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In the earlier phases of menopause, some women experience heart palpitations and irregular heartbeats.
January 19, 2026
Sharon Burbat
They can significantly affect quality of life: sleep disorders, sweating, mood swings. However, the list of menopause symptoms is much longer.
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That hot flashes are a symptom of menopause is known to most people – even those who are not affected by them. However, there are many other, lesser-known signs and complaints. In fact, there are said to be around 34 symptoms of menopause!
For women, menopause is a significant hormonal change. It is therefore not surprising that a number of symptoms occur as a result. Not all of these affect every woman, especially not equally and not evenly across all phases of menopause. Rather, it is an individual "compilation" of symptoms that are perceived as more or less burdensome.
Menopause, also medically known as the climacteric, marks the transition from the reproductive phase to a new stage of life. This process spans several years and is triggered by hormonal changes, particularly by the gradual decline in estrogen levels.
In this early phase, the ovaries slowly begin to produce fewer hormones. Most women initially do not notice any changes, and the cycle is usually still regular. However, the first subtle symptoms such as occasional sleep disturbances or slight mood swings may already occur.
This is the phase of the most noticeable changes. Estrogen levels fluctuate greatly, leading to irregular cycles. The intervals between periods become longer or shorter, and the intensity varies. During this time, most menopause symptoms occur: sleep disturbances intensify, mood swings become more frequent, and the first hot flashes may begin. This phase lasts an average of four to five years.
Menopause refers to the time of the last spontaneous menstrual period. However, this can only be determined retrospectively - namely when there has been no period for twelve months. The average age is 51 years, but it can vary individually between 45 and 55 years.
The phase after the last menstrual period is called postmenopause. Hormone levels have now settled at a low level. Many acute symptoms like hot flashes subside, while long-term changes like osteoporosis risk or weight gain become the focus. This phase lasts until the end of life.
The entire transition phase from the first signs to the complete end of hormonal changes lasts an average of 7 to 10 years. Every woman experiences this process differently - some have hardly any symptoms, others are severely affected.
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The hormonal changes during menopause can trigger a variety of symptoms. Important to know: Not every woman experiences all of these symptoms. The type, intensity, and duration of symptoms are very individual. Some women go through menopause almost symptom-free, while others suffer from several symptoms at the same time.
The symptoms also do not all occur simultaneously but develop over the different phases. Some are typical for early perimenopause, others only appear after menopause. These are the 34 most important symptoms:
Sleep issues are among the first and most common signs of menopause and often occur in perimenopause, even before other typical symptoms like hot flashes begin. Many women report difficulty falling asleep, frequent night awakenings, or early morning awakenings without being able to fall back asleep.
How do sleep disturbances occur? The declining estrogen levels affect the production of melatonin, the sleep hormone, and impair deep sleep phases. Additionally, the hormone deficiency impacts the body's temperature regulation, which can lead to night sweats that further disrupt sleep.
What helps?
By the way: Women need on average half an hour more sleep per night than men and are more sensitive to noise disturbances. Sleep problems usually improve for most women after menopause.
When the mood-lifting effects of estrogen decrease, many women experience emotional roller coasters reminiscent of premenstrual syndrome (PMS). These mood swings are among the early symptoms and often occur at the beginning of perimenopause.
How do mood swings manifest? Those affected report sudden irritability, baseless sadness, inner restlessness, and general dissatisfaction. Some women feel like they're undergoing a personality change and "are no longer themselves." The mood can swing from ecstasy to deep sadness in a very short time.
Why does this happen? Estrogen influences the production of serotonin and other neurotransmitters responsible for mood regulation. Hormonal fluctuations during perimenopause lead to an imbalance of these messengers in the brain.
What helps?
Night sweating can be so intense that nightwear and bedding are soaked and need to be changed. These sweats not only disrupt the affected woman's sleep but often also her partner's.
Why does night sweating occur? It is suspected that the declining estrogen levels affect the hypothalamus, the part of the brain that regulates body temperature. It reacts hypersensitively and falsely signals that the body is overheated. As a reaction, blood vessels expand and sweat production is massively increased.
What helps?
Hot flashes are the most well-known and for many women the most distressing symptom of menopause. About 75 percent of all women are affected. Unlike sleep disturbances, hot flashes usually do not occur with the first signs but rather with the onset of actual menopause.
What do hot flashes feel like? A hot flash typically begins with a sudden feeling of heat that rises from the chest area and spreads over the neck and face. The skin visibly reddens, especially on the face, neck, and chest. Within seconds, intense sweating begins, followed by chills as the body cools down. An episode usually lasts 30 seconds to 5 minutes.
How do hot flashes occur? The declining estrogen level affects the hypothalamus, the temperature control center in the brain. It becomes oversensitive to minor temperature changes and mistakenly triggers cooling mechanisms even though body temperature is normal. Blood vessels suddenly dilate, blood rushes to the surface of the skin – this is how a hot flash occurs.
Triggers and causes Certain factors can intensify or trigger hot flashes:
What helps?
When will it get better? Most women experience hot flashes over a period of 2 to 5 years. However, in about 10 percent, they can last up to 10 years or longer. The intensity usually decreases during postmenopause.
With hormonal changes, there is an accelerated loss of bone density. Estrogen plays an important role in building bones and inhibits bone-resorbing cells. After menopause, women lose 1-2 percent of their bone mass annually, and in the first years after menopause, up to 5 percent per year.
What is osteoporosis? In osteoporosis, the bones become increasingly porous and brittle. The risk of fractures, especially in the vertebrae, hips, and wrists, increases significantly. The disease develops gradually and initially causes no pain.
Other risk factors besides estrogen deficiency:
What helps preventively?
Because during menopause the vagina is less well perfused and the glands in the cervix produce less mucus, the lining in the vagina becomes drier and thinner. This is a typical symptom of postmenopause and affects about 40-50 percent of women.
Accompanying symptoms:
What helps?
It is common for women, especially after menopause, to have less interest in sex. The declining levels of sex hormones, particularly testosterone and estrogen, play a central role. About 20-40 percent of women in menopause report reduced libido.
Causes are varied:
Interesting: In some cases, the opposite occurs – some women experience an increase in libido, possibly because the absence of contraception is liberating or because the relative ratio of testosterone to estrogen changes.
What helps?
When fluid accumulates in the breast and its structure changes because the glands that produce milk regress and connective tissue increases, feelings of tension, pulling pain, and sensitivity to touch can occur. These symptoms are particularly pronounced in perimenopause when hormone levels still fluctuate greatly.
Not only the body, but also the soul can suffer when menopause begins. Lack of drive, persistent sadness, and hopelessness are possible signs. The risk of depression is about twice as high during perimenopause as before.
What helps?
During perimenopause, the cycle becomes more irregular. The bleeding can be less frequent, heavier, more frequent, or lighter. Some women experience spotting or very long periods. This is one of the first and most obvious signs of the onset of menopause.
Existing migraines may worsen during menopause, especially in perimenopause when estrogen levels fluctuate significantly. Many women report more frequent headaches. After menopause, this usually improves for most women.
As in puberty, women more frequently experience dizziness or vertigo during menopause. The hormonal changes affect the autonomic nervous system, which disrupts the sense of balance in the ear. Nausea can be a secondary symptom.
On average, women gain five to seven kilograms during menopause. Metabolism slows down by about 15 percent, and the basal metabolic rate decreases. At the same time, the distribution of fat in the body changes dramatically: fat accumulates less on the hips and thighs and more on the abdomen. The body shape changes from a "pear" to an "apple."
Why do women gain weight?
What helps?
In the early stages of menopause, some women experience palpitations and irregular heartbeat. Later, along with hot flashes, some report palpitations and dizziness. Estrogen has a protective effect on the cardiovascular system. After menopause, the risk of heart attack increases significantly and aligns with that of men.
Joint complaints in the knees, hips, fingers, and shoulders are among the most common but least known menopausal symptoms. About 50-70 percent of women are affected. The symptoms arise from accelerated degeneration of joint cartilage, as estrogen also has a protective effect here.
What helps?
The hair follicles shrink, causing the hair to grow more slowly and fall out more easily. The hair on the head becomes thinner and less dense. Sometimes the armpit hair also stops growing. This is due to the changed ratio of estrogen to androgens.
Fatigue and exhaustion are often the result of sleep disturbances and night sweats during menopause, but they are also directly related to hormonal changes and mood swings. Many women report persistent lack of energy.
Not only hot flashes, sleep problems, and stress can harm concentration, but the fluctuating estrogen levels themselves can also be a reason. Many women report "brain fog" – a foggy feeling in the head. Concentration problems usually disappear after menopause.
The skin becomes thinner, less elastic, and drier. Estrogens ensure that the skin is supplied with enough moisture. Since about 30 percent less collagen is produced during menopause and sebum production decreases, the skin becomes more prone to dryness and wrinkles.
This also applies to:
What helps?
Bladder weakness is a common, but often unspoken symptom during menopause. An overactive bladder or urgency incontinence with sudden, uncontrollable urge to urinate along with urine leakage affects about 30-40 percent of women after menopause.
Causes:
What helps?
Metabolism changes, it becomes sluggish, and hormonal changes affect the digestive system. The result: bloating, constipation, and digestive issues. About 40 percent of women report increased digestive problems.
During menopause, the risk of high blood pressure and coronary heart disease increases. Estrogen has a vasodilatory effect and protects blood vessels. After menopause, this protection is lost. Regular blood pressure checks are important.
Saliva production decreases, leading to a dry mouth. This increases the risk of cavities and gum diseases such as periodontitis. Bone loss can also affect the jawbone, promoting tooth loss.
It is more common for hands, feet, arms, and legs to tingle. The cause may be a nerve-related sensory disorder. Sometimes it feels as if the feet are burning. This can be linked to hot flashes and night sweats, where increased blood flow causes a sudden rise in core body temperature.
It's not surprising that increased sweating due to hot flashes and stress also affects body odor. At the same time, the sweat is more concentrated because the body can no longer regulate fluids as well.
Hormonal changes can trigger anxiety disorders that may worsen at night or in certain situations. About 15-20 percent of women experience anxiety for the first time during menopause or a worsening of existing anxieties.
Why does anxiety arise? Estrogen influences the production of GABA, a calming neurotransmitter. The declining hormone levels can lead to an imbalance that favors anxiety disorders. Other physical changes and the psychological burden of menopause can also intensify anxiety.
What helps?
The anxiety can lead to panic attacks, which come unexpectedly and without preparation. Symptoms include palpitations, shortness of breath, sweating, trembling, and the feeling of losing control.
Acute help during a panic attack:
Long-term strategies:
As histamine levels are elevated during menopause, allergies can worsen now. Some women even develop new allergies or intolerances they didn't have before.
Due to a lack of keratin and reduced estrogen effect on the nail matrix, brittle, splitting nails may occur. They grow slower and break more easily.
What helps?
Some women complain about increased facial hair and so-called "female mustache" after menopause. This is due to the changed ratio of hormones: while estrogen levels drop, testosterone levels remain relatively constant, making its effect more pronounced.
Muscle pain or muscle tension is not uncommon during menopause. In addition, muscle mass decreases from the age of 35 and this process accelerates during menopause. Without targeted strength training, women lose up to 1 percent of muscle mass per year.
Why do muscle pains occur? Estrogen has an anti-inflammatory effect and supports muscle regeneration. Hormone deficiency can lead to muscle tension, slowed recovery after exertion, and diffuse muscle pain. Muscle breakdown itself can also cause discomfort.
What helps?
Sometimes, vaginal discharge changes during menopause. If it is odorless and yellowish, there is no need for concern. Other forms may indicate conditions such as bacterial vaginosis, infections, a tumor, or a yeast infection. In any case, this should be clarified by a doctor.
Water retention occurs especially at the beginning of menopause due to the (still) high estrogen levels. Initially, the production of progesterone decreases, leading to estrogen dominance. Also, before ovulation, when estrogen levels rise, women tend to retain more water, which can lead to swollen hands, feet, and a puffy face.
Similar to pregnancy, where hormonal balance changes, women in menopause often struggle with nausea. Sometimes, however, this arises from ovarian cysts or is caused by medications intended to alleviate other menopausal symptoms.
Menopausal symptoms do not develop all at once but follow a typical pattern over the different phases. This knowledge helps women better categorize and understand their symptoms.
Early symptoms (Premenopause and early Perimenopause)
The first signs of menopause usually appear between the ages of 40 and 45 and are often subtle:
Symptoms of the middle phase (perimenopause)
In the active transitional phase, approximately between ages 45 and 51, the most intense symptoms occur:
Late symptoms (postmenopause)
After the last menstrual period, from about 51-52 years, long-term changes develop:
Important: Hot flashes and sweating can last 2-5 years, and for about 10 percent of women, even up to 10 years. They usually subside afterward. Many other symptoms also improve after post-menopause when hormone levels stabilize at a low level.
Not every woman needs treatment for her menopause symptoms. About 30-40 percent manage well without medical intervention through this phase. For those who suffer from severe symptoms, there are various effective therapy options.
Hormone replacement therapy is considered the most effective treatment for moderate to severe menopause symptoms. It replaces the missing hormones estrogen and progesterone (in women with a uterus) or only estrogen (after uterus removal).
When is HRT advisable?
Advantages:
Risks (with long-term use over 5 years):
Important: The benefit-risk ratio varies greatly among individuals. HRT should be used at the lowest effective dose and for the shortest necessary duration. Women under 60 and within the first 10 years after menopause have the best benefit-risk ratio.
For women who only suffer from vaginal dryness, local treatment with estrogen-containing creams, suppositories, or a vaginal ring is often sufficient. This form of therapy has significantly fewer systemic side effects than oral HRT.
Various plant extracts are traditionally used for menopausal symptoms:
Black cohosh (Cimicifuga racemosa)
Red clover isoflavones
Chaste tree (Agnus castus)
St. John's Wort
Sage
Important: Even herbal remedies are not free from side effects and interactions. Their intake should be discussed with a doctor.
Certain antidepressants (SSRI and SNRI) can reduce hot flashes by 40-60 percent in low dosages. They are an alternative for women who cannot or do not want to take hormones, especially if mood problems are also present.
Lifestyle changes, which have been shown to alleviate menopausal symptoms, should not be underestimated:
Nutrition:
Exercise:
Stress management:
Weight management:
A doctor's visit is advisable for:
The symptoms of menopause do not all develop simultaneously but follow a typical pattern over the different phases. This knowledge helps women better categorize and understand their complaints.
Early symptoms (premenopause and early perimenopause)
The first signs of menopause usually occur between the ages of 40 and 45 and are often subtle:
Symptoms of the middle phase (perimenopause)
In the active transition phase, approximately between 45 and 51 years, the most intense symptoms occur:
Late symptoms (postmenopause)
After the last menstrual period, around 51-52 years old, long-term changes develop:
Important: Hot flashes and sweating can last 2-5 years, and for about 10 percent of women, even up to 10 years. After that, they usually subside. Many other symptoms also improve after postmenopause when hormone levels have stabilized at a low level.
Although there are 34 different symptoms, some are perceived as particularly distressing. Here are the five most common "top complaints" and concrete coping strategies:
Immediate measures:
Long-term strategies:
Optimize sleep hygiene:
If you wake up at night:
Natural sleep aids:
For persistent problems:
Acute help:
Preventive:
Professional help:
The hard facts:
What really works:
Realistic expectations:
Immediate solutions:
Long-term:
Pelvic floor training:
Menopause does not necessarily have to be a time of suffering. With the right strategies, you can actively shape this phase and even use it as an opportunity for positive changes.
The anti-menopause diet:
Calcium for bones (1200 mg daily):
Vitamin D (1000-2000 IU daily):
Omega-3 fatty acids (2000 mg daily):
Phytoestrogens (plant hormones):
What you should reduce:
The ideal weekly schedule:
Strength training (2-3x per week, 30-45 min each):
Endurance training (3-4x per week, 30-45 min each):
Flexibility & Balance (2-3 times a week, 20-30 min each):
Everyday movement:
Daily routines:
Weekly timeouts:
Social support:
Menopause does not mark the end, but the beginning of a new phase of life. Many women report a newfound freedom:
Advantages of post-menopause:
Reframing: Changing perspective: Instead of "I am getting old" → "I am becoming more experienced and confident" Instead of "My body is failing" → "My body is undergoing a natural transformation" Instead of "The end of my femininity" → "A new phase of my womanhood"
When do menopause symptoms begin?
Menopause typically begins between the ages of 45 and 50, but it can occur earlier or later for some. The first signs (perimenopause) often appear as early as 40. Some women experience premature menopause before the age of 40, affecting about 1 percent.
How long do the symptoms last?
The entire transition phase lasts an average of 7-10 years. Hot flashes and night sweats, the most burdensome symptoms, last for 2-5 years for most women, and up to 10 years for about 10 percent. Many symptoms diminish after menopause as hormone levels stabilize.
Can menopause start earlier?
Yes, approximately 1 percent of women experience menopause before the age of 40 (premature menopause or premature ovarian insufficiency). Causes can include genetic predisposition, autoimmune diseases, chemotherapy, radiation therapy, or surgical removal of the ovaries. Women with premature menopause should receive medical care due to increased osteoporosis and cardiovascular risk.
What is the difference between perimenopause and menopause?
Perimenopause is the transition phase before the last menstrual period, during which hormone levels fluctuate and most symptoms occur (average 4-5 years). Menopause itself is the point of the last spontaneous menstrual period, which can only be determined retrospectively (after 12 months without a period). Postmenopause is the time after that.
Do I have to expect all 34 symptoms?
No, definitely not! Every woman experiences menopause differently. About 30-40 percent of women have hardly any symptoms. Most experience 3-5 different symptoms in varying degrees. Only a small portion suffers from many and severe symptoms at the same time.
Are all symptoms treatable?
Most symptoms can be well treated, either through lifestyle changes, herbal preparations, or – in case of severe symptoms – hormone therapy. There are effective strategies for almost every symptom. It is important not to hesitate to seek medical help if the quality of life is severely affected.
Can I still get pregnant during menopause?
In perimenopause, pregnancy is still possible, although increasingly unlikely. Only after 12 months without menstruation (in women over 50) or 24 months (in women under 50) can pregnancy be safely ruled out. Until then, contraception should be used if pregnancy is not desired.
Are menopausal symptoms a sign of illness?
No, menopause is not an illness but a natural biological phase. The symptoms arise from hormonal changes. However, if symptoms are very severe and significantly affect quality of life, treatment is sensible and important. After menopause, the risk of certain diseases (osteoporosis, cardiovascular diseases) increases, making preventive care important.
What examinations are important during menopause?
Does hormone therapy really help and is it safe?
Hormone replacement therapy (HRT) is the most effective treatment for moderate to severe menopausal symptoms. It reduces hot flashes by 80-90 percent, significantly improves sleep and quality of life, and protects against osteoporosis. For women under 60 years and within the first 10 years after menopause, the benefits clearly outweigh the risks. HRT should be individually tailored (lowest effective dose, shortest necessary duration) and be under medical supervision.
Menopause is a phase of profound physical and hormonal changes, experienced differently by each woman. No woman experiences all 34 possible symptoms, and many go through this time with few or no complaints.
The most important insights:
What you can do:
With the right knowledge, self-care, and, if necessary, medical support, most women can navigate menopause well and embrace this phase as a natural part of their lives.
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