Menopausal symptoms

Primary symptoms are those caused directly by hormonal fluctuations in the body. They may last between six months and 15 years or more.

Secondary symptoms occur as a result of other physical changes associated with aging:

  • Hot flashes
  • Night sweats
  • Palpitations
  • Sleep disturbances
  • Anxiety attacks
  • Difficulty concentrating
  • Fatigue
  • Irritability
  • Memory loss
  • Mood swings
  • Joint aches and pains, without swelling
  • Changes in eye and oral health

Menopausal symptoms up close

Hot flashes, night sweats, and other vasomotor symptoms

Around 60-80% of women will experience “vasomotor symptoms”, which primarily manifest as hot flashes and night sweats. These symptoms can begin in the perimenopause, at a time when you may still be having fairly regular periods, and persist through into menopause. Other symptoms may accompany hot flashes, including sweating, palpitations, apprehension, and anxiety. Some women find these symptoms very uncomfortable and distressing. Usually these symptoms go away with time, and most postmenopausal women experience hot flashes for less than 7 years. In some women they may last much longer.

A number of factors can increase the frequency of vasomotor symptoms, including obesity, certain medications, ambient temperature changes, spicy foods, cigarette smoking, and alcohol consumption. Ethnicity also impacts the likelihood of having vasomotor symptoms; compared to Caucasian women, African-American women experience more vasomotor symptoms, and Japanese and Chinese women experience fewer. There are multiple forms of treatment available to help manage or treat hot flashes, including lifestyle modifications, non-prescription drugs, and prescription drugs. Using a fan, lowering room temperature, dressing in layers, and drinking cold drinks can all help with night sweats and flushing. Some women report benefit from herbal preparations, but the most effective treatment agent for hot flashes is hormone therapy.

Sleep disturbances

Difficulty sleeping is a hallmark of the menopause transition. Two major sleep concerns often occur during menopause, difficulty falling asleep, and waking in the middle of the night. Women may find themselves waking up repeatedly with hot flashes and have difficulty falling back to sleep, or wake for no apparent reason.

 As a first step consider the steps you can take to improve sleep:

  • Check your mattress—is it in need of a replacement?
  • Is your bedroom quiet and dark?
  • Does your partner snore? Consider earplugs.
  • Cut back on caffeine, especially after noon.
  • Avoid eating heavy meals late at night.
  • Cut back on alcohol, even wine consumed 6 hours before bed time can cause “wine wakefulness”, typically during the second half of sleep. It is caused by some of the chemicals that are produced when alcohol is metabolized. Alcohol also reduces the quality of the sleep that you do get.
  • Shut down your screens (TV, computer and smart phone) an hour or two before bedtime and start a relaxing bedtime routine that works for you.
  • Write your to-do list for the next day, so you don’t need to lie awake thinking of it.
  • Practice yoga, meditation or paced breathing to settle yourself prior to bed time.
  • Be sure that your phone, if it comes into the bedroom, is on night-mode.
  • Consider cool nightgowns, sheets and pillows.

Non-prescription therapies such as valerian and St. John’s wort are also options for treatment. Cognitive behavioural therapy can also be useful. Currently, there is not enough evidence on cannabis use (either THC or CBD products) to enhance sleep or improve other symptoms during menopause.

If you are still having difficulties, see your doctor to make sure that you aren’t suffering from a medical disorder such as sleep apnea, reflux or restless legs, and to get advice on specific treatments. Your doctor may discuss treatment options, including hormonal treatments that have been shown to help sleep quality. Sleeping medications need to be used with caution – they are designed for occasional, not chronic sleeplessness.

Mood changes and memory loss

The most prevalent mood symptoms during perimenopause include mood swings, irritability, tearfulness, anxiety, depression, and lack of motivation and energy. During this period, some women may also be vulnerable to episodes of depression and/or anxiety. These mood-related symptoms can be worsened by sleep disruptions, and may also be improved with increased activity and improved diet. Antidepressants may provide some relief and in some cases are also helpful to treat hot flashes. Memory loss can also be a challenge in menopause: the most common complaint is difficulty finding a word, or recalling a name. These relatively minor memory lapses can be quite disruptive depending on your job, but for the most part do not interfere with performance. Likewise, adopting a healthy lifestyle offers the best strategy for keeping your mind sharp. Maintain good social connections, get adequate rest, eat a healthy diet, exercise frequently, and avoid cannabis or alcohol.

Weight gain

On average, women gain 4.5 lb during menopause. Increases in body weight are associated with increased risk of cardiovascular disease, breast cancer, diabetes, and hypertension. Weight gain around the middle also increases a number of health risks. Women on hormone therapy (HT) accumulate less body fat, less abdominal fat and gain more lean body mass compared to women who do not use HT.

Women can control weight gain by reducing their daily caloric intake and adding regular exercise to their routine. Insulin resistance increases with age, so reducing carbohydrates, and especially sugars in the diet is important for weight control. Read more about how to incorporate a healthy diet and exercise into your life, check out

Joint pain and skin changes

Joint pain is a common complaint among women during their menopausal transition. Hormone therapy may provide some relief but physical activity is the best therapeutic option. Women may also experience changes to their skin—often in response to sun exposure, smoking or hormonal changes. Hormone therapy can help limit collagen loss in the skin and help maintain the skin’s thickness, in women who are taking it for medically indicated reasons. If you experience severe joint pain, or if you have joint swelling or deformity, you should see your doctor.

Eye and oral health

As part of the natural aging process and due to hormonal fluctuations, women experience changes in eye function. To date, evidence is unclear about the effects of hormone therapy on eye disorders. HT has, however, proven effective in preventing dental pain, and decreasing tooth mobility and periodontal pockets. However, HT is not recommended solely as a treatment for oral health difficulties.


Whatever your situation, there are strategies to help you manage the transition.
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