1. Hot Flashes and Night Sweats

According to the North American Menopause Society (NAMS), 75 percent of North American women have hot flashes during perimenopause, prompting almost one-quarter of them to see their healthcare providers for help.

Hot flashes are the sudden feeling of intense warmth, usually around the face and upper body. Your face and chest may also turn red, and you can perspire heavily. Some women also experience a rapid heartbeat. When it ends, you might feel chilled.

Night sweats are similar; you'll wake up sweating heavily, sometimes drenched to the point that you have to change clothes and bedding.

Causes

Experts aren’t entirely clear on the cause, but one theory is that changes to the hypothalamus (the area of the brain that regulates body temperature) cause it to misread body temperature. It then begins the process of cooling down by dilating blood vessels close to the skin surface in order to increase blood flow. This in turn causes the skin to turn red and sweaty.

2. Slowed Metabolism and Weight Gain

During menopause, many women experience the dreaded “menopot” or “menopause spread,” gaining weight usually in the abdomen. According to the Mayo Clinic, menopausal women gain on average 1.5 pounds per year.

Two-thirds of women ages 40 to 59 and around three-quarters of women older than 60 are overweight. Excess weight can up the risk of type 2 diabetes, heart disease, hypertension, respiratory problems, and uterine and breast cancers, and can intensify hot flashes.

Causes

During menopause, estrogen levels drop, which causes fat storage to shift from hips and thighs to the belly. Research from Mayo Clinic published in the journal Diabetes found that when estrogen drops, proteins cause the fat cells to store more fat and slow down your metabolism’s fat-burning capability.

Also, as we age, we tend to naturally exercise less and eat more.

3. Depression, Anxiety, and Mood Swings

Studies have shown that mood changes occur in up to 23 percent of peri- and postmenopausal women.

Causes

Estrogen fluctuation can bring on changes to your brain and nervous system that can affect mood. It can also interfere with sleep — lack of sleep can cause mood disturbances.
This stage of life is a time of great change for women — they are winding down their childbearing and child-rearing years, facing midlife, a new body, and a new identity. Some may mourn what can now never be; others are anxious about the new stage to come.
Stigmas against menopause and mental illness prevent many from getting help.

4. Insomnia and Sleep Disruptions

Menopause can wreak havoc on your ability to get some solid z’s — either you can’t fall asleep or you are waking up several times during the night.

Causes

Research shows menopause keeps you awake for a variety of reasons:

Levels of estrogen and progesterone, sleep-promoting hormones, are dropping.
Night sweats; the sudden flash of heat and soaking sweat wakes you up. It may take a while to get back to sleep, especially if you have to change clothes and strip the bed.
Depression and anxiety can both affect your sleep (see above).

5. Hair Loss and Brittle Nails

Many women experience thinning hair during menopause; some encounter an extreme form known as female pattern hair loss. Your nails may become ridged and brittle.

Cause

Blame those estrogen and progesterone drops again. Those are the hormones responsible for maintaining healthy hair. It’s also a double whammy: When they decrease, male hormones, called androgens, have more of an effect. To add insult to injury, the latter may cause hair to start growing in unwanted places, like your chin and upper lip.

Hair and nails are made up largely of keratin, which your body makes less of as estrogen drops.

Lack of estrogen can also make your skin and nails dry.

6. Sexual Dysfunction, Desire Issues

Many women find that with menopause comes some unpleasant changes in their vaginas, which can make sexual activity mildly difficult to extremely painful. Women report a feeling of vaginal tightness during penetration, and are at higher risk for tearing and bleeding during intercourse. In fact, between 17 and 45 percent of post-menopausal women say sex really hurts.

Some women may feel a marked decrease in their libido, coupled with distress about that decline, a condition known as hypoactive sexual desire disorder (HSDD). One study published in the journal Archives of Internal Medicine found that 26.7 percent of perimenopausal women experienced low libido as opposed to 52.4 percent among women who had gone through menopause.

Cause

The hormone drop causes vaginal walls to become thin, dry, fragile, and less flexible, a situation known as vulvovaginal atrophy. If the vagina also becomes inflamed (vagina becomes red and produces discharge), it is atrophic vaginitis. Along with the estrogen decrease, libido can be squashed by stress, depression, poor body image, and frustration over how long it takes to reach orgasm.

7. Bone Loss and Osteoporosis Risk

You can build more bone than you lose up until around age 30. After age 35, loss outpaces creation, causing overall bone loss. When menopause hits, the demineralization process speeds up, leading some women to develop osteoporosis (brittle, fragile bones).

Cause

One of estrogen’s jobs is to protect bone health. When it depletes, so goes that benefit, leaving bones vulnerable to deterioration.

8. Dry Skin and Other Skin Problems

If you are noticing that your skin is getting dry, slack, easily irritated, and thin, leading to the development of jowls and easy bruising, you are not imagining it. You may also develop acne and rashes, and find that wounds heal much more slowly.

Cause

Say it with me: Estrogen depletion. It causes skin to thin, which leaves it vulnerable to bruising. The dryness is because skin loses some ability to retain moisture. The wrinkling, jowls, and slackness is due to skin losing collagen. According to the American Academy of Dermatology, women’s skin loses about 30 percent of its collagen during the first five years of menopause. After that, you lose about 2 percent each year for the next 20 years.

9. Dry Eyes and Dry Mouth

Menopausal women often suffer from dry, inflamed, irritated eyes, and their mouths can also become dry and tacky. Many find they can’t even wear contact lenses regularly anymore due to the lack of lubrication on the tissue that covers the eyeball. Mouth dryness can be so severe that it can affect oral health. Lack of saliva can lead to increase in cavities, periodontal disease, gingivitis, and more.

Causes

Estrogen gets a break on dry eyes. Researchers give the blame to decreasing androgens. Since women have less of these hormones to begin with, a slight drop can have a big effect.

But we’re back to estrogen levels dropping for the dry mouth: A study published in the Journal of Mid-Life Health shows that it dries out the oral mucosa in the same way it does in the vagina.

10. Memory Issues and Problems With Concentration

Your cognitive function may go a little screwy. Words are harder to retrieve, you forget why you walked into a room, and darned if you know where your keys ended up. A Baylor University study confirmed that trouble with working memory and complex attention and vigilance is completely normal, and it isn’t permanent.

Cause

Diminished estrogen production is once again the cause, but that’s not the whole story. Disrupted sleep, depression, and hot flashes can also play a role, according to a paper published in the journal Integrative Medicine Insights.

Editorial Sources and Fact-Checking

Everyday Health follows strict sourcing guidelines to ensure the accuracy of its content, outlined in our editorial policy. We use only trustworthy sources, including peer-reviewed studies, board-certified medical experts, patients with lived experience, and information from top institutions.

Sources

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Hot Flashes. Mayo Clinic. December 12, 2023.
The Reality of Menopause Weight Gain. Mayo Clinic. July 8, 2023.
Midlife Weight Gain….Sound Familiar? Ward Nutrition.
Santosa S et al. Adipocyte Fatty Acid Storage Factors Enhance Subcutaneous Fat Storage in Postmenopausal Women. Diabetes. March 2013.
Depression, Mood Swings, Anxiety. The North American Menopause Society.
How to Protect Your Brain Health During Menopause. NewYork-Presbyterian.
Han Y et al. Sleep Disorders and Menopause. Journal of Menopausal Medicine. December 2019.
Rinaldi F et al. The Menopausal Transition: Is the Hair Follicle ‘Going through Menopause’? Biomedicines. November 14, 2023.
Bravo B et al. Dermatological Changes During Menopause and HRT: What to Expect? Cosmetics. January 15, 2024.
Caring for Your Skin in Menopause. American Academy of Dermatology Association. November 20, 2023.
Pain With Penetration. The North American Menopause Society.
West S et al. Prevalence of Low Sexual Desire and Hypoactive Sexual Desire Disorder in a Nationally Representative Sample of US Women. Archives of Internal Medicine. July 14, 2008.
Postmenopause. Cleveland Clinic. October 5, 2021.
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Gorimanipalli B et al. Hormones and Dry Eye Disease. Indian Journal of Ophthalmology. April 5, 2023.
Sliwinski J et al. Memory Decline in Peri- and Post-menopausal Women: The Potential of Mind–Body Medicine to Improve Cognitive Performance. Integrative Medicine Insights. August 3, 2014.