Menopause can be divided into three phases:

• Perimenopause: This phase can begin several years before actual menopause. Hormone levels fluctuate, leading to irregular menstrual cycles and initial symptoms such as hot flashes.

• Menopause: This term refers to the point in time when a woman experiences her last menstrual period. Since it can only be determined retrospectively, a woman is considered to be in menopause once her period has been absent for at least twelve consecutive months.

• Postmenopause: After menopause, hormone levels stabilize at a permanently lower level. The body gradually adjusts to this new state, which lasts for the rest of life.

Each woman experiences these phases differently in terms of timing and associated symptoms (WHO,2024). 

Menopausal symptoms – what signs can occur?

Menopause is associated with a variety of physical and emotional changes caused by hormonal shifts. The type and intensity of symptoms vary greatly from woman to woman. While some notice only slight changes, others experience more severe symptoms. Hot flashes and night sweats are among the most common, followed by sleep disturbances, fatigue, mood swings, and vaginal dryness (Wang et al., 2021). The symptoms can be divided into different categories:

Hormonal and physical changes:

• Irregular menstruation: In perimenopause, cycles become increasingly irregular until periods stop altogether.

• Hot flashes and night sweats: Sudden waves of heat, often accompanied by heart palpitations and sweating, occur especially in perimenopause.

• Weight gain and altered metabolism: Hormonal changes slow metabolism, leading to increased fat storage around the abdomen. Muscle mass may also decrease while fat percentage increases.

• Skin and hair: Falling estrogen levels reduce the skin’s moisture retention and elasticity, making it drier and more sensitive. Hair may become thinner and lose volume.

Psychological and emotional symptoms:

• Mood swings: Hormonal changes can influence emotions, causing irritability, nervousness, or sadness.

• Sleep disturbances: Many women experience trouble falling or staying asleep, often worsened by night sweats.

• Concentration problems and forgetfulness: Hormonal fluctuations can affect cognitive performance, leading to forgetfulness or difficulties concentrating.

Long-term health effects:

• Bone density and osteoporosis risk: Since estrogen plays a key role in bone metabolism, the risk of osteoporosis increases after menopause.

• Cardiovascular disease: Estrogen protects blood vessels. As hormone levels decline, the risk of high blood pressure, atherosclerosis, and other cardiovascular conditions increases (John Hopkins, 2024; Cleveland Clinic, 2024).

• Bladder weakness and vaginal dryness: Estrogen deficiency can affect mucous membranes and tissue elasticity, leading to dryness, itching, or frequent urination.

Sources: NHS, 2022

How long do hot flashes last during menopause?

Hot flashes are one of the most common menopausal symptoms, but their duration and intensity vary widely:

• Single hot flash: Typically lasts between 30 seconds and 10 minutes. It often begins with a sudden feeling of heat in the upper body and face, followed by sweating and sometimes palpitations.

• Overall duration during menopause: On average, hot flashes occur over a span of 4 to 7 years, but in some women, they can last more than 10 years.

Some women experience only occasional hot flashes, while others have several episodes daily, especially during perimenopause.

Treatment and tips for menopause – finding the right strategy

Every woman experiences menopause differently, and there is no one-size-fits-all solution. Although menopause is a natural part of life, the associated symptoms can significantly affect quality of life. While some manage well with lifestyle changes, others may require medical support.

1 – Natural measures and lifestyle changes

• Healthy diet: A balanced diet rich in fruits, vegetables, whole grains, and healthy fats can help support hormonal balance. Calcium (e.g., dairy products, kale) and vitamin D (e.g., fatty fish like salmon, eggs) are particularly important in preventing osteoporosis.

• Regular physical activity: Exercise not only helps with weight control but also boosts metabolism, maintains bone health, and balances mood swings. Endurance sports like walking or swimming and strength training are recommended.

• Adequate sleep: A consistent sleep schedule and a relaxing bedtime routine can help alleviate sleep disturbances. A cool bedroom and breathable bedding are especially helpful for night sweats.

• Stress reduction: Relaxation techniques such as yoga, meditation, or breathing exercises can help ease nervousness and mood swings.

• Avoiding stimulants: Alcohol, caffeine, and spicy foods can intensify hot flashes. It may help to reduce or avoid these.

Sources: NHS, 2022

2 – Herbal and alternative treatments

Herbal remedies like phytoestrogens from soy, flaxseeds, or red clover may have estrogen-like effects and alleviate mild symptoms. However, as they can interact with medications, medical advice is recommended. Mindfulness techniques and, in more severe cases, cognitive behavioral therapy may also help reduce stress and better manage emotional changes (Oxford Health, 2024).

3 – Hormone replacement therapy (HRT) – who is it for?

In some cases, hormone replacement therapy (HRT) may be appropriate. It involves administering estrogen or a combination of estrogen and progestin (a hormone that balances estrogen and protects the uterine lining) to alleviate symptoms such as hot flashes, sleep disturbances, or osteoporosis.

Benefits:

• Effective against severe menopausal symptoms

• Protects against bone loss (osteoporosis)

• May reduce the risk of certain conditions like colorectal cancer

Possible risks:

• Increased risk of thrombosis, stroke, and certain cancers

• Not suitable for women with a history of breast cancer or blood clotting disorders

Hormone therapy should always be discussed individually with a doctor and regularly monitored (Mayo Clinic, 2022).

Monitoring hormonal changes

Menopause brings many physical changes often accompanied by symptoms such as hot flashes, sleep disturbances, or mood swings. A menopause blood test can help you understand your hormone levels and determine which phase of menopause you are in. This can be a helpful basis for targeted symptom relief or for discussing treatment options with your doctor.

Summary

Menopause is a natural phase of life marked by declining estrogen and progesterone levels, which can lead to physical and emotional changes. Common symptoms include hot flashes, sleep disturbances, mood swings, and a slower metabolism. Lifestyle changes, herbal remedies, or hormone therapy in some cases can provide relief. Personalized medical advice helps find the best strategy for navigating this transition.