21 Symptoms of Menopause

21 Symptoms of Menopause
Yes, 21! We asked Dr Rebecca Lewis, a GP and menopause doctor, to take us through the full list of what to look out for in the menopause and perimenopause years.

You might well be thinking, how can there possibly be this many menopause symptoms? You likely associate hot flushes and changes in your period with hormonal changes, but the joy doesn’t stop there. There are a whole host of other symptoms that are way less specific. And this makes them way more confusing to diagnose.

“It can be a relief when women discover these symptoms are down to hormonal changes,” says GP and menopause doctor Dr Rebecca Lewis, who is based at Newson Health Menopause & Wellbeing Centre in Stratford upon Avon. “Women come and see me, worried they have dementia because their brain fog is so bad. I see women with memory and concentration problems who’ve given up their jobs, gone part time, gone off sick as they can no longer cope with the demands of the job. Or they think they have a brain tumour because their migraines are so bad. Or they’ve been prescribed antidepressants for their low mood, when really it’s down to lack of oestrogen. All along, it has just been menopause symptoms.

“We have oestrogen receptors all over our bodies – in the brain, bone, heart, vagina, skin and hair, in fact everywhere. So that’s why lack of oestrogen gives rise to ALL the above symptoms as well as the rest of the 21. You won’t get all these symptoms but you may get a combination.”

Read on Dr Lewis’s list of 21 menopause symptoms:


Hair loss

“Among menopause symptoms, it is quite common to get thinner and dryer hair at this time. The oestrogen in HRT can help with improving hair strength and texture.”


Dry and itchy skin 

“This is down to a breakdown of the oily barrier in the skin. If you have eczema, it can get worse. The oestrogen in HRT can help to reduce moisture loss from the skin and also helps to increase collagen in the skin.


Hot flushes 

“The lack of oestrogen at this time upsets your body’s natural system of thermoregulation. Some people describe hot flushes as a mild, warm feeling but other women say they get so hot that’s it’s extremely uncomfortable, with a racing heart and profuse sweating. Flushes are often over very quickly but they can feel very embarrassing.”


Night sweats 

“Some people have these occasionally, others have them two or three times a night. They happen for the same reason as hot flushes, above. They can ruin sleep: if the heat doesn’t wake you up, the cold does after you throw off the duvet. Some women tell me they sweat so much, they have to change their nightclothes and sheets.” 


Breast pain 

“This is due to fluctuations in oestrogen levels, though it can also be a side effect of HRT.”


Loss of libido 

“If this is you, please be reassured it’s very common. There are a few possible reasons. One is vaginal dryness and discomfort caused by low oestrogen (see point 7). This can make sex very uncomfortable – and if you do something that’s not comfortable, your brain will tell you, don’t do that again. It switches off your desire. Another possible cause could be low levels of oestrogen and testosterone. Or it could be down to women not feeling good about themselves, feeling tired, exhausted, that they’ve put on weight. Women often tell me the menopause leaves their confidence and self-esteem very low.”


Vaginal dryness

“This is a direct effect of a drop in oestrogen – there are oestrogen receptors all around the vagina. The whole area can feel very dry, sore, irritated, uncomfortable and itchy, too.”


Frequent urination and urinary pain

“The pelvic floor also has oestrogen receptors, so low oestrogen leads to slackening the muscles in this area, and so to more urinary frequency or involuntary urination. It can also cause cystitis like symptoms – but the cause isn’t an infection, rather it’s down to irritation. The skin can become red and raw, giving a stinging and burning sensation. Using soap doesn’t help as it strips away the protective barrier.” 


Vaginal infections

“A lack of oestrogen increases the pH of the vagina, making it more more alkaline. This can make you more susceptible to conditions such as thrush, an overgrowth of yeast, or bacterial vaginosis, an overgrowth of bacteria.”


Joint and muscle pain

“Oestrogen works as an anti-inflammatory in the muscles and also the joints.There are oestrogen receptors all the ligaments and muscles and around the joints. I’ve seen women who’ve referred to a rheumatologist as their pain is so bad – but it then turns out to be hormonal. Women tell me they feel stiff in the morning and really ache, as if they’ve done too much at the gym, but every day.”


Loss of muscle mass

“This has a name – sarcopenia. Even women who are keen gym-goers might notice they’re not building muscle like they used to at this time.”



“There are oestrogen receptors in bone tissue. Women are at very low risk of osteoporosis before the menopause but the risk increases massively after it.”


Irregular heartbeat

“Women commonly report heart palpitations, a feeling of the heart racing. This can often happen in the middle of the night. There are a lot of referrals to cardiologists in women of this age where the cause turns out to be hormones.”


Brittle nails

“In the same way as happens with skin and hair, with lower levels of oestrogen, our tissues hold less moisture and so nails become drier.”



“This can be due to lighter sleep or to hot flushes. Women tell me that whereas when they used to feel tired they could keep going but this new kind of tiredness feels like a physical barrier.”


Lack of concentration

“There are a large amount of psychological and rather non specific but debilitating symptoms from lack of oestrogen in the brain. This is one of them, but the list also includes brain fog, memory lapses and inability to multitask.” 


Memory lapses

“This symptom often comes with fatigue, poor concentration and memory. You might find, mid sentence, you forget what you were talking about.”


Irritability and anger

“This is one of the mood changes that can happen due to lower oestrogen in the brain. Some women describe it as feeling as if you have PMS but all the time.”



“If you get migraines, you may find they get worse, due to oestrogen fluctuations. If you don’t, you might start suffering from headaches.”  


Depression and low mood

“Low mood caused by hormones feels different to clinical depression. Often women feel flat and low but, unlike clinical depression, they are sometimes able to go out out and enjoy themselves, too.”


Weight gain

“Even if you don’t gain weight you are likely to carry more weight around your tummy and hips. Or you may put on weight too – it’s not surprising if you are feeling tired, and so craving sugar and not eating as healthily as you normally would.”

Dr Rebecca Lewis is based at the Newson Health Menopause & Wellbeing Centre, www.newsonhealth.co.uk.

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