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​​​​​​​Symptoms of Menopause

​​​​​​​Understanding what the body is going through during menopause can enhance meaningful conversations about menopause. Click on each symptom to discover more:​​​​​​​

Hot flushes

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  • Hot flushes are a common symptom of peri- and postmenopause, affecting at least 65% of women1,2
  • ​​​​​​​They are believed to be related to declining levels of oestrogen3
  • Hot flushes may continue after menopause1,2
  • Oestrogen therapy may be effective in treating hot flushes. Black cohosh and red clover supplements are no more effective than placebo4,5

Night Sweats

  • Night sweats are episodes of excessive sweating during sleep that can be due to a number of underlying causes6
  • Night sweats, or heavy sweating due to hot flushes at night, may occur in women at or around the time of menopause6
  • Hot flushes and night sweats when sleeping may result in sleep disturbance, which could lead to irritability during the day. Evidence suggests that sleep-disruptive hot flushes and night sweats related to menopause are more likely to occur during the first half of the night, when there is less rapid eye movement sleep7
  • Treatments for hot flushes and night sweats associated with menopause include, lifestyle changes, over-the counter (OTC) remedies, and prescription therapy6

Difficulty Sleeping

  • Between one quarter to one half of women will have trouble sleeping during menopause. They either can’t fall asleep, wake up in the middle of the night and can’t get back to sleep, or wake up too early. Sleep problems seem to get worse closer to menopause8
  • Hormonal shifts during this time can contribute to sleep problems, including waking up more often, having trouble falling asleep, and feeling like your sleep is not restful9
  • Other reasons for sleeping problems at this time of life include waking at night to go to the bathroom, aches and pains, depression and other psychological conditions, life stressors, and even the disruption that comes from sleeping with a partner or a pet10,11

Mood Issues

  • There is mixed evidence about the effect of menopause on mood. Some studies find a higher risk of depression as you move through perimenopause. Others find that some women actually feel better as they move into menopause12
  • If you have a history of hormone-related depression, including postpartum depression and premenstrual syndrome, you may be more likely to experience depression during the menopausal  transition13

Poor Memory and Concentration

  • The menopause transition is frequently accompanied by depressive symptoms and subjective declines in cognitive function14
  • The loss of estrogen could have an effect on cognitive abilities and on the brain itself, above and beyond aging14,15

Vaginal and Urinary Changes

  • Before menopause, a woman’s vaginal walls have an average of 30%-60% superficial cells and 0% parabasal cells16
  • After menopause, superficial cells decrease and parabasal cells increase16  and oestrogen levels drop, causing changes to the vagina, which can lead to painful intercourse17
  • Unlike most menopausal symptoms, urogenital symptoms without treatment may get worse over time18​​​​​​​​​​

Avoiding Intimacy - Sexual Concerns

​​​​​​​Talking to Your Partner

  • The first step to restoring intimacy is conversation. Remind your partner how you feel about your relationship and how important intimacy is to you19
  • Explain why sex has not been enjoyable
  • Explain how menopause has affected your vagina, leading to dryness, which causes pain20
  • Talk about how you can remain intimate while you begin treatment

Aching in muscles and joints

  • There is some evidence that joint and muscle pain worsen during the menopausal transition, possibly due to the loss of oestrogen, which seems to serve as a natural anti-inflammatory21,22
  • Oestrogen deficiency renders postmenopausal women vulnerable to degenerative conditions such as osteoarthritis, osteoporosis, atherosclerosis, and Alzheimer’s disease22


Estring (estradiol hemihydrate) prescribing information can be found here
Premarin (oestrogens, conjugated) prescribing information can be found here
Premique (medroxyprogesterone acetate oestrogens, conjugated) prescribing information can be found here

1.    Gold EB, Colvin A, Avis N, et al. Longitudal analysis of the association between vasomotor symptoms and race/ethnicity across the menopausal transition: study of women's health across the nation. Am J Public Health. 2006;96(7): 1226-1235.
2.    Takahashi TA, Johnson KM. Menopause. Med Clin North Am. 2015;99(3):521-534.
3.    Deecher DC, Dorries K. Understanding the pathophysiology of vasomotor symptoms (hot flushes and night sweats) that occur in perimenopause, menopause, and postmenopause life stages. Arch Womens Ment Health. 2007;10(6):247-257.
4.    American College of Obstetricians and Gynecologists. ACOG Practice Bulletin No. 141 : management of menopausal symptoms. Obstet Gynecol. 2014; 123(1):202-216.
5.    Geller SE, Shulman LP, van Breemen RB, et al. Safety and efficacy of black cohosh and red clover for the management of vasomotor symptoms: a randomized controlled trial. Menopause. 2009; 16(6): 1156-1166.
6. The North American Menopause Society. Menopause 101 : a primer for the perimenopausal. treatments/menopause-101 -a-primer-for-the-perimenopausal [Accessed June 2022].
7.    Freedman RR, Roehrs TA. Effects of REM sleep and ambient temperature on hot flash-induced sleep disturbance. Menopause. 2006;13(4):576-583. 3. McNamara M, Batur P, DeSapri KT. In the clinic. Perimenopause. Ann Intern Med. 2015; 162(3):ITC1 -ITC15.
8.    Eichling PS, Sahni J. Menopause related sleep disorders. J Clin Sleep Med. 2005; 1(3):291 -300.
9.    Tom SE, Kuh D, Guralnik JM, Mishra G. Self-reported sleep difficulty during the menopausal transition: results from a prospective cohort study. Menopause. 2010; 17(6): 1128- 1135.
10.    Duthuluru S, Stevens D, Steens S. Sleep quality due to co-sleeping with pets. Sleep. 2014;37:A189.
11.    Dittami J, Keckeis M, Machatschke I, Katina S, Zetlhofer J, Kloesch G. Sex differences in the reactions to sleeping in pairs versus sleeping alone in humans. Sleep Biol Rhythms. 2007;5:271-276.
12.    Vesco KK, Haney EM, Humphrey L, Fu R, Nelson HD. Influence of menopause on mood: a systematic review of cohort studies. Climacteric. 2007;10(6):448-465.
13.    Soares CN, Zitek B. Reproductive hormone sensitivity and risk for depression across the female life cycle: a continuum of vulnerability? J Psychiatry Neurosci. 2008;33(4):331-343.
14.    Epperson CN, Amin Z, Ruparel K, Gur R, Loughead J. Interactive effects of estrogen and serotonin on brain activation during working memory and affective processing in menopausal women. Psychoneuroendocrinology. 2012;37(3):372-382.
15.    Silva I, Naftolin F. Brain health and cognitive and mood disorders in ageing women. Best Pract Res Clin Obstet Gynaecol. 2013;27(5):661-672.
16.    Reimer A, Johnson L. Atrophic vaginitis: signs, symptoms, and better outcomes. Nurse Pract. 2011;36(1):22-28.
17.    Bachmann G, Bouchard C, Hoppe D, et al. Efficacy and safety of low-dose regimens of conjugated estrogens cream administered vaginally. Menopause. 2009; 16(4):719-727.
18.    Kaunitz AM, Manson JE. Management of Menopausal Symptoms. Obstet Gynecol. 2015; 126(4):859-876.
19.    Bullard DG, Caplan H, Derzko C. Sexual problems. In: Feldman MD, Christensen JF, Satterfield JM, (eds), Behavioral Medicine: A Guide for Clinical Practice. 4th ed. New York, NY: McGraw-Hill Education; 2014.
20.    Mayo Clinic. Painful intercourse (dyspareunia). conditions/painful-intercourse/basics/definition/con-200332. Last updated January 24,2015. [Accessed June 2022].
21.    Domoney C. Treatment of vaginal atrophy. Womens Health (Lond Engl). 2014; 10(2): 191 -200.
22.    Gao HL, Lin SQ, Wei Y, Chen Y, Wu ZL. The effect of age and menopausal status on musculoskeletal symptoms in Chinese women aged 35-64 years. Climacteric. 2013;16(6):639-645.
23.    Shivers KY, Amador N, Abrams L, Hunter D, Jenab S, Quiñones-Jenab V. Estrogen alters baseline and inflammatory-induced cytokine levels independent from hypothalamic-pituitary-adrenal axis activity. Cytokine. 2015;72(2): 121-129.

PP-UNP-GBR-0581. June 2022

Managing Menopause

​​​​​​​Learn recommendations to support patients with lifestyle, diet and exercise, core recommendations regarding hormone replacement therapy (HRT), appropriate candidates for HRT, benefit-risk profile of HRT and Bioidentical Hormone Therapy

Learn more

Treatment Options

Discover a wide range of treatment options for menopause including both systemic and local therapies

Learn more

Diagnosing Menopause

Learn the fundamental strategies for diagnosing menopausal symptoms principles before you make a treatment decision

Learn more

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PP-PFE-GBR-3863. November 2021



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