Is This Normal? Postmenopausal Symptoms Explained

One moment, you’re throwing off the blankets because it feels like your whole body is on fire, and the next, you’re feeling a wave of sadness without any reason. If you’ve ever wondered whether what you’re experiencing is normal, here’s postmenopausal symptoms explained.

It’s easy to feel like you’re losing control, but many women are right there with you. In fact, 70% to 95% of us have/will experience postmenopausal symptoms1, 2.

What are common postmenopausal symptoms?
Postmenopausal symptoms can include hot flashes, mood swings, cognitive changes, joint pain, vaginal dryness, heart health risks, and osteoporosis. Understanding these changes helps manage your health.

From Hot Flashes to Heart Health

Postmenopause can feel like a rollercoaster, with a mix of symptoms that range from hot flashes to mood swings, and even unexpected changes like dry skin or joint aches1, 2, 3. But the ride doesn’t have to be bumpy! Learn how to manage these symptoms and take back control with expert tips and science-backed strategies that can make life smoother and more enjoyable.

Vasomotor Symptoms (VMS)

Vasomotor Symptoms (VMS) are the most common and recognizable signs of menopause. These are directly linked to the hormonal changes your body is going through, especially the drop in estrogen. This drop affects the hypothalamus, the part of your brain responsible for regulating body temperature.

When estrogen levels fluctuate, the hypothalamus gets “confused”, often overreacting to minor temperature changes and making you feel overheated out of nowhere. It’s like your internal thermostat is malfunctioning, which is why you might suddenly break into a sweat, even in the middle of a cool day8, 10.

• Hot flashes are experienced (sometimes up to 20 times a day) by up to 80% of women, and they may last up to 12 years, sometimes late into the 70s4, 5, 6, 7​. Hot flashes are sudden sensations of intense heat that can spread across the body, especially the chest, neck, and face, often accompanied by sweating and a flushed appearance.
• Night sweats are what they sound like: episodes of excessive sweating during sleep experienced by at least 13% of women.
• Palpitations. About 54% of women experience palpitations, which are rapid or irregular heartbeats that can feel like pounding/fluttering in the chest11, 12.

Mood Disorders

Almost half of us going through menopause will feel easily irritated. You might notice yourself losing patience with your family, friends, or coworkers, and feeling more tired or down than usual. These emotional shifts can leave you feeling on edge, nervous, or stressed, and sometimes even more frustrated than you’d like to admit13.

• Mood swings. Moderate to severe mood swings are reported by approximately 8% of women.
• Irritability. Nearly half of women experience irritability. “Why am I snapping at everyone? I wasn’t even that annoyed a minute ago!” this inner dialog is more than familiar to most women.
• Depression. There is a higher risk of depression during the menopause transition and early postmenopause, especially for those with previous depression episodes14.
• Anxiety includes nervousness, worry, or panic attacks. Hormonal changes, VMS, and the everyday stresses of midlife all play a part in why you might be feeling more anxious.
• Insomnia (difficulty sleeping or staying asleep) is often linked with anxiety, stress, and depressive disorders. Sleep disturbances can be related to hormonal changes, hot flashes, and other health issues. About one-third of women report sleep difficulties.

Cognitive and Memory Issues

Many women notice changes in their memory and focus. You might find it harder to remember words or numbers, misplace things like your keys more often, or struggle to concentrate. For some women, these changes can even feel a bit like attention deficit symptoms, where staying focused is a challenge. The cognitive changes that happen during menopause are not the same as dementia. In fact, dementia before the age of 64 is quite rare20.

• Brain fog refers to a collection of symptoms that many women experience during and post menopause. These often show up as memory and attention problems, such as trouble recalling words, names, or numbers, and difficulty staying focused or keeping a train of thought. You might also find yourself more easily distracted, forgetting why you walked into a room, or struggling to switch between tasks20.
• Higher-order cognitive functions, like executive functions (such as strategic thinking and planning), generally remain unchanged throughout the menopause transition. These skills tend to stay intact despite other cognitive shifts21. What a relief!
• Alzheimer’s disease. There is a higher incidence of Alzheimer’s disease in postmenopausal women, possibly due to the role estrogen plays in supporting cognitive health and protecting the brain22.

Genitourinary Symptoms

As estrogen levels drop during menopause, it can lead to thinning and drying of the tissues in your vaginal and urinary tract. The lack of natural lubrication and weakened pelvic floor muscles can make these issues more noticeable, leaving you more prone to discomfort and infections18, 19.

• Discomforting sexual activity.
• Painful sexual activity, bleeding, or discomfort after sex is often due to thinning and loss of elasticity in the vaginal tissues.
• Vulval, vaginal itching, soreness, burning, and discomfort are not uncommon. Vaginal dryness or lack of lubrication are experienced by at least 11% of women.
• Urinary urgency and urinary tract infections. About 20–30% of postmenopausal women experience urinary urgency (a sudden, strong need to pee), increased frequency (needing to go more often), nocturia (waking up during the night to urinate) and recurrent urinary tract infections (UTIs)15.

Osteoporosis

Osteoporosis is a condition where bones become weak and brittle due to a loss of bone density and quality. This happens when the body loses more bone tissue than it can replace, making bones more fragile and likely to break, even from minor falls or injuries.

• Osteoporosis-related fractures. About 50% of women over 50 will experience an osteoporosis-related fracture. During the first 5-7 years after menopause, women lose bone about 2-3% each year16, 17.
• Unexplained back pain. Ongoing, unexplained back pain, often linked to brakes or changes in the spine’s shape. It can lead to a hunched posture or a loss of height.

Obesity and Weight Changes

Shifting hormones, especially as estrogen levels drop, often leads to more fat being stored around your midsection. It’s common to see an increase in waist size and body mass index (BMI) during this time, even if you haven’t changed your habits.

Skin Changes

Lower estrogen levels, and a relative increase in male hormones, affect your skin and hair. Your body produces less collagen, making your skin thinner, drier, and more prone to wrinkles. You may also notice more facial hair, thinning hair on your scalp, and even brittle nails as your hormones continue to change.

Joint Pain

Approximately 32% of women report joint pain, stiffness, and swelling (osteoarthritis), especially in the knees and hands.

Cardiovascular Issues

After menopause, cardiovascular issues can become more common because estrogen is no longer there to help protect your heart and blood vessels. Estrogen helps keep blood vessels healthy, so when the levels drop, the risk of heart problems like heart attacks or angina increases. Women often experience different symptoms compared to men, such as fatigue, nausea, or shortness of breath. These signs can sometimes delay diagnosis23.

Sarcopenia

Sarcopenia is the gradual loss of muscle mass and strength that happens as we age, and it speeds up during postmenopause. This can lead to gaining more body fat and feeling less physically strong than before.

Dry Eye Disease

Dry eye disease is common during postmenopause, most likely due to androgen hormone (e.g. testosterone) levels drop24.

Oral Health Issues

When estrogen levels drop, it affects your mouth the same way it does in your vagina. The tissue becomes thinner and weaker, making it more prone to injuries and infections. In addition, when estrogen and progesterone levels drop, it can change how much saliva you produce and its thickness. This can lead to issues with your teeth and gums, increasing the risk of cavities and gum disease25, 9.

Breast Tenderness

Breast tenderness affects 3.5% of women. It may cause the breasts to feel tender, swollen, or painful, though it typically diminishes as hormone levels stabilize postmenopause2.

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