Menopausal symptoms: what types are there and what can you do about them?

Menopause, also known as menopause, is the natural transition from a fertile period to a period without menstruation. The average age of menopause is between 45 and 55 years of age.

During menopause, the balance of hormones involved in reproduction, such as estrogen and progesterone, changes. This can lead to symptoms such as hot flashes, night sweats, and mood swings.

Not every woman experiences these hormonal changes as unpleasant. The intensity can vary considerably from person to person, but most women notice that menopause impacts their daily lives.

Menopause consists of three distinct phases: perimenopause, menopause, and postmenopause. Each phase brings changes due to hormonal changes. This results in menopausal symptoms on both a physical and emotional level:

Hormonal fluctuations - This is the phase in which the first hormonal fluctuations begin, often years before menstruation stops. Estrogen and progesterone levels fluctuate, and these fluctuations can lead to irregular periods.

Typical complaints - During this stage, women often experience irregular or heavier periods, hot flashes with redness and sweating, and mood swings ranging from irritability to sadness.

Stopping of menstruation - This is the phase in which menstruation finally stops (after 12 months without a period). Estrogen and progesterone production decreases sharply.

Typical complaints - Many perimenopausal symptoms may persist, but other symptoms may become more apparent or intense, such as hot flashes and night sweats.

Stable but low hormone levels : After menopause, hormone levels stabilize, but remain lower than before.

Typical complaints : In this phase the hormonal fluctuations have stopped, but some complaints may persist or even worsen.

On average, menopausal symptoms begin in Europe around the age of 51. However, this average varies from country to country, as various factors can cause menopause to occur earlier or later.

Research shows that higher education levels, the use of nutritional supplements, and taking contraceptives can contribute to later menopause.

On the other hand, certain factors such as smoking, lack of exercise, genetic predisposition, alcohol and drug use can cause you to enter menopause sooner.(1)(2)

If you experience menopausal symptoms before the age of 40, this is considered premature menopause.

It is important to know that premature menopause can have several causes:

• Genetic factors
• Smoking
• Autoimmune diseases
• Medical treatments
• Removal of ovaries
• An HIV infection

The types of menopausal symptoms can therefore differ per phase, but are usually the result of hormonal fluctuations in the body, especially the drop in estrogen.

These complaints can be both physical and emotional, with the intensity varying greatly from person to person.

Let's take a closer look at the most common menopausal symptoms:

Sleep problems are a common problem during menopause. Up to 79% of women experience sleep problems around menopause.(3)

• Hormonal fluctuations, especially the decrease in estrogen and progesterone, cause hot flashes and restlessness, which can make it harder to fall asleep or stay asleep.
• The drop in estrogen levels also causes a decrease in the neurotransmitter serotonin, which causes your body to produce less melatonin.
• You're also more likely to develop sleep apnea during menopause. With this condition, your breathing temporarily stops during sleep, causing you to wake up frequently and often feel tired and irritable during the day.

Poor sleep during menopause can therefore have a direct impact on your daily life. Take sleep problems seriously, because a good night's sleep is essential for your health and well-being during this phase of life.

There are also nutritional supplements that can help support your sleep. These aren't medications for sleep problems, but they are safe aids that support your natural sleep.

Hot flashes are sudden heat attacks that 80% of women experience during menopause, often without warning. They usually last 1 to 5 minutes and can disrupt your sleep and daily life.

• Hot flashes are usually easy to recognize; a warm, uneasy feeling that starts in your chest and quickly rises to your head (hence the name "hot flash"). This causes a jittery feeling, often accompanied by chills, palpitations, dizziness, and headaches.
• Hormonal changes, particularly the decline in estrogen, are a major cause of menopausal hot flashes. These affect the brain's heat center, causing fluctuations in body temperature.
• Certain triggers, such as warm environments, stress, alcohol, and caffeine, can make hot flashes worse.

Having hot flashes is unpredictable, but avoiding certain foods and drinks can help reduce their frequency and intensity.(4)

Menopause is a time of significant change, and that can significantly impact your mood. Many women experience mood swings during this period, which is perfectly normal.

• The drop in estrogen can make your emotions feel unpredictable, and this can lead to feelings of sadness or even depression.
• Studies have shown that peri- and postmenopausal women are at increased risk for depressive symptoms compared to pre-menopausal women. This may mean you're more likely to feel irritable, sad, or anxious.(5)

It's important to acknowledge these feelings and talk about them. This can help put emotions and feelings into perspective.

A lesser-known effect of menopause is joint pain. Declining estrogen levels, which are important for healthy joints, can lead to stiffer and more painful joints due to reduced cartilage protection and increased inflammation.

• The production of collagen, the protein that supports the structure of your joints, also decreases. This weakens your cartilage.
• Because many women gain weight during menopause, there is extra pressure on the knees and hips, which can worsen the symptoms.
• The drop in estrogen also leads to dry mucous membranes, which causes the bones in the joints to rub against each other more and can cause pain.

Women going through menopause may experience pain in small joints, such as those in the hands and toes, as well as in the shoulders, knees, back and hips.

Night sweats during menopause are very normal and are caused by the decrease in estrogen, which causes hot flashes, even at night.

• This type of sweating is usually temporary and often goes away when your hormones return to balance.
• When your estrogen levels drop, your hypothalamus, the part of your brain that regulates your body temperature, goes haywire. It thinks your body is overheating, even if it isn't.
• This causes your body to suddenly activate cooling mechanisms, such as sweating, even when you don't actually feel hot.
• This often happens at night, leading to hot flashes and night sweats.

Besides waking up completely sweaty, you may also experience an irregular heartbeat, chills, nausea, and headaches.

Irregular menstruation is a characteristic sign of the start of menopause for many women.

• This usually means that bleeding and menstrual symptoms increase in severity.
• The time between menstrual periods also becomes shorter or longer, breakthrough bleeding occurs and more menstrual clots may occur during menopause.

Over time, the intervals between periods become longer and longer, until your periods finally stop altogether. This is called menopause.

Fatigue during menopause is common and can be quite draining. The main causes are a combination of hormonal changes, lack of restful sleep, mental health issues, and a slower metabolism.

• The drop in estrogen and progesterone disrupts your sleep pattern, causing you to sleep less deeply or wake up more often.
• Mood swings, including feelings of anxiety and depression, can affect your energy levels and make you tire more quickly.
• Due to the decrease in muscle mass and a slower metabolism, your body uses more energy, which contributes to exhaustion.

By paying attention to your lifestyle, you can maintain your energy levels. Make sure you get enough exercise, eat a healthy diet, and get enough rest to reduce your fatigue.

Menopausal women often experience headaches due to fluctuations in their hormones, mainly estrogen.

• Researchers believe that these hormones lower serotonin, among other things, which affects pain regulation and can therefore cause headaches or even migraines.
• In addition, other symptoms of menopause, such as stress and sleep problems, can also contribute to headaches.

Get plenty of rest and relax whenever possible to reduce headaches during menopause. It's also always a good idea to discuss serious symptoms, such as headaches, with your doctor.

During menopause, it's easier to gain weight because your metabolism slows down. Your body burns less energy and stores fat more quickly. Why is that?

• On the one hand, this is due to the decrease in estrogen, a hormone that supports your metabolism.
• On the other hand, because your metabolism slows down anyway as you get older.
• Moreover, you often lose muscle mass during menopause. Because muscle burns more calories than fat, this muscle loss contributes to weight gain.

This combination allows you to gradually gain weight. Adjust your diet to your new energy needs and start with light weights or resistance bands to build muscle strength.

You can also experience irritated skin during menopause. Some women experience dry skin, while others experience very oily skin or even a burning sensation.

• Declining estrogen levels lead to decreased collagen production, making your skin less firm and elastic. This can lead to wrinkles and thinner, drier skin.
• Although testosterone levels don't actually rise, the balance between the hormones changes, making the influence of male hormones (such as testosterone) relatively stronger. This can cause oilier skin and breakouts.
• In addition, your skin retains moisture less well, which can cause dry skin during menopause.
• Also, less blood flows through the skin, which slows down skin renewal.

Fortunately, good care and a healthy lifestyle can help with troubled skin during menopause.

Palpitations are an annoying symptom that many women experience during menopause.

• This is often due to a drop in hormones like estrogen and progesterone, which normally help regulate heart rate and blood vessels. When these hormones fluctuate, it can lead to an irregular or accelerated heartbeat.
• In addition, stress and anxiety, which are common during this phase, can further increase your heart rate.
• Hot flashes (at night) also contribute to a faster heart rate.
• And remember that some medications for menopausal symptoms can have side effects that affect your heart rate.

Although palpitations can feel frightening and unpleasant, they're usually harmless during menopause and often don't require treatment. Stay calm and use breathing techniques to calm yourself.

During menopause, many women experience changes in their libido, which can be confusing. But what exactly happens?

• Menopause is often accompanied by fluctuations in hormones like estrogen and testosterone. These hormones play a significant role in your sex drive.
• When estrogen levels drop, it can lead to a decreased sex drive (lower libido) during menopause.
• Many women also notice that they are less sensitive, which can reduce the feeling of intimacy.
• In addition, other menopausal symptoms, such as hot flashes, insomnia, and mood swings, can also affect your libido.

It's important to know that these changes are normal and that you're not alone. If you have a partner, discuss how you're feeling and explore new ways to boost your libido (together).

Another annoying side effect of menopause is that your hair often thins or even starts to fall out. This, too, is caused by hormonal changes.

• When estrogen levels decrease, this can lead to changes in hair growth. Hair may grow more slowly and fall out more quickly.
• Testosterone fluctuations affect hair structure. This can result in thinning hair on the scalp and increased unwanted hair growth elsewhere, such as the face.
• Stress and other menopausal symptoms, such as insomnia and mood swings, can also contribute to hair loss.

Fortunately, there are several ways to address these changes. A healthy diet, rich in vitamins and minerals, can support hair growth.

Wondering if you're in menopause? You're not alone! Many women experience changes in their bodies and wonder what's going on.

There are several ways to test whether you are actually in this phase, such as blood, urine and self-testing, but it is important to understand when menopause testing is useful.

• Blood tests - The doctor usually measures the levels of hormones such as FSH, LH, estrogen, progesterone, and testosterone. These hormones provide insight into your hormonal balance and can help explain symptoms such as hot flashes and mood swings.
• Self-tests - These tests measure the FSH level in your urine. You can order the tests online and perform them at home.
• Online questionnaires - Questionnaires such as the Greene Climacteric Scale can be helpful in assessing your symptoms and determining whether you may be in menopause.

The answer is simple: a single test is not reliable, because during menopause your hormones are all over the place and a test is therefore always a snapshot.

Only when you are further along in the menopause and your hormones have stabilized somewhat can a test provide more clarity:

• Perimenopause - You can experience menopausal symptoms several years before menopause. But as long as you're still menstruating regularly, it can be difficult to determine where you are in menopause. During this phase, blood or urine tests are less reliable because hormone levels fluctuate significantly.
• Menopause - Menopause is officially defined as the point at which you haven't had a period for 12 months. This is the point at which tests are usually more reliable.
• Postmenopause - After menopause, your hormone levels stabilize even more, and changes become more noticeable. However, testing is often pointless at this stage, as you already know you've gone through menopause.

Testing for menopause is only useful if you have doubts, especially in the early stages. Ironically, menopause tests are least reliable during this phase.

Here's what I would recommend:

1. Pay close attention to your menopausal symptoms
2. Keep a daily diary
3. Complete the online questionnaire

If you'd like more clarity, you can regularly take a blood test or home test and compare the results. I also recommend exploring what you can do yourself to reduce your menopausal symptoms.

Finally, it is always good to visit your doctor if you have any doubts.

By adapting your lifestyle and diet to the changing needs of your body, you can do a lot to reduce your menopausal symptoms.

1. Drink plenty of water - Stay hydrated to reduce hot flashes and night sweats. Water also helps combat dry skin and fatigue.
2. Eat more fruits and vegetables - Eating more fruits and vegetables every day can have a positive effect on your menopausal symptoms. Research shows that women (n=17,000) who ate more fruits and vegetables experienced 19% fewer hot flashes compared to the control group.(7)
3. Maintain a regular sleep pattern - Sleeping well becomes increasingly difficult during menopause. Therefore, try to go to bed and wake up at fixed times. A consistent schedule promotes sleep quality, which can help with mood swings and fatigue.
4. Avoid caffeine and alcohol - Caffeine and alcohol can worsen hot flashes and sleep problems. Limiting these can reduce your symptoms and keep your energy levels more stable.
5. Exercise daily - Even a short 30-minute walk can reduce hot flashes and mood swings and boost your energy. Moreover, exercise supports your bones and muscles, which become more vulnerable during menopause.
6. Eat foods rich in calcium and vitamin D - Dairy products, green leafy vegetables, and sunlight can help keep your bones strong, which is essential during menopause. Vitamin D also helps you feel good about yourself if you're deficient.
7. Do strength training - Strength training strengthens bones and muscles, which is crucial during menopause. It can also help boost your metabolism and maintain your energy levels. It also helps prevent muscle loss.

Finally, I'd like to point out that there are many plant extracts that can help with menopausal symptoms. These are a few examples of commonly used natural remedies during menopause.

Chasteberry is an herb with blue-purple flowers, also known as vitex agnus castus. This herb grows primarily in areas around the Mediterranean and is especially popular with women.

It can help with menstrual discomfort and helps support the woman's hormonal system.

• Helps to alleviate menopausal symptoms*
• For discomfort around menstruation*
• Good for the mood*

Cimicifuga is an herb native to the Netherlands and is also called black cohosh. The roots of this plant were already used by women in Northern India.

It was already used then as an aid against discomforts associated with menopause and menstruation.

• Helps to alleviate menopausal symptoms*
• For a normal, regular menstruation*

Chinese angelica (Angelica Sinensis) is also called Don Quai or female ginseng. It is rich in folic acid, vitamin B12, and magnesium, among other nutrients.

• Contains phytoestrogens
• Synergistic effect with Hops
• Helps with menopausal symptoms*

The isoflavones in Menopause Premium are extracted from hops. This plant is rich in isoflavones (phytoestrogens), substances that resemble the body's own estrogen.

• Helps with menopausal symptoms*
• Rich source of phytoestrogens

Sources used

1. Dratva, J., Real, F.G., Schindler, C., Ackermann-Liebrich, U., Gerbase, M.W., Probst-Hensch, N.M., Svanes, C., Omenaas, E.R., Neukirch, F., Wjst, M., Morabia, A., Jarvis, D., Leynaert, B., & Zemp, E. (2009). Is age at menopause increasing across Europe? Results on age at menopause and determinants from two population-based studies. Menopause The Journal Of The North American Menopause Society , 16 (2), 385–394. https://doi.org/10.1097/gme.0b013e31818aefef
2. Stepaniak, U., Szafraniec, K., Kubinova, R., Malyutina, S., Peasey, A., Pikhart, H., Pająk, A., & Bobak, M. (2013). Age at natural menopause in three Central and Eastern European urban populations: The HAPIEE study. Maturitas , 75 (1), 87–93. https://doi.org/10.1016/j.maturitas.2013.02.008
3. Salari, N., Hasheminezhad, R., Hosseinian-Far, A., Rasoulpoor, S., Assefi, M., Nankali, S., Nankali, A., & Mohammadi, M. (2023). Global prevalence of sleep disorders during menopause: a meta-analysis. Sleep And Breathing , 27 (5), 1883–1897. https://doi.org/10.1007/s11325-023-02793-5
4. Bansal, R., & Aggarwal, N. (2019). Menopausal hot flashes: A concise review. Journal Of Mid-life Health , 10 (1), 6. https://doi.org/10.4103/jmh.jmh_7_19
5. Weber, M. T., Maki, P. M., & McDermott, M. P. (2013). Cognition and mood in perimenopause: A systematic review and meta-analysis. The Journal Of Steroid Biochemistry And Molecular Biology , 142 , 90–98. https://doi.org/10.1016/j.jsbmb.2013.06.001
6. Mauvais-Jarvis, F., Clegg, D.J., & Hevener, A.L. (2013). The Role of Estrogens in Control of Energy Balance and Glucose Homeostasis. Endocrine Reviews , 34 (3), 309–338. https://doi.org/10.1210/er.2012-1055
7. Kroenke, C. H., Caan, B. J., Stefanick, M. L., Anderson, G., Brzyski, R., Johnson, K. C., LeBlanc, E., Lee, C., La Croix, A. Z., Park, H. L., Sims, S. T., Vitolins, M., & Wallace, R. (2012). Effects of a dietary intervention and weight change on vasomotor symptoms in the Women's Health Initiative. Menopause The Journal Of The North American Menopause Society , 19 (9), 980–988. https://doi.org/10.1097/gme.0b013e31824f606e
8. Mei, Z., Hu, H., Zou, Y., & Li, D. (2023). The role of vitamin D in menopausal women's health. Frontiers in Physiology , 14 . https://doi.org/10.3389/fphys.2023.1211896