Your Complete Guide to the Symptoms of Menopause and Perimenopause

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Are you experiencing signs of menopause or perimenopause, such as hot flashes, weight gain or mood swings? It turns out that many symptoms you might be experiencing are caused by the hormonal changes of menopause and perimenopause. Here’s a complete list of menopause and perimenopause symptoms and what causes them.

This is our second post in the Midlife Rambler Real Talk about Menopause series. Too many of us (including myself) don’t fully understand what’s happening and don’t know where to go to for accurate information. I am not a doctor and this is not medical advice but I’m hoping to provide some of the information I wish I had known when I went through menopause and give you some resources to check out if you want to learn more. 

More Real Talk About Menopause

Ah, middle age. That glorious time when we feel like we no longer know our own bodies. Suddenly, all kinds of weird and unexplainable things are happening and you would be totally reasonable if it freaked you out a little bit. I remember lying in my bed at night, feeling my heart pounding wildly and convinced I was having a heart attack. In fact, heart palpitations are a fairly common symptom of menopause, although you don’t hear about them nearly as often as you hear about hot flashes and weight gain.

As we discussed in our last post, the hormones estrogen and progesterone affect multiple areas within the body in addition to managing our reproductive cycle. It only makes sense that the hormonal changes we go through during perimenopause and menopause can cause changes in the parts of our body affected by these hormones.

If you’re struggling with new or unexplained symptoms, check out this list that I’ve compiled of symptoms that may be caused or exacerbated by menopause and perimenopause. Don’t worry: you’re not going to get all of these symptoms during your menopause and perimenopause journey! But it is helpful to know if know if your issue could be caused by hormonal changes and to know exactly what hormonal changes are causing your particular symptom.

Most symptoms of menopause can be traced to one of four root causes. If you know which of these is causing your issue, you can take measures to alleviate your symptoms. These causes are:

  • Lower Estrogen Levels.
  • Lower Progesterone Levels.
  • Hormonal Imbalance. (For example, in early perimenopause the body stops making as much progesterone, but estrogen levels stay high.)
  • Fluctuating Hormone Levels.  (In perimenopause, your body may make progesterone one month and not make it the next month because you didn’t ovulate. These fluctuations can cause multiple symptoms.)

For each menopause/perimenopause symptom in the list below, I’ve indicated the root cause of the symptom as well as a short description. In my next post, I’ll examine each root cause and discuss some proven ways to relieve symptoms caused by each root cause.

It’s important to understand the root cause of your symptoms because, for example, if your symptom is caused by high estrogen relative to lower progesterone, the last thing you would want to do is increase estrogen levels. Knowing the root cause of your symptom can help you determine the best way to alleviate it.

Menopause and Perimenopause Symptoms

Aches and Pains, such as Joint Pain or Muscle Aches

Root Cause: Estrogen

It’s not fully understood how estrogen affects joint or muscle pain, but it’s thought that it works by keeping swelling down. As estrogen drops, this effect is lessened and can cause joint swelling or pain or muscle aches.

Estrogen also helps to regulate the fluid levels in your body. When estrogen drops, you may be more prone to dehydration which can also cause joint pain due to inflammation.

New or Worsening Allergies, such as Hay Fever and Food Intolerances

Root Cause: Fluctuating Hormone Levels

Allergies tend to worsen or appear during times when our hormones are fluctuating, such as adolescence or during pregnancy. The hormonal fluctuations of perimenopause can also cause increased allergies.

Anxiety and Panic Attacks

Root Cause: Lower Estrogen Levels

Estrogen helps calm fear responses – the reaction we have to real or perceived danger. A lowering of estrogen in our brain can make up more susceptible to overreaction to stress and fear, which can lead to anxiety. Additionally, the lowering of estrogen makes our brains less resilient; when trauma occurs, we are often not as able to bounce back to our normal baseline state as we were when our estrogen levels were higher.

Bitter, or Metallic Taste, in The Mouth or a Burning Sensation at the Tip of Your Tongue

Root Cause: Lower Estrogen Levels

Here’s a fun one! Because estrogen helps regulate the body’s fluid levels, decreased levels of of estrogen can lead to dry mouth. This, in turn, can cause a bitter or metallic taste in your mouth, or, in rare cases, Burning Mouth Syndrome, which can cause the mouth to burn as if you’ve just eaten hot peppers.

Bladder Infections, Leaking and Urgency

Root Cause: Lower Estrogen Levels

When estrogen drops, the lining of the urethra thins and the urethral muscle loses its strength. This can result in leaking urine and increased urgency (sudden, strong urges to urinate). The lack of muscle tone can allow small pockets of bacteria to remain in the bladder, causing increased chance of bladder infections.


Root Cause: Hormonal Imbalance

Estrogen effects fluid retention in the body and if progesterone drops, your estrogen levels may start to work too well, resulting in water retention and bloating.

Breast Tenderness

Root Cause: Fluctuating Hormone Levels

Breast tenderness can have one of two causes: estrogen can cause your breasts to retain fluid and progesterone can cause your milk glands to swell. Both of these can cause tenderness in your breasts. During your regular cycle, you may experience some breast tenderness around ovulation (caused by estrogen) or just before your period (caused by progesterone). However, during perimenopause, your hormone levels can fluctuate wildly causing breast tenderness that seems random or especially painful.

Brittle Nails

Root Cause: Lower Estrogen Levels

Who knew so many problems were caused by dehydration? Because estrogen helps regulate your fluid retention, your nails may become brittle because your body becomes more dehydrated as your estrogen levels drop. Drink that water!


Root Cause: Lower Estrogen Levels

Chills are much more rare than hot flashes but the the two symptoms are related. The lower levels of estrogen affect your body’s ability to regulate temperature, which is what causes hot flashes. However, the hypothalamus in your brain may become overactive and think you are overheating. It can cause your body to shed heat, whether it really needs to or not, and this can cause the chills that can be so disruptive.


Root Cause: Lower Estrogen Levels

Estrogen helps increase serotonin and serotonin receptors in the brain, as well helping boost the effects of endorphins. As estrogen levels drop, it’s very normal to experience depression. The good news is that the depression typically lifts once your body has adjusted to its new estrogen levels, but there’s no need to suffer until then. If you feel that you’re experiencing clinical depression, reach out to your doctor for advice.

Difficulty Concentrating

Root Cause: Fluctuating Hormone Levels

Both estrogen and progesterone affect the activity of the brain and as your hormones fluctuate during perimenopause and menopause, you can often feel a sort of “brain fog.” Additionally, if you’re suffering from insomnia because of hormonal changes, that can often affect your ability to concentrate.

Digestion Issues

Root Cause: Lower Estrogen Levels

Estrogen helps keep the level of cortisol low and cortisol is the hormone that causes us to feel stress. When estrogen is high, cortisol is low. As the levels of estrogen decrease, your cortisol levels increase. Without the calming influence of estrogen, cortisol can release adrenaline more easily and the release of adrenaline shuts off the digestive system. This can cause a variety of digestion issues: increased gassiness, constipation, or abdominal pain or indigestion.


Root Cause: Fluctuating Hormone Levels

It’s actually not well understood why fluctuating hormone levels can cause dizziness but one theory is that your body is under stress due to hormonal levels changing inconsistently. This is my own personal theory, but now that I’ve learned how decreased estrogen can cause dehydration, I wonder if that is also a factor.

Dry Mouth or Dry Eyes

Root Cause: Lower Estrogen Levels

As we’ve discussed earlier in this post, estrogen helps regulate the body’s ability to retain fluids and as estrogen drops, this reduces moisture in the mucous membranes, causing dry mouth and/or dry eyes.

Dry Skin

Root Cause: Lower Estrogen Levels

Estrogen helps retain moisture in the skin and stimulates the production of natural oils and collagen. Collagen helps maintain the strength and elasticity of the skin. When estrogen decreases, the natural moisture and the collagen in the skin both decrease, causing the skin to become drier and thinner.


Root Cause: Hormonal Imbalance

Both estrogen and progestrone work together to help regulate cellular energy throughout the body. Progesterone increases your metabolic rate, giving you more energy. Estrogen works on recepters in your brain to increase your mood and your energy. When these two hormones are out of balance, you can experience fatigue.

Hair Loss or Thinning Hair

Root Cause: Lower Estrogen Levels

Estrogen promotes hair growth so when the estrogen levels decrease, your hair becomes thinner and hair growth slows. In a cruel twist, the drop in estrogen causes testerone to be more dominent in the body which can cause increased facial hair.


Root Cause: Hormonal Imbalance

Estrogen causes blood vessels to dilate and progesterone causes them to tighten. As these hormones flucuate, your blood vessels are expanding and contracting rapidly, which can cause headaches.

Heart Palpitations

Root Cause: Hormonal Imbalance

Some recent studies have found that estrogen lengthens the time between heartbeats and progesterone shortens it. When the estrogen/progesterone ratio gets out of whack as it can during early perimenopause, increased heart rate or the feeling of “skipping” beats can occur. This is typically benign but, of course, you should always check out any heart issues with your doctor.

Heart palpitations can be very scary; they certainly were for me! This article gives some great information about why they can happen.

Heavy Bleeding During Your Period

Root Cause: Hormonal Imbalance

If you didn’t ovulate during the month, estrogen remains high but there’s no progesterone to balance it out. This causes the lining of the uterus thicken more than usual, resulting in a heavier flow.

High Blood Pressure

Root Cause: Lower Estrogen Levels

Recent research has shown that estrogen can help prevent the build up of plaque in the arterial walls as well prevent the narrowing of the arteries. When estrogen levels are reduced, the arteries of the heart can narrow, increasing blood pressure.

Be sure to have your blood pressure checked regularly after menopause and if it’s consistently high, over 120–129/80, check with your doctor.

Hot flashes and Night Sweats

Root Cause: Lower Estrogen Levels

It’s not really known exactly why some women have hot flashes during menopause but the current theory is that hot flashes aren’t really caused by lower estrogen levels, but rather because your body is shocked by the decrease in estrogen. This causes the hypothalmus, which regulates body temperature,  to get out of whack, resulting in hot flashes or even chills.

Increased PMS

Root Cause: Hormonal Imbalance

PMS symptoms are caused by the drop in progesterone just before your period. During permenoupause, progesterone is not released if you didn’t ovulate, so it remains low, causing longer and more intense PMS symptoms.

Irregular Periods

Root Cause: Fluctuating Hormone Levels

Your monthly cycle is controlled by signals sent by estrogen and progesterone rising and falling throughout the month. During perimenopause, hormone levels flucuate and your body reacts accordingly. This can mean a shorter-than-usual monthly cycle or periods that occur infrequently before stopping all together.


Root Cause: Lower Estrogen Levels

Your skin becomes drier and thinner and your collagen levels drop  during menopause due to the drop in estrogen levels. This can cause itchiness, which can be very mild or very severe.

Tingling, Numbness or a “Pins and Needles” Feeling

Root Cause: Lower Estrogen Levels

Because your skin becomes drier and thinner during menopause due to the drop in estrogen, it can become sensitive. This can lead to a syndrome called Paresthesia, which is a feeling of tingling or numbness or a sensation similar to the “Pins and Needles” you may get when your arms or feet “fall asleep.”

Loss of Libido

Root Cause: Lower Progesterone Levels

Progesterone stimulates the production of testosterone, which is the main hormone for sexual desire. When progesterone levels drop during perimenopause, your libido may wane as well.

Memory Lapses

Root Cause: Lower Estrogen Levels

Estrogen is actually a powerful influence on our brains, helping with cognitive tasks such as verbal fluency and memory. This means that we can become more forgetful during menopause. So that time you forgot the word for “nephew” probably isn’t a sign of early Alzheimer’s.

Mood Swings

Root Cause: Lower Estrogen Levels

Estrogen has a profound effect on the brain, affecting our serotonin and norepinephrine levels in the brain. Both of these affect mood and energy levels so as your estrogen levels drop, you may experience irritability, anxiety or depression.

Muscle Tension

Root Cause: Fluctuating Hormone Levels

Fluctuating hormone levels can cause cortisol (the “stress hormone”) to rise, causing tension in your muscles and ultimately, fatigue.


Root Cause: Fluctuating Hormone Levels

Your fluctuating hormone levels can cause nausea during menopause just as they can cause morning sickness during pregnancy.

Period Pain without a Period

Root Cause: Fluctuating Hormone Levels

Fluctuating hormones can send your body mixed messages which can result in menstrual cramps even when you’re not having your period.

Shorter or Lighter than Normal Periods

Root Cause: Lower Estrogen Levels

Estrogen causes the lining of the uterus to thicken, so when estrogen levels fall, there is less lining to shed and periods can be short or very light.

Sleep problems

Root Cause: Fluctuating Hormone Levels

It’s thought that menopause can cause sleep problems in several ways. Progesterone may help prevent sleep apnea by dilating the nasal passages and sinuses. As progesterone levels drop, sleep apnea issues may appear. Additionally, your body temperature needs to be low in order to sleep and menopause disrupts your body’s ability to maintain a low temperature at night. Finally, anxiety caused by menopause can also manifest as insomnia.

Vaginal Dryness

Root Cause: Lower Estrogen Levels

Just as estrogen helps keep our skin lubricated, it also helps keep the tissues of the vagina lubricated as well. As estrogen decreases, we can have increased vaginal dryness.

Weight Gain and Slowed Metabolism

Root Cause: Lower Estrogen Levels

The drop in estrogen causes two enzymes that work within our body to synthesize and store fat to become more active. So, it’s not your imagination; your metabolism has indeed slowed down. Interestingly, fat cells can produce estrogen so it’s possible that we can benefit from a little extra padding once we become menopausal.

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