Common Signs and Symptoms of Menopause

Menopause is a natural life stage that marks the end of menstrual cycles, yet it can bring a wide range of physical and emotional changes. These changes are driven by declining oestrogen and progesterone levels and can affect almost every system in the body.

While menopause is a normal process, many women feel unprepared for the symptoms that may arise. Recognising the signs early and knowing what support is available can make a big difference in quality of life, long-term health, and confidence in managing this transition.

What Are the Most Common Symptoms of Menopause?

Hot Flushes and Night Sweats

Hot flushes are sudden feelings of heat, often accompanied by flushing of the face and sweating. Night sweats can severely disturb sleep, leaving women feeling fatigued and irritable. These symptoms occur due to changes in how the body regulates temperature as hormone levels fluctuate.

Irregular or Changing Periods

During perimenopause, menstrual cycles can become unpredictable. Periods may be lighter, heavier, or spaced closer or further apart until they stop completely. Menopause is diagnosed after 12 months without a menstrual period.

Sleep Disturbances

Falling asleep and staying asleep often become more difficult. Night sweats may worsen insomnia, leading to tiredness, poor concentration, and irritability during the day.

Mood Changes and Anxiety

Hormonal shifts can contribute to irritability, anxiety, low mood, and even depression. These changes are compounded by disrupted sleep and other physical symptoms, which can affect self-esteem and relationships.

Vaginal and Vulval Changes

Oestrogen is vital for the health of vulval and vaginal tissues. When levels fall, the tissues become thinner, drier, and less elastic, a condition known as vulvovaginal atrophy (or genitourinary syndrome of menopause).

Common symptoms include:

• Vaginal dryness or itching

• Burning or discomfort

• Pain with intercourse (dyspareunia)

• Spotting or bleeding after sex

• Recurrent urinary tract infections or urgency/frequency

When vaginal tissues become painful, pelvic floor muscles can become tense in response. This tension can make penetration, tampon use, or even pelvic exams uncomfortable. Tools like vaginal dilators can be used gradually to improve comfort and stretch tolerance, while a pelvic floor wand can target tender or tight muscles internally to reduce pain and restore mobility.

Brain Fog and Cognitive Changes

Many women report forgetfulness, difficulty concentrating, and feeling mentally “foggy.” These symptoms are thought to be related to hormone fluctuations and sleep disturbances.

Weight Gain and Joint Pain

Shifting hormones affect fat distribution, often leading to weight gain around the abdomen. At the same time, joint stiffness and aching may occur due to declining oestrogen.

Pelvic Floor Symptoms

The drop in oestrogen affects the bladder, urethra, and supporting tissues. This can lead to:

• Urinary leakage (stress incontinence)

• Overactive bladder symptoms (urgency/frequency)

• Bowel changes such as constipation or incomplete emptying

• Pelvic organ prolapse symptoms, including heaviness or bulging

Why Addressing Symptoms Early Matters

Menopause is more than just hot flushes. Untreated symptoms can lead to:

• Reduced sexual confidence and intimacy

• Poor bladder and bowel function

• Recurrent UTIs or vaginal infections

• Loss of bone density and increased fracture risk

• Cardiovascular changes that affect heart health

Early intervention can prevent symptoms from worsening and support long-term pelvic, bone, and heart health.

Treatment and Management Options

Topical Vaginal Oestrogen

Prescribed by a GP or gynaecologist, vaginal oestrogen is safe for long-term use in most women and can dramatically improve tissue health, lubrication, and comfort.

Pelvic Floor Relaxation Techniques

Learning to release tension in the pelvic floor is crucial for reducing pain and improving intimacy. Breath work and mobility exercises are highly effective tools to downtrain overactive pelvic floor muscles – see examples here.

Vaginal Dilators and Pelvic Floor Wands

• Vaginal dilators provide gradual stretching of the vaginal tissues, helping rebuild comfort and confidence with penetration.

• Pelvic floor wands allow precise release of tight muscles and scar tissue inside the vagina, reducing pain and improving muscle flexibility.

Lifestyle Support

• Regular exercise for bone, heart, and mental health

• A balanced diet with adequate calcium and vitamin D

• Limiting alcohol and caffeine, which can worsen hot flushes and sleep issues

• Seeking support for mood changes and anxiety if needed

When to Seek Help

Any new or persistent vaginal, urinary, or pelvic symptoms should be assessed. A health professional can provide guidance on whether oestrogen therapy, pelvic floor rehabilitation, or other treatments are appropriate.

Specialist pelvic floor physiotherapists provide education, internal assessments, and personalised treatment plans using evidence-based strategies to address pain, bladder or bowel issues, and sexual discomfort.

A directory of qualified professionals can be found on the BIEN Practitioner Locator.

Support is available, and with early treatment, it’s possible to maintain pelvic health, sexual wellbeing, and confidence throughout menopause and beyond.