Symptoms

You are not alone! Approximately 85% of women report menopause symptoms.

Source: Agency for Healthcare Research and Quality (US)

The menopause journey can cause women+ to experience symptoms from head to foot. With more than 34 symptoms, it affects more than just your ovaries!

Your symptoms may even change during the three-stage menopause journey – perimenopause, menopause, and post-menopause.

With the average journey lasting at least 7.5 years, it’s time to take control of your symptoms rather than letting them control you! 

You have the power to make a change!

Choose an area of the body to learn about symptoms and management. 

  • General – body odor, cold and hot flashes, fatigue, muscle aches and pains, sleep, skin/nails
  • Upper Body (Zone 1) – brain/mood/emotions, anxiety, ears, eyes, hair, headaches, teeth/gums/tongue, thyroid
  • Torso (Zone 2) – heart, GI, liver, shortness of breath
  • Lower Body (Zone 3) – legs/arms, pins and needles sensations, loss of libido/orgasm, pelvic floor, UTIs, vaginal dryness/painful sex, weight gain  

General Symptoms

Body odor

This “stinky” menopause symptom is less common, but it’s bothersome for the women+ in the pausitive health survey who told us they have to deal with it.

During the menopause journey, some women+ notice their overall smell changes or they notice a change in a body part. This may be their armpits, skin, vagina, or urine. The smell can be unpleasant, ranging from tangy to dead fish!

Take action to improve how you smell and feel.

Cold flashes

For many of the same reasons women experience hot flashes, a woman+ can experience a cold flash. It’s a sudden rush of a cold sensation throughout your body, but women say it feels different than that cold feeling you have when you’re not feeling well.

Cold flashes during the menopause journey can happen during the day or night.

Like hot flashes, women can manage cold flashes with:

woman yawning from fatigue and exhaustion Fatigue and exhaustion

Are you feeling tired all the time? Fatigue can be physical and/or mental and involves feeling severely tired, no matter how much sleep and rest you get.

Exhaustion is a situation in which you feel extreme fatigue.

Of course, we all feel tired from time to time, but what makes fatigue different is the inability to get through the day. It can affect your mood, ability to focus and concentrate, exercise, or your daily routine. 

Causes of fatigue

There are many potential causes of fatigue, including the menopause journey. For example, menopausal symptoms like sleeplessness, hot flashes and night sweats (which can lead to problems with sleep or make pre-existing issues with sleep worse), or the mental energy exerted to try to compensate for brain fog can lead to fatigue or exacerbate it. 

And for the majority of women+ who embark on the menopause journey during midlife, pressures from work and juggling life at home, which may include taking care of children and aging parents, can be draining, both physically and mentally.

While fatigue and exhaustion can be a symptom of the menopause journey for women+, talk with a doctor or other healthcare professional, as there are other medical reasons for fatigue. They include:

  • not getting enough high-quality sleep
  • being chronically dehydrated
  • chronic fatigue syndrome (CFS)
  • fibromyalgia
  • thyroid disease
  • chronic pain
  • cancer and cancer treatment
  • anemia
  • chronic conditions like diabetes, COPD, congestive heart failure, liver disease, kidney disease
  • autoimmune conditions
  • depression and anxiety
  • poor nutrition, eating disorders, being underweight
  • sleep disorders like sleep apnea and narcolepsy
  • medication
  • infections
  • long COVID

It’s important to find out the root cause of your fatigue and exhaustion in order to know the best way to proceed.

For example, although it may seem counterintuitive, regular exercise can often help. But if you have long COVID, some types of exercise are better than others, and vigorous exercise can make things much worse or even cause a major setback.

Ways to energize your body and refresh your mind

You can do several things to regain energy and help get over fatigue and exhaustion during the menopause journey. These steps may also help you manage other menopause symptoms.

  • Use food to fuel your body. Focus on foods rich in vitamins a woman’s body needs during menopause. Energy-rich foods include fruit, vegetables, fish, chicken, and whole grains. And avoid spicy foods, caffeine, and alcohol, as they may trigger hot flashes and also negatively impact sleep.
  • Get enough good-quality sleep. Figure out why you can’t sleep. Do you need to create or revamp a sleep routine or learn ways to relax your mind and body before bed? Taking a quick nap might also help, but avoid more than 20-30 minutes. Longer than that and you may awake feeling groggy rather than refreshed and also disrupt your sleep later.
  • Drink lots of water. It hydrates your body. 
  • Get exercise. Even a walk outside can refill your cup and energize you enough to make it through the day. Gradually add more exercise as you chip away at fatigue and exhaustion.
  • Prioritize so you don’t feel overwhelmed and can feel like you accomplished something each day rather than wading through an endless To-Do list. And sometimes the best action you can take is to surrender and accept the reality that there is only so much anyone can get done in a day.
  • Learn coping skills to help manage stress. You can start by relaxing your mind and body with techniques that include meditation, guided imagery, and yoga nidra. 
  • If you’re an extrovert, socialize with friends and family. It’ll help you tap into energy to help alleviate your fatigue. 
  • If you’re an introvert, take some “me” time to focus on recharging your tank.
  • Get help from your healthcare provider. If hot flashes, night sweats, sleeplessness, depression, anxiety, or other menopausal symptoms contribute to or are the root cause of your fatigue, you have options. Speak with your doctor about hormonal and non-hormonal possibilities and come up with a plan that is effective for you. 

The menopause transition is a journey that lasts up to 10 years for most women+. Don’t spend it exhausted and suffering in silence. It’s time to make a change for the better!

Hot flashes and night sweats

Up to 80% of women+ experience hot flashes during the menopause journey. They are the result of the hormonal transition which occurs during this stage of life, marked by volatility in hormone levels and an overall drop in the levels of estrogen (primarily) and progesterone. 
 

Hot flashes tend to affect Black and Hispanic women+/Latinas more than other racial groups, and Black women often experience them with more intensity/severity and a longer duration during the menopause journey.

Hot flashes are a component of symptoms referred to as vasomotor symptoms or VMSs. VSMs include hot flashes, night sweats, and palpitations.

Women+ typically feel hot flashes mostly in the head, neck, chest, and upper back. They can also cause sweating or flushed skin (redness in the face especially).

Some ways to manage hot flashes

Hot flashes can last for years and there is also a potential relationship between having more hot flashes and night sweats and the risk of stroke and dementia, so it’s important that you look for treatment options. These can include:

woman grabbing shoulder due to muscle aches and painsMuscle aches and pains

Are you feeling achy or stiff all over? There could be a lot of reasons, and one of them might be the menopause journey.

Studies suggest that muscle aches and pains can be more common in women+ in midlife during this stage of life, with up to 60% reporting this symptom and 15% of those indicating the aches and pains were severe. 

Your body goes through a lot during the menopause journey. The hormonal changes that occur during the transition (volatile and falling levels of estrogen and progesterone) impact muscles and joints because estrogen receptors are all over the body.

Then there is the wear and tear on the body as one ages. In addition to preexisting conditions, you may have arthritis, fibromyalgia, lupus, and sickle cell disease.

And being sedentary, depressed, stressed, or anxious can also lead to muscle and joint aches and pains or make them worse.

Chronic pain

Some studies suggest that women who have a heavy burden of menopause symptoms are more vulnerable to chronic pain. If you have severe menopause symptoms, the stiff, achy muscles and joints can become more than a nuisance and evolve to issues with chronic pain. This may also be the case if you’ve had chronic pain at another point in life or leading up to menopause. 

Chronic pain is defined as persistent or intermittent but lasting more than 3 months.

Up to 85% of patients with chronic pain also have depression. During menopause, the risk of depression increases, starting in perimenopause.

So, don’t ignore your pain and what your body tells you.

Sleep apnea and chronic pain

Do you have sleep apnea or do you suspect you do?

Sleep apnea leads to insufficient oxygen getting to your body and can also lead to general inflammation. It also results in an increased risk of hypertension (high blood pressure), heart disease, and stroke. These are all conditions for which the risk is already increased during the menopause journey.

Unfortunately, women+ are also at greater risk of sleep apena during menopause due to the hormonal transition which occur during this stage of life.

A study published in 2022 in Menopause, The Journal of The Menopause Society, found a significant association between sleep apnea and chronic pain among postmenopausal women. 

If you haven’t been tested for sleep apnea and have severe joint pain and fatigue, researchers believe testing is warranted for sleep-disordered breathing.

So, what can you do about the pain?

First, check with your healthcare provider to help determine the root cause of your aches and pains, particularly if they are sudden and/or severe. That can provide information to guide the actions you can take, including both hormonal and non-hormonal options.

In general, physical activity can be a good place to start in many instances, often regardless of the cause of the discomfort. Moving your body improves blood flow, strength, flexibility, balance, your posture, and lubrication of the joints.

It also has the extra bonus in many of having a positive impact on depression, stress, and anxiety, all of which are more common during the menopause transition. And don’t forget to get enough good-quality sleep and find ways to relax your body and mind, like meditation, guided imagery, body scans, and paced breathing.

Check out these exercises designed with menopausal women+ in mind. But be sure to make sure your healthcare practitioner has provided advice regarding the type and levels of activity that will be safest for you, particularly if you have been sedentary for a long time or have underlying medical conditions.

Also, take a look at your weight. It’s common during the menopause journey to put on extra weight, especially in the midsection. It can put extra pressure on your joints and muscles, which can cause them to hurt. And having a lot of internal fat in your abdomen sets up inflammation in the body, which can contribute to aches and pains. Having and maintaining a healthy weight will serve you well both now and for the rest of your life.

woman looking at her skin and nails in mirrorSkin and nails

Is your skin dry and itchy? 72% of women in menopause reported skin changes in a 2018 survey.

Are your nails brittle? 19% of women younger than 60 report brittle nails, and the number rises to 35% after age 60. 

The natural drop in estrogen levels impacts collagen in your skin. That leaves it dry and itchy. Moisturize, moisturize, moisturize.

Falling estrogen levels can also be a culprit when it comes to your nails. Nails are made of a protein called keratin. The drop in estrogen levels during the menopause journey weakens the keratin layer and can make them brittle and easy to break.

How to prevent brittle nails

There are things you can do to help your nails.

  • Limit the use of nail polish remover with acetone and harsh chemicals, which can be very drying and exacerbate the situation.
  • Protect your nails (and hands) with gloves when washing dishes and other activities where they may be exposed to hot water and chemicals.
  • Avoid gel nail extensions and acrylic tips, as they can be damaging and make brittle nails worse.
  • Don’t file the surface of your nails.
  • Moisturize.

Several supplements may be worth discussing with your healthcare provider, including:

  • biotin – may help strengthen your nails and help them grow. You can also get biotin from foods like liver, eggs (the yolk), salmon, legumes (e.g., lentils, peanuts), soybeans, yeast, salmon, avocado, sweet potato, nuts, and seeds.
  • zinc – helps promote healthy growth. It can be found in fish, beef, poultry, black beans, almonds, and eggs.

Although most people get enough protein, the amount you need to eat increases as you age and lose muscle mass. Keep an eye on your intake to help ensure your consumption is adequate, especially if you have been sedentary and start a vigorous exercise. Eat these lean protein foods to help during the menopause journey.

Your doctor may also check for conditions like iron deficiency and thyroid disease. (You’ll need to stop taking a biotin supplement prior to thyroid testing because it can interfere with the accuracy of the bloodwork.)

Sleep

How many times have you slept consistently for 8 hours? It’s one of the most common menopause symptoms – falling asleep, staying asleep, and falling back asleep. 

Hormone fluctuations can jolt you awake as well as symptoms. Perhaps you wake up in the middle of the night with night sweats, cold flashes, leg pain, or restless leg syndrome.

Falling back asleep during menopause can be harder than other stages of life due to what’s causing you to wake. The key to getting the sleep your body needs rests with your day and night habits.

Upper Body

Anger and rage

During menopause, women can experience mental and emotional concerns from rage to depression and everything in between.  

In addition to the hormonal fluctuations of menopause, you may be upset with your spouse, disappointed in your weight, confused by symptoms like brain fog, or lamenting on the loss of fertility. The list of contributing reasons for your emotions can go on and on! 

It's been awful, and the mood swings and rage are the worst!

If you’re having these emotions, it’s essential to get to the bottom of “why” you’re feeling the way you are because long-term anger and rage are bad for your health

Are you even able to tell the difference between rage and anger or when one fuels the other?

A good starting point is the pausitive health downloadable anger log. It can help you identify your emotions and feelings, triggers, and trends.

mood log workbook mockup

Get Relief From Your Emotions

Having mood swings? Track how you feel, identify your triggers, and find ways to calm the emotional firestorm with this mood log.

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woman with anxietyAnxiety

Are you feeling anxious? Have you always felt this way, or is it a new experience? 

How long do the symptoms last? Do you continue to feel anxious long after the stressful situation passes? That’s an indicator that you could have an anxiety disorder. 

According to the American Psychological Association, anxiety “is considered a future-oriented, long-acting response broadly focused on a diffuse threat…” It is characterized by “a feeling of fear, dread, and uneasiness.”

Anxiety evolves to a disorder when it persists (i.e., occurs more days than not, for at least 6 months). It may impact your work and activities of daily living. Generalized anxiety disorder (GAO) is seen in close to 6% of the adult population in the U.S. at some point in their lives and is more common  in women+ than men. In some studies, it was found to be twice as common.

Like depression, the risk of anxiety increases during the menopause journey. One reason is the fall in estrogen levels. And anxiety has been noted to be more common in women+ who experience vasomotor symptoms (VSMs) – hot flashes, night sweats, and palpitations.

There are other potential causes of or contributors to anxiety, like a thyroid condition or past trauma. Therefore, as always, contact your healthcare provider to get guidance and develop a treatment plan.

Symptoms of anxiety

Look out for these symptoms: 

  • Being angry and on edge
  • Going back to the same thought over and over
  • Being worried or stressed on a regular basis
  • Avoiding public or social settings
  • Having panic attacks (which may include symptoms like palpitations, nausea, feeling weak or lightheaded, sweating, and having chest pain)
  • Being afraid (the feeling of fear) or fearful 
  • Hot flashes 
  • Having difficulty sleeping
  • Shaking
  • Having tense muscles/body
  • Having fatigue and exhaustion

These feelings may come and go or last longer. As you can see, many of the symptoms of anxiety are also menopause symptoms, so it may be difficult to distinguish between the two.

Managing anxiety

There are basic steps you can take, like improving your sleep routine, that will be helpful for anxiety and other menopause symptoms like mood swings. Others include watching your intake of caffeine and physical activity.

Some women find relief with non-hormonal treatment options like yoga and meditation, which can help you to relax your mind and body, decrease stress, and get better sleep. Some may need medication, like antidepressants. And some women+ may find cognitive behavioral therapy (CBT) an effective modality for anxiety, as well as sleep issues and hot flashes.

Brain fog

Do you feel like you’re losing your mind or are your thoughts all scrambled? Brain fog can make it hard to go about your day, and can impact your personal and professional life. 

In a pausitive health survey, 18% of respondents listed brain fog as one of their emotional and mental health concerns. 

I worry brain fog will prevent me from performing tasks and assuming the responsibilities that my position requires.

Depression

How are you feeling? Truthfully! If you’re struggling with sadness or medically diagnosed depression, you are not alone. It’s common in women, and can be one of the first symptoms of menopause.

One of the reasons is that menopause changes your brain. That’s why you may feel a wide range of emotions, almost as if you’re on an emotional rollercoaster. Learn if you’re at risk for depression.  

Ear symptoms

During the menopause journey, there are also possible changes related to your ears and hearing, including:

  • ringing of the ears during perimenopause (tinnitus)
  • blocked ear canals
  • infection
  • hearing loss, especially for postmenopausal women+
  • hot ears
  • itchy ears

The drop in estrogen levels during the menopause transition can cause the lining of the ear canal and inner ear to dry out, impact blood flow, and affect certain cells as well as bone metabolism. As a result, you may be more prone to ear infections, dizziness and issues with balance, and itchy ears. Some women experience hot ears related to hot flashes, particularly if the hot flashes prmarily occur from the chest up.

Tinnitus, a hearing disorder which results in noise in the ear(s) that can sound like ringing, buzzing, or other sounds, may also develop related to hormonal volatility. 

woman having her ears checked for hearing lossHearing loss and HRT

You may notice a change in your hearing during this stage of life. It may be something as simple as a wax build-up related to the dryness from lower estrogen levels. However, you should check to make sure it is not something more serious, especially since hearing impairment/loss can be a risk factor for dementia

It may not be surprising that hearing loss increases with age, but there are surprising links to age of onset of menopause and hormone replacement therapy.

In a prospective study of 80,972 women+ published in Menopause, there wasn’t an association between menopausal status and hearing loss. But, there was an association between the age at which women+ reached menopause and HRT use. The link appeared to be related to the age at which HRT was started and the amount of time it was used. 

  1. Women who experienced menopause at an older age had a higher risk of hearing loss. Women who experienced natural menopause at age 50 or older had a 10% higher chance than women who experienced it before age 50.

2. Use of oral estrogen hormone therapy or an estrogen-progestogen combination increased the risk, and the risk was greater for women+ who used HRT longer.

3. The risk was also greater for women+ who used HRT for 5 years or more, compared to those who did not use it.

Always talk to your doctor about hormone therapy. The latest guidelines say HRT should be individualized, and you should use the lowest dose possible that is effective. There are many risks and benefits to be taken into account. In addition to timing and dose, you should also consider the type of hormone therapy and duration when discussing treatment with your doctor. 

eye examHow your eyes can change 

The menopause transition can also lead to eye issues like: 

  • dry eyes
  • light sensitivity
  • blurred vision
  • increased tearing 
  • red or swollen eyelids
  • scratchy eyes 

These symptoms are believed to be related to the hormonal shifts and fall in estrogen and progesterone levels that occur during the journey. 

Don’t take unnecessary risks with your vision or suffer when there are steps you can take to get relief. Make time to see an eye specialist to find out if the cause of your symptoms is related to the menopause transition or potentially a sign of conditions like thyroid disease or diabetes. Regular eye exams can also detect issues like glaucoma and AMD early so treatment can begin to help protect your vision. 

Menopause and glaucoma

As you age, your vision may decrease due to conditions like cataracts, and glaucoma, and age-related macular degeneration (AMD), which are more common as one gets older. 

new (2023) study suggests menopause may also increase a woman’s chance of developing glaucoma. It’s the leading cause of blindness that can’t be cured. 59% of people who develop it are female. 

Now, researchers believe the changing levels of estrogen during the menopause journey cause women+ to develop glaucoma and other vision issues. 

Additionally, women+ who experience early (older than 40 but younger than 45 years of age) menopause are at increased risk of open-angle glaucoma. 

Some studies found postmenopausal hormone therapy can decrease the risk of secondary open-angle glaucoma and elevated pressure in the eyes, which can lead to glaucoma. Researchers believe further studies are needed to examine the relationships between medications like HRT and the risk of glaucoma.

woman looking at hair loss on brushHair changes

Have you noticed a change in your hair texture or receding hairline? Is it more dry or frizzy even though you haven’t changed your care routine? Is your hair thinning or shedding more hair than usual? 

These all can be a sign you’ve started on the menopause journey. 

As you might have come to expect, hormonal changes may be to blame for these symptoms. Estrogen and progesterone can help hair stay in the anagen (growing) phase of the hair life cycle. When levels fall, hair thins out and grows more slowly. At the same time, the level of androgen hormone increases, which leads to hair loss on your head but can also cause hair growth on your face/chin. It’s a potential perfect storm of hair changes resulting in a distribution that’s less than optimal. 

Hair thinning and loss (alopecia) can also be caused or exacerbated by other factors like stress, anemia, a problem with your thyroid, or insufficient intake of protein, biotin, iron, or zinc.  Alopecia is the sixth most common dermatologic diagnosis for African American women.

Women+ are at increased risk of depression and hypertension. Certain medications for depression and high blood pressure can also cause hair loss. So, check in with your healthcare provider to determine if you need a work-up, a referral to a dermatologist, or a change in your medication regimen.  

You may also experience a dry, itchy, or sensitive scalp. 

The hair changes experienced in menopause may also vary depending on your race/ethnicity and degree to which you stressed your hair over the years. 

Caucasian hair

Hair is typically at its thickest between ages 42 and 53 years old for Caucasian women+, and it can thin out as estrogen levels drop during the menopause journey. 

Flat irons, blow drying, coloring, and other hair treatments can damage hair. Some of that damage can lead to further graying. Depending on the number of treatments and grooming habits, one woman’s hair may be more or less susceptible to stress.

African American hair changes

African hair is more fragile and breaks earlier and at lower stress levels than Caucasian and Asian women. It also breaks faster than it grows. Compared to Asian women, the growth difference can be as much as 5-cm less in one year.

The denisty is also less than Caucasian and Asian women, and it decreases with age.

Asian hair

Asian hair is more resistant to stress from coloring and straightening, but it does become weaker with age. That’s after 40 years of age for Japanese women+ and 50 years of age for Korean women+.

Hispanic/Latino hair 

A Hispanic or Latino woman has hair similar to that of an Asian woman. But, Hispanic women tend to report more heat-styling habits to achieve smooth, shiny hair. That can damage the hair, and depending on the extent of treatments and habits, damage can show up earlier than it otherwise would with natural aging.

Helping hair grow

There are steps you can take to help support your hair and scalp health. For many women+, the thinning and hair loss may eventually abate, and regrowth may occur.

  1. Manage emotional stress and avoid physical stress to your hair and scalp from:
    • harsh chemicals
    • hairstyles that put a lot of traction on the hair
    • heat tools like curlers and hair straighteners
  2. Speak with your healthcare provider about:
    • topical treatments like minoxidil, which can help some people regrow hair when used consistently
    • spironolactone, an oral medication used for hypertension and other conditions, and off-label for hair loss and thinning
  3. Look at your eating habits.
    • Are you consuming foods that ensure sufficient intake of vitamins that play a role with regard to the condition of your hair like biotin, zinc and vitamins C, B, A, and D
    • Are you experiencing heavy periods during perimenopause that may lead to an iron deficiency?
    • Are you eating omega-3 fatty acids, which can be found in foods like salmon, tuna, and walnuts
    • Are you eating foods packed with these nutrients so you can help make your menopause symptoms better?

Additionally, some women+ who use HRT for menopausal symptoms like hot flashes and may find their hair issues improve. However, depending on the type of hormone formulation, others may find HRT worsens hair and scalp changes.  

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Headaches

Is your head throbbing? You are not alone.

Headaches are common in the general population (approximately 17% of individuals) and up to twice as prevalent in women+ than those of the male sex.

There are several types of headaches, including:

  • Migraine – characterized by a throbbing pain, often severe, typically on one side of the head and commonly accompanied by symptoms like nausea, vomiting, light sensitivity and sensitivity to sound; cause believed to be abnormal brain activity which can also cause a change in blood flow
  • Tension – the most common type, characterized by mild – moderate pain, and often described as a tight band around the head; cause unclear
  • Cluster – an uncommon type, more prevalent in men and may run in families, characterized by one-sided head pain that can be severe and often accompanied by symptoms such as a stuffy nose or tearing of the eyes; cause unclear

In women+, headaches are often related to hormonal shifts, particularly changes in estrogen levels. Therefore, they may be present throughout the course of a woman’s life cycle, starting with menses all the way through to the menopause journey. They can also be seen in response to hormonal changes related to other factors such as a surgical procedure like a hysterectomy.

Headache is common during the menopause transition, starting in the perimenopause stage of the journey.

Migraines

Migraine headaches are among the most common type of headache during the hormonal transition. 

For those with a history of migraines, there can also be a reciprocal relationship with hot flashes – women+ with migraines are more likely to have severe hot flashes, and those with severe hot flashes are more likely to have migraine flares.

Researchers have also found women+ with a history of migraine headaches had varying patterns when the menopause journey was underway. 24% saw their headaches get worse, 36% got better, and 40% experienced no change during the menopause transition.

Some 25 – 30% of migraine sufferers experience an “aura,” which can be a signal a migraine is on its way. During an aura, which can last up to an hour, an individual may experience a tingling or numb sensation of various parts of the body, seeing zig zags, sparks, and bright dots, or being unable to speak clearly. Visual changes are the most common type of aura.

Women+ going through the menopause journey are already at an increased risk of coronary heart disease. Unfortunately, a recent study found an association (currently unexplained) between migraine with aura and an increased risk of cardiovascular disease.

Besides hormonal changes, there are many other potential triggers for a migraine:

  • Certain foods and fluids – chocolate, those containing tyramine (e.g., wine, aged cheese, chicken livers smoked fish, figs, and certain beans), meats containing nitrates (e.g., bacon, hot dogs, cured meats), fermented, processed, pickled, and marinated foods, foods containing MSG, onions, peanuts, avocado, citrus fruit, bananas, alcohol
  • Caffeine withdrawal
  • Missing meals
  • Not getting enough sleep
  • Loud noises and bright lights
  • Perfume
  • Smoking or being exposed to smoke
  • Stress/anxiety

Headaches and health disparities

Like so many other areas of medicine, health disparities exist when it comes to headaches. Both Black women and Latinas are less likely to get a migraine diagnosis than their white counterparts, which also means greater risk of delayed or even no migraine-specific treatment altogether.

Some studies have also found health disparities in the queer community compared to cisgender heterosexual individuals. For those who are transgender, there are the additional potential challenges of the applicable hormonal regimen, its impact on headaches, and finding a provider who is knowledgeable. And, related to a greater prevalence of anxiety and depression, LGBTQIA+ members are at additional greater risk for coronary heart disease beyond hormonal shift and migraines with aura.

Be mindful of the intensity of those headaches as they can become migraines. A severe headache is one symptom of a migraine. It may be accompanied by nausea, blurry vision, dizziness, light sensitivity, and fatigue. 

The researchers said migraine and tension-type headaches are the most common types of headaches during menopause. 

Migraine help

As you can tell from the trigger list, there are many lifestyle changes you can make to help manage migraines, several of which may also help with other menopausal symptoms like hot flashes, fatigue, and weight gain – healthy eating, reducing or eliminating alcohol use, and getting enough high-quality sleep

There are many additional options you can try for migraines, both hormonal and non-hormonal, including: 

Many of these treatment options can also help with other menopause symptoms.

As always, seek guidance from your healthcare provider to identify the best regimen for your particular situation, as well as to learn about the risks, benefits, and various formulations of HRT.

Mood swings

In a pausitive health survey, mood swings were the top emotional and mental health concern, affecting 22% of respondents.

Some women compare the up-and-down range of emotions to being on a rollercoaster

Know that you are not alone, and you don’t have to suffer in silence. There are treatment options available and steps you can take to adjust your mindset, to find the positives of this ride through life! 

It is difficult to think of anything positive about this time of life.

Oral health

Your oral health is important throughout your life and can impact many other parts of the body. For example, periodontal (gum) disease can cause inflammation in the body that can increase the risk of cardiovascular disease, make diabetes more difficult to manage, and result in premature delivery.

This stage of life is no different, as both the gums and teeth can be affected.

During the menopause journey, the hormonal changes can increase the risk of plaque, which in turn increases the risk for gingivitis (gum inflammation) and advanced periodontitis (gum infection)

Women+ can also experience:

  • dry mouth (xerostomia)
  • metallic taste
  • mouth pain and burning tongue (Burning Mouth Syndrome aka BMS)
  • receding gums
  • tooth decay
  • tooth sensitivity
  • loose teeth/losing teeth
  • TMJ
woman getting teeth checked for oral health

Periodontal issues are the most common sign of the impact of the menopause transition on oral health, present up to 60% of the time, followed by dry mouth (25%), and burning tongue (15%) of the time.

Dry mouth is more than an inconvenience. Saliva plays an important role in clearing bacteria from your teeth, so a reduction in saliva increases the risk of cavities, gum recession (which can lead to tooth loss), thrush (oral yeast), a bad taste in the mouth, and issues with the jaws. 

Burning mouth syndrome (BMS)

Just like it sounds, BMS can affect all parts of the mouth, including the tongue, palate, lips, or areas that support dentures. 

It affects mostly women+ in their 40s and 50s but is most common in postmenopausal women. 

TMJ jaw pain

Some of your menopausal muscle aches and pains may be in a jaw joint, commonly referred to as TMJ or the temporomandibular joint.

You can feel these joints on either side of your face just below your ears. Open and close your mouth, and you’ll feel the joint at work. 

TMJ can cause:

  • pain in the jaw
  • chewing pain
  • pain opening and closing your mouth
  • popping noises in your ears
  • clicking or popping noise in your jaw
  • headaches
  • neck pain

Pain in this joint that lasts more than six months can lead to a degenerative disease known as chronic TMD. So, it’s important to tell your dentist if you’re experiencing pain.

One study has reported that women with severe menopausal symptoms also experienced more severe TMJ pain. And another study also found it’s more common in menopausal women than in non-menopausal women.

It’s less clear during which stage of menopause you’re most at risk for TMJ pain, as studies have shown conflicting findings.  

Preventing oral health symptoms related to menopause

The risk of several oral health issues during the menopause journey may be reduced by good oral hygiene. Steps you can take include:

  • Brushing your teeth at least twice a day for at least two minutes with fluoride toothpaste.
  • Flossing at least once a day.
  • Reducing the consumption of sugar and eliminating sugary food and drinks.
  • Using a fluoride rinse once a day.
  • Eliminating tobacco products.
  • Using xylitol toothpaste, gum, or candy, which can help prevent cavities.
  • Seeing a dentist for a check-up at a frequency based on your particular situation; for example, you might be prescribed a special rinse for dry mouth or toothpaste with a higher concentration of fluoride.

Additionally, according to the American Dental Association (ADA), “Systematic reviews found that mouth rinses containing an antimicrobial effective amount of a fixed combination of four essential oils (eucalyptol, menthol, methyl salicylate, and thymol) or cetylpyridinium chloride, and toothpastes containing triclosan or stannous fluoride, were associated with decreased risk of gingivitis and periodontal disease.”

Treatment

For oral health issues, studies present a mixed bag. Hormone replacement therapy has proven effective in some, but others have not shown marked improvement.

HRT can increase bone density, and some studies have found postmenopausal women on HRT for osteoporosis prevention had a lower prevalence of severe periodontitis, and tooth loss

When it comes to TMD, the American Academy of Orofacial Pain (AAOP) says treatment depends on the cause, of which there are many.

Stress management, physical therapy, medication, a night guard to prevent clenching or grinding which can worsen TMJ, or a stabilization splint can help.

In most cases, conservative treatments work. Surgery is only required in 5 out of 100 cases, according to AAOP. 

Your dentist can help address your TMJ symptoms, or you might be referred to an orofacial pain specialist

Woman having her thyroid checked by doctorThyroid

One in eight women+ will develop an issue with the thyroid over a lifetime. And hypothyroidism (underactive thyroid) was found to be more common in Korean women in later perimenopause and during the post-menopause stage of the journey than in earlier stages of their lives.

As is often the case, many of the symptoms of the menopause journey overlap with those of various conditions. Thyroid disorders are no exception. Both overactive (hyperthyroidism) and underactive (hypothyroidism) thyroid function changes can lead to symptoms commonly experienced by menopausal women+ – palpitations, weight gain, hair changes, fatigue, GI symptoms, mood changes, sleep issues, and menstrual irregularities.

For example, your thyroid helps regulate your metabolism. As you age, your metabolism naturally slows. So, if you gain weight, is it your metabolism slowing or is it your thyroid? Both? It can be difficult to tell the root cause without further testing. 

Thyroid conditions can also increase the risk of certain conditions for which women going through the hormone transition are already at increased risk – heart disease, high cholesterol, depression, and osteoporosis. And if you already have hypothyroidism and are taking levothyroxine, a dosage reduction may be needed. However, if you are on hormone therapy for menopause symptoms, the dosage may need to be increased.

Thyroid issues can also make menopause symptoms worse. 

Your doctor can check your thyroid for changes in the size and feel for nodules during an exam. It’s also likely bloodwork would be ordered to check your thyroid hormone levels.

Torso

Heart palpitations

In addition to an overall increased cardiovascular risk, women+ may also experience palpitations. They’re most common in perimenopause but they can also occur in postmenopausal women+.

Up to 42% of perimenopausal women and 54% of postmenopausal women have palpitations.

Symptoms may vary among women+. You may describe it as:

  • an irregular heartbeat
  • fast heartrate
  • fluttering
  • pulsating
  • racing
  • pounding
The palpitations may come and go or continue for awhile.

Risk factors for palpitations

Like other menopause symptoms that vary by race and ethnicity, there are differences with palpitations too. Hispanic women are more likely than white women+ to have palpitations.

Cardiovascular disease risk factors are also higher in Hispanic individuals.

Palpitations are also seen more commonly in women+ who are inactive, have sleep disturbances, and hot flashes.

By managing some of the other correlated symptoms, you may also be able to manage a racing heart.

When your heart is involved, always talk to your doctor, as it can be a sign of a more serious heart condition.

Cardiovascular concerns for women+

Cardiovascular disease is the leading cause of death in women+ in the United States. While it can strike at any time, the risk increases as a woman+ transitions through the stages of menopause. 

It’s critical that you seek the advice of a doctor and get help immediately at any sign of heart distress. Research shows that while it’s a leading cause of death, only 56% of women recognize it as the #1 killer.

Women may have different signs than men, including:

  • nausea
  • vomiting
  • fatigue that won’t go away

They may also feel:

  • dull or heavy chest
  • pain in the neck, jaw, or throat
  • pain in the back or upper abdomen

Risk factors for women+

Risk factors include overall lifestyle, the timing of menstruation and menopause, and your health during pregnancy. You’re at risk if you had/have:

  • period before age 11
  • early menopause (before age 40)
  • polycystic ovary syndrome
  • gestational diabetes during pregnancy
  • preterm delivery
  • delivery of a low birth or high birth-weight baby
  • hypertensive disorders of pregnancy

Reducing the risk of heart disease

To reduce the risk of heart disease:

  • watch your weight
  • exercise
  • eat healthy foods
  • find ways to decompress after a long day
  • minimize stress
  • limit alcohol
  • monitor your cholesterol
  • monitor your blood pressure
  • check you triglycerides
This is important for all women+, especially Black women, who are nearly 60% more likely to have high blood pressure than white women.

Indian woman having her blood pressure checked for heart health

Gastrointestinal pain

During menopause, you may increase a wide range of gastrointestinal pain including:

  • gas 
  • indigestion
  • abdominal cramps
  • bloated 
  • changing bowel habits
  • heartburn and acid reflux
  • indigestion
  • constipation 
  • nausea
  • vomiting
  • diarrhea

You can also get gallstones and pancreatitis. For some women+, the symptoms can also indicate gastrointestinal diseases like irritable bowel syndrome.

It’s critical that you talk to your doctor about many of these symptoms as they can be a sign of other, more serious conditions like colon cancer or ovarian cancer. 

Learn about the various stomach diseases that affect menopausal women and the ways to treat gastrointestinal concerns and stomach pain.

Non-alcoholic fatty liver disease (NAFLD) 

Your liver is also part of the GI tract, but it’s unlikely you’ve given as much thought to it. New research suggests postmenopausal women are at risk for non-alcoholic fatty liver disease (NAFLD). 

NAFLD refers to several liver diseases that affect people who drink little to no alcohol. With this disease, there’s too much fat in the liver cells.

In a review of 12 cross-sectional studies, researchers found the risk of getting non-alcoholic fatty liver disease (NAFLD) increases nearly 2.4 times in postmenopause. Plus, the mortality rate is higher for women.

Symptoms of NAFLD

You may not have many symptoms with NAFLD. If you do have signs of it, you may struggle with fatigue or pain in the upper abdomen. 

More advanced cases of this disease have more pain and symptoms like yellowing of the skin and eyes.

Age and hormonal fluctuations increase the risk of liver disease in postmenopausal women enough that researchers say there should be a heightened sense of suspicion of this so you can get treatment early before the disease becomes advanced.

Shortness of breath

Shortness of breath and breathing difficulties are symptoms of menopause that you probably don’t know about until it happens to you. 
 
Researchers in Norway found declining estrogen changes lung size and the amount of air a person can blow out in one second. And, get this – the decline was so sharp it’s as if women were smokers for a decade!
 
Shortness of breath and fatigue are considered symptoms of this decreased lung capacity.
 
However, shortness of breath can also be a sign of a serious lung condition, so talk to your doctor if you’re having shortness of breath.

Lower Body

Leg pain

Pain during the menopause journey can be generalized muscle aches and joint pain or specific to a part of the body like the leg.

When the pain is specific to the leg, women+ complain of:

  • cramps
  • restless legs
  • achiness
  • swelling
  • tingliness
  • pain near the hip
  • hot and cold feet
Leg pain is common at night, which can make sleeping (already an issue) a bigger problem.

Restless Leg Syndrome (RLS)

When the pain causes you to move your legs uncontrollably while you rest, you may have Willis-Ekbom disease, also known as Restless Leg Syndrome (RLS).

In addition to the leg movements, you may have a pins and needles feeling in your legs or pain between the ankle and knee. 

There are specific criteria used to diagnose RLS, which is more common in women than men. Some of the changes women+ experience during the menopause journey can increase the chance of getting RLS.

couple texting in bed uninterested in sexLoss of libido 

If you’re having vaginal pain, you may not be interested in sex because it’s painful or causes you to not orgasm. Unrelated to that pain, fluctuating hormones during the menopause journey can also result in a loss of libido or sex drive.

Women+ may also find it harder to be aroused by their partner, impacting their relationship and mood

Other menopause symptoms like urinary incontinence can also cause you to lose your sex drive. If you’ve gained weight or experiencing mood swings, you may feel less sexy and find it hard to get in the mood.

The status of your relationship with your partner in midlife can be a factor. Talk to your partner about how you feel. Open communication will help you manage this symptom of menopause.

Loss of libido is a complex issue in midlife that’s likely hormonal, physical, and emotional. While your doctor can prescribe medication to increase sex drive, you also need to address this symptom’s emotional and physical components.

If you experience this, it may happen to be your only sexual symptom or there can be others. It can also happen in combination with other sexual, urinary, and genital symptoms and may be referred to as genitourinary syndrome of menopause.

woman stepping on pins to symbolize menopause pins and needles sensationPins and needles in hands and feet

Do your hands and feet tingle so intensely that it feels like pins and needles? These sensations can happen throughout a woman’s body, but typically on the arms (hands, fingers), feet (toes), and skin.

It’s called paresthesia. It can make it difficult to walk or grab things, and can cause you to lose your balance.

Women+ describe this sensation as:

  • pins and needles
  • tingling
  • prickly
  • a sensation of something crawling on you 
  • burning
  • numbness
  • cold sensation
  • increased sensitivity
  • electric shock

It’s all related to how menopause changes your body – from head to toe – including the nervous system.

Pay attention to the pins and needles sensation in combination with other symptoms. Does it make your anxiety or mood swings worse? Does it bring about a cold or hot flash? 

How to manage tingling sensations

Like so many other symptoms, lifestyle modifications are a great way to manage this menopause symptom.

You can:

Urinary incontinence

Does urine randomly leak from your bladder? This uncontrolled leakage is considered urinary incontinence. It may happen when you’re exercising, coughing, sneezing, or laughing.

If you’ve been pregnant, you may blame it on that. Just like during that time of your life when your doctor perhaps told you to do Kegel exercises, the same advice holds during the menopause journey. 

Urinary incontinence can be due to an overactive bladder and/or weak pelvic floor muscles, which Kegels strengthen.

Urinary GSM symptoms

Urinary incontinence is just one of the urinary symptoms of genitourinary syndrome of menopause (GSM). Others include:

  • painful urination
  • urgency (need to go to the bathroom quickly)
  • blood in the urine
  • more frequent UTIs
  • stress/urgency incontinence

Any of these urinary symptoms can appear on their own or in combination with sexual and vaginal symptoms. That’s why it’s referred to as genitourinary syndrome of menopause (GSM).

Managing urinary symptoms

Urinary symptoms can impact daily life and your sex drive, if you have leakage during sex.

So talk to your doctor about it before it affects your relationship too.

If you have urinary incontinence, you can manage it by:

  • Watching your weight, as this is a risk factor.
  • Limiting caffeine, alcohol, or drinks with gas.
  • Monitoring for activities that make symptoms worse.
  • Trying bladder training which means going to the bathroom less and exercises to control your urine stream.
  • Doing pelvic floor exercises like Kegel exercises.
  • Using a professional pelvic floor therapist who can use other techniques.
  • Having surgery as a last resort.

If you have urinary leakage or have to go to the bathroom too much, you can:

urine lab test for someone with frequent UTIUrinary tract infection (UTI)

Urinary tract infections are common in postmenopausal women. It’s a bacterial infection and can also be associated with genitourinary syndrome (GSM) of menopause. 

They’re recurrent when you have three UTIs in 12 months or two in six months. 

The most likely symptom is a burning pain when you go to the bathroom and urinate. It may also feel like you have to use the restroom but only produce a few drops of urine. Your urine may also have an odor or look cloudy.

You may also feel pain in your lower abdomen, pelvic area, and even your lower back.

If you notice blood in your urine, seek the help of a doctor immediately. This can be a sign of a more serious condition.

Why menopausal women get UTIs

The microbiome of the urinary tract changes during the menopause journey, which can make women+ prone to UTIs. Also, vaginal tissues thin, and trouble emptying your bladder during the menopause journey can also contribute.

UTI treatment

While antibiotics can help, you don’t want to take those frequently to minimize drug resistance. Topical and intravaginal estrogen can help reduce the risk. 

You can also try probiotics, cranberry juice, and d-mannose. Your doctor may also suggest an oral immunostimulant or filling your bladder with a solution and then draining it in a procedure known as a bladder instillation.

When you have to go to the bathroom, go! Take your time urinating.

Research also shows women+ have success with an oral combination of hyaluronic acid, chondroitin sulfate, curcumin and quercetin while using estrogen therapy.

Researchers are also working on a promising bladder vaccine that helps your bladder fight off the E-coli bacteria. 

Vaginal pain

During menopause, your vagina tissues change. It can lead to:

  • frequent urinary tract infections
  • pain during sex
  • vaginal dryness
  • vaginal itching
  • lack of an orgasm

The pain and symptoms can involve your vagina, vulva, and urinary tract.

Due to the number of body parts involved in this region, you may hear your doctor refer to it as genitourinary syndrome of menopause or GSM. Depending on the specific symptoms, there are other names, like vaginal atrophy. 

Don’t be embarrassed to tell your doctor about sexual issues like pain or orgasm issues. The key is to get treatment quickly before the vaginal or sexual pain gets worse. 

Treating GSM

Depending on where the pain is located, treatment may vary. You have options to help with the pain and lack of an orgasm including:

  • HRT
  • non-hormonal medication
  • pelvic floor and Kegel exercises
  • vaginal stretching
  • dilators
  • moisturizer

What to look for in a vaginal lubricant or moisturizer

Lubricants and moisturizers will become your best friend if you’re experiencing this pain or itching in your vagina.

Do not use petroleum jelly or mineral oil as they can make the symptoms worse.

Look for a long-acting vaginal moisturizer that you can apply inside the vagina. The word “internal” is important on the label. You don’t want to apply an external product.

Weight gain

Have you noticed a few extra pounds in your midsection? It’s a common menopause symptom as your body’s metabolism slows.


The average woman gains 4.5 pounds during the menopause transition and then another pound each year as the woman ages in her/their 50s and 60s.

In our pausitive health survey, women told us they want to lose weight, but they feel alone on their journey to do this.

Women said weight gain was the most difficult symptom to manage. With you in mind, we created the menopause shopping list to help you pick foods that will provide the right combination of vitamins and nutrients menopausal women need.

Shopping List Download

Make A Change For The Better!

This menopause grocery list contains a combination of foods specifically selected to help you feel better today and even better in the future.

Please send the following:(Required)

If you don’t feel good about your body weight, it can affect other physical, emotional, and sexual aspects of your daily life.

  • Your mental health can suffer.
  • Your relationship with your partner can be affected.
  • Your sex drive can decrease.
  • You may feel more aches and pains.

Losing weight can improve your mood and make menopause symptoms better, including hot flashes and night sweats. 

Ready to get started?

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