Hot flashes are among the more common symptoms you could experience during perimenopause and menopause. (Getty Images)
Hot flashes and night sweats are just the tip of the iceberg when it comes to menopause. Women's health doctors and menopause specialists say there are many surprising symptoms — from sleep changes to brain fog — that can catch you off guard.
That’s because women's bodies go through an immense number of changes. From puberty to childbirth to perimenopause, hormones are constantly in flux, and each new phase can feel unpredictable as the body adjusts.
Menopause is a natural part of aging, and while new symptoms can feel disruptive, there are effective ways to manage them. For those already experiencing signs of menopause or perimenopause, understanding what’s happening in the body and learning about available options can make the transition easier.
We spoke with several women's health experts to answer common questions about menopause, including things your own doctor might not tell you.
“Menopause is when you go 12 months consecutively without a period, which means without the use of medications, like birth control, that prevent your period from coming each month," explains Dr. Karen Tang, a board-certified gynecologist. If your body has gone a year on its own without a menstrual cycle, you've likely fully transitioned into menopause.
“Many symptoms are very disruptive such as hot flashes, poor sleep or brain fog,” says Dr. Joanne Armstrong, vice president and chief medical officer of women’s health and genomics at CVS Health. “These symptoms don’t suddenly turn off when it’s time for work.” She adds that stigma and lack of supportive workplace culture often leave women struggling in silence, despite the fact that nearly 90% of women over 35 experience some menopausal symptoms.
Menopause isn't something that happens overnight. Going 12 months without a menstruation cycle may take a long time, with perimenopause — the body's transition into menopause — often lasting between two to eight years. Once your body has fully transitioned, you'll no longer ovulate and will be unable to get pregnant.
Menopause can also be medically induced by a hysterectomy or surgical removal of the ovaries, according to the National Institute on Aging. "If you have surgery to remove your uterus or ovaries and are not taking hormones, you will experience symptoms of menopause immediately," the organization reports.
Menopause can be broken down into three stages, though Tang says that menopause and perimenopause are typically grouped together.
Perimenopause: During this stage, symptoms such as hot flashes and mood swings often begin as you gradually transition toward menopause. Periods often become irregular.
Menopause: This stage marks the point when menstrual periods have stopped for 12 consecutive months.
Postmenopause: This stage lasts for the rest of your life and may be accompanied by additional symptoms.
You can start transitioning into menopause several years before you reach it, a stage known as perimenopause. This transition is different for everyone: For instance, you may start experiencing perimenopausal symptoms at age 42, while your best friend doesn't have any symptoms until 47.
On average, women reach perimenopause in their mid-to-late 40s, according to the Office on Women's Health, part of the U.S. Department of Health and Human Services. Perimenopause might last anywhere from two to eight years, but on average, it lasts about four years. Menopause itself is not a stage you remain in for a defined time frame, according to the Cleveland Clinic — it's simply the point at which you've gone a year without your period.
Perimenopause is often less discussed, which can make it harder to distinguish from menopause. Perimenopause is the time frame that leads up to menopause and is when you experience the most symptoms, such as hot flashes, mood swings and irregular periods.
"People actually feel more symptoms during perimenopause than they do when they're in full menopause," Tang notes. "It can last a decade before your periods fully stop, which can be a confusing time when you're missing periods and having hot flashes.” Tang says your symptoms should dissipate once you've officially reached menopause.
When most people think about menopause, they picture hot flashes and night sweats. But experts emphasize that menopause can trigger many more changes — in fact, at least 34 different symptoms have been documented. “This surprises people as they mostly tend to associate menopause with the hot flashes and night sweats,” says Helen Stearns, a nurse practitioner and certified menopause specialist through the Menopause Society.
“It can be challenging to get to the root cause for many of these symptoms, but my approach is always to rule out the easy things first,” says Dr. Barbara Levy, a board-certified ob-gyn, certified menopause provider and Chief Medical Officer at Visana Health. “Menopause or perimenopause happens to everyone — like aging — but unlike aging, the symptoms can be managed when we listen to women and pay attention.”
Here are some of the lesser-known symptoms, along with what’s happening in the body and how to manage them:
Yes, night sweats can wake you up — but hormone changes also disrupt sleep directly. “Rising levels of FSH [follicle-stimulating hormone that affects sexual development and fertility] and decreasing levels of estrogen are two of the main culprits,” Stearns explains. That’s why some women struggle with falling or staying asleep even without hot flashes. Poor sleep can then worsen fatigue, irritability and brain fog.
Beyond the night sweats themselves, hormone disruption can fragment sleep cycles. The ripple effect often intensifies anxiety, depression and fatigue. Guidance from Mayo Clinic emphasizes that sleep hygiene — like limiting alcohol, exercising regularly and keeping a cool bedroom — can help, along with medical options if needed.
Declining estrogen affects receptors in the brain, according to a review in Nature Reviews Endocrinology. Stress and lack of sleep make it worse. “We have estrogen receptors all over our bodies, including in our brains,” says Stearns. This helps explain why memory lapses and difficulty focusing are common during perimenopause.
Estrogen also protects joints and reduces inflammation, so declining levels may explain why many women notice new aches in the knees, feet and hands. Cleveland Clinic notes that these pains are especially common during perimenopause. Several studies note that strength training, stretching and anti-inflammatory diets can help support joint health.
The urinary tract is sensitive to hormone shifts. With less estrogen, tissues become thinner and dryer, which increases urgency, frequency, and infection risk, per Mayo Clinic. “Many women have increased risk and recurrence of UTIs, and over time this can become a serious health issue,” Stearns adds. Vaginal estrogen therapy or non-hormonal options may help restore comfort and reduce infections.
From dryness and pain during sex to a lower libido, vaginal and vulvar changes are among the most disruptive menopause symptoms. Estrogen supports blood flow and elasticity in this tissue, so its decline can cause burning and tearing, which can make sex difficult. These changes can affect relationships — but lubricants, moisturizers and local hormone therapy can provide relief.
Estrogen plays a role in hair growth and thickness, so declining levels may cause shedding or thinning around the scalp. While this can be distressing, many dermatologists note that topical treatments, supplements and low-level laser therapy can help.
Some of the most surprising symptoms seem unrelated to hormones at first. But Stearns says body odor changes, itchy ears and even postmenopausal burning mouth syndrome are reported. Estrogen receptors in the skin and mucous membranes may play a role. While research is limited, these symptoms are real — and worth bringing up with a provider.
According to Cleveland Clinic, estrogen helps protect the cardiovascular system, so after menopause, women’s risk for heart disease rises. “It is well known that estrogen provides cardiovascular protection before menopause. After menopause, cholesterol often rises,” Stearns says. That’s why sustainable nutrition and strength training are crucial for heart health during menopause. Hormone therapy started within 10 years of menopause may also provide protective benefits.
Estrogen also protects bone density, so perimenopause and menopause are a turning point for bone health. Significant bone loss can occur, raising fracture risk. Cleveland Clinic recommends for those around menopause with significant fracture risk, strength training, calcium/vitamin D intake and, in some cases, hormone therapy to help preserve bone strength.
There are several ways to treat common menopause symptoms, but your doctor may make different recommendations based on your specific symptoms.
As estrogen levels drop, your metabolism often slows. This might contribute to menopause weight gain and increased abdominal fat, Tang says. According to Mayo Clinic, most people also become less active as they age, which can make weight changes more noticeable. Implementing more daily movement and activity can help support a healthy weight. Tang recommends changing your exercise program to include more strength training because women transitioning into menopause tend to lose more muscle mass.
There are many over-the-counter and prescription hair growth products designed for women that can help with hair thinning and shedding.
You can receive a combination of estrogen and progesterone via a skin patch or pill, Tang says. There are also creams and gels that can be applied directly to the vagina, and a vaginal ring that can be inserted. These help symptoms by replacing the hormones your body isn't making enough of estrogen, for example, according to Cleveland Clinic. When your hormone levels stabilize, your symptoms should ease.
Lubrication and moisturizers
Vaginal dryness is a common menopause symptom, caused by declining estrogen levels that thin and dry out vaginal tissue. Tang says using a water-based or silicone-based lubricant during sex can help with the vaginal dryness associated with lower estrogen levels. In addition to lubricant used at the time of intercourse, Armstrong notes that a wide range of over-the-counter products — from vaginal moisturizers to suppositories — can help, as can prescription hormonal and non-hormonal therapies. For women with more persistent symptoms, prescription options — both hormonal (such as estrogen creams, tablets, or rings) and non-hormonal therapies — may also be effective.
Non-hormonal medications for symptom relief
For people who aren't interested in taking hormones or those who can't (for instance, breast cancer patients whose treatments and risk factors preclude hormone therapy) there are non-hormone treatments for hot flashes, Tang says. "There's a medication called Veozah, which works on the receptors in the brain to help with hot flashes, and antidepressants can help with mood swings," she says.
Supplements
Some people turn to supplements to help with menopause symptoms, but experts caution that the evidence is mixed and it’s important to talk to your doctor before starting anything new. “With any supplement, it’s important to look for something that addresses your individual health needs and to talk to a health care professional before starting a new regimen,” Armstrong says.
Phytoestrogens (plant estrogens)
Found in soy, red clover and flaxseed, these compounds act like weak estrogens in the body. Some studies suggest they may modestly reduce hot flashes, but results are inconsistent.
Vitamin D and calcium
Both are crucial for bone health, especially since estrogen decline accelerates bone loss during and after menopause. Many women don’t get enough vitamin D from food or sun exposure, so a supplement may be recommended.
Omega-3 fatty acids
Found in fish oil and algae-based supplements, omega-3s may support heart health, which becomes even more important after menopause as cholesterol and cardiovascular risks rise.
Herbal remedies
Black cohosh, evening primrose oil, and other herbs are popular, but scientific support for their effectiveness is limited. Some can have side effects or drug interactions, so it’s best to proceed with caution.
Bottom line: Supplements may play a supporting role in managing menopause symptoms, but they’re not a cure-all. Lifestyle changes, medical treatments, and talking with your provider about options will usually have the biggest impact.
"You don't actually need a blood test to tell you that you're in menopause," Tang says. If someone's in the typical age range, their periods are irregular and they're having menopausal symptoms, doctors will generally diagnose the patient with perimenopause, she says.
Testing could be needed if someone is younger than the typical age for menopause — for example, in their late 20s or early 30s. While perimenopause can begin in the mid-30s, it’s less common. If periods stop or symptoms such as hot flashes appear at that age, doctors will usually run tests to rule out other conditions like thyroid disorders or a condition such as polycystic ovary syndrome (PCOS), which can present with similar symptoms, Tang says.
If you believe you might be in perimenopause and you're curious about your hormone levels (and you're not quite due for your annual trip to the gynecologist), check out the at-home menopause test kits that we've tested and reviewed. These shouldn't be used in lieu of a doctor's supervision, as a professional can give you a more thorough diagnosis, but the kits may be able to give you more insight into what's going on with your body.
Several issues can cause postmenopausal bleeding, a common one is vaginal dryness (thin tissue that can tear easily) to polyps. According to the American College of Obstetricians and Gynecologists, any bleeding after menopause should be evaluated to rule out serious causes, including uterine cancer, even though most cases are ultimately noncancerous. Doctors typically start with a transvaginal ultrasound and may follow with imaging or biopsy based on the findings.
Menopause is officially confirmed when you haven’t had a menstrual period for 12 consecutive months without another cause.
Shifts in hormones can slow metabolism and change how your body stores fat. Research recommends focusing on strength training, lean protein, fiber, and calcium and vitamin D-rich foods to protect bone health while losing weight. Consistency in exercise and nutrition is key.
No you cannot get pregnant during menopause. Once your body has fully transitioned into menopause, you'll no longer ovulate and will be unable to get pregnant.
Experiences vary, but common symptoms include hot flashes, sleep disruption, mood swings and brain fog. Some women also notice changes in their sexual health, joints or bladder function. Talking to a provider can help identify options to manage these changes. “The biggest misconception is actually about perimenopause — people think it’s simply a time of declining estrogen, when in reality it’s an estrogen rollercoaster,” Levy explains. She adds that single blood or saliva tests are not reliable: “The best care comes from a professional who listens, believes you know your body best and adjusts with you during this transition.”
Dr. Karen Tang, board-certified gynecologist based in Bryn Mawr, Pa.
Dr. Joanne Armstrong, vice president and chief medical officer of women’s health and genomics at CVS Health
Dr. Barbara Levy, board-certified ob-gyn and Chief Medical Officer at Visana Health
Helen Stearns, doctor of nursing practice and certified menopause specialist through the Menopause Society
Our health content is for informational purposes only and is not intended as professional medical advice. Consult a medical professional on questions about your health.