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What Are the Worst Menopause Symptoms?

cartoon women going through menopause symptoms such as tiredness, sweating, etc.

Menopause refers to a time when a woman stops having her menstrual cycle. It is a natural biological process in a woman’s life. The average age when it happens is between 45 and 55 years. If it occurs before age 45, it is called premature menopause.

A woman is said to have entered menopause or become postmenopausal if she has not had a period for at least 12 months. 

During this transition period, the ovaries make very little of the reproductive hormones - estrogen and progesterone. Decreasing hormone levels can lead to a variety of menopausal symptoms. Some of the symptoms of menopause can have a cascading effect. For example, vaginal dryness can lead to low sex drive, and night sweats can lead to insomnia.

In this article, we’ll look at some of the most common and worst menopausal symptoms and how best to manage them. 

Hot Flashes

Hot flashes are one of the most common symptoms of menopause. A woman typically experiences sweating, pink or red skin, and palpitations during a hot flash. Hot flashes may be accompanied by emotional symptoms like anxiety or a feeling of dread. 

On average, menopausal women experience hot flashes for 3-5 years. Hot flashes are usually worse in the year after the last menstrual period. Women who have had surgical menopause or are taking tamoxifen (a medication to prevent breast cancer) often experience the worst hot flashes.

The reason for hot flashes during menopause is not completely clear, but it is believed they are mediated by a part of the brain called the hypothalamus, which is the body’s natural thermostat. 

Lifestyle changes to relieve hot flashes

  • Avoid the common triggers of hot flashes such as hot beverages, spicy food, alcohol, caffeine, warm temperatures, and stress. Keeping a diary can help you identify the most common triggers for your hot flashes.
  • Dress in layers and remove as needed. 
  • Regulate air conditioning to keep your environment cool. 
  • Try deep-breathing exercises or paced respiration to alleviate a hot flash. You can learn these techniques in a yoga class. 
  • Practice stress-relief methods like meditation or biofeedback.

Herbal remedies for hot flashes

Many dietary supplements and herbal products claim to reduce menopausal symptoms like hot flashes, but there is no strong scientific evidence that they work, so that’s something to keep in mind before spending money on herbal remedies. 

Hormone therapy and medications for menopausal hot flashes

If your hot flashes are especially bothersome, talk to your healthcare provider about hormone replacement therapy (HRT). Short-term hormone therapy with low-dose estrogen can effectively treat hot flashes. 

Another option is to try an antidepressant medication such as fluoxetine (Prozac), venlafaxine (Effexor), or paroxetine (Paxil). 

Some women get relief from hot flashes by taking an anti-seizure medication called gabapentin (Neurontin) or an antihypertensive drug called clonidine (Catapres). Your doctor can help you decide which medication is right for you.

Night Sweats

Hot flashes that occur at night are called night sweats. Severe symptoms can cause enough sweating to soak clothes and bed linen. Night sweats can lead to trouble sleeping, leading to mood changes and fatigue. 

Lifestyle changes to relieve night sweats

  • Sleep in a cool room.
  • Keep a cold pack under your pillow and turn your pillow over if you wake up sweating.
  • Change your nightclothes if you wake up soaked. This will help you sleep more comfortably and get some rest.

Vaginal Changes

Some of the biggest changes during the menopausal transition occur in the lining of the vagina due to falling estrogen levels. These include thinning of the vaginal lining, decrease in vaginal secretions, and shortening and narrowing of the vagina.

As a result, many women experience vaginal dryness and irritation, which can make sexual intercourse uncomfortable and lead to sexual dysfunction

Atrophic vaginitis or inflammation of the vaginal wall can also occur, leading to further thinning of the vaginal lining. This can cause menopausal symptoms like vaginal bleeding, painful sex, and painful pelvic exams. 

Treatment for vaginal changes 

Vaginal moisturizers and lubricants (Replens, Silk-E, Astroglide) can help relieve vaginal dryness. Estrogen creams, rings, or tablets are also effective. Regular sexual stimulation can help keep the vagina moisturized and healthy.

Irregular uterine bleeding

Because of the hormonal changes during perimenopause, the uterus shrinks in size, and the inner lining stops shedding with the monthly cycle. These changes are a hallmark of menopause. Most women experience shorter menstrual cycles, lighter or heavier bleeding, and going several months without a period and then resuming regular periods after a break.

Treatment for irregular periods

  • Nonsteroidal anti-inflammatory drugs like ibuprofen (Motrin, Advil) and naproxen (Aleve) are helpful for some women.
  • Doctors may prescribe birth control pills to women with very irregular, prolonged, or heavy bleeding to help make the periods more regular and lighter. 
  • Progestogen (a synthetic form of the hormone progesterone) may be helpful in women with intermittent bleeding. 
  • The application of Mirena, which is an intrauterine device (IUD) that secretes low-dose levonorgestrel (synthetic progesterone), can help regulate ovulation and reduce unpredictable bleeding. 
  • Heat (thermal) and cold (cryo) procedures can be done on the uterine lining. 

Other Symptoms of Menopause

Some common menopausal symptoms reported to women’s health specialists are unrelated or not directly related to fluctuating hormone levels. These include mood changes, depression, sleep problems, memory and cognitive problems, reduced sexual desire, sexual dysfunction, weight gain, urinary incontinence, urinary tract infections, dry skin, and thinning hair. 

Mood Changes, Depression, Memory Problems, Concentration Problems

There does not appear to be a direct link between emotional symptoms and hormonal fluctuations. It is possible that mood changes and depression occur because women, in general, are more prone to depression than men. Also, disrupted sleep due to night sweats can cause fatigue, irritability, mood swings, and memory and concentration problems. Notably, perimenopause is typically a time in a woman’s life associated with stressors like professional responsibilities, children leaving home, and elderly parents with health conditions. 

It is worth trying lifestyle changes before turning to antidepressant medications for mood changes during perimenopause. Try to get restful sleep, eat a healthy diet, get regular exercise, and use stress-relief methods like yoga and meditation to help with mood changes, mood swings, and depression. Stay mentally active by doing puzzles or learning something new to help with memory and concentration problems.

Herbal remedies like St. John's Wort may work as mood elevators, but the scientific evidence is conflicting. 

If these measures don’t work, your doctor may prescribe antidepressants such as selective serotonin reuptake inhibitors (SSRIs) to provide relief. 

Insomnia in Postmenopausal Women

Sleep disruption during perimenopause can occur due to night sweats. Changes in sleep cycles could also be due to age. Sleep deprivation can cascade into other symptoms like fatigue, irritability, and mood swings.

Practicing good sleep hygiene and treating hot flashes and night sweats can be effective treatments for insomnia. If these measures do not work, insomnia medications are available, but remember, they are a temporary solution.

Low Sexual Desire

Low sex drive during perimenopause typically occurs due to various reasons, including less estrogen, reduced blood flow to the genitals and decreased sensation, vaginal dryness, and painful intercourse. Insomnia and fatigue from night sweats can also play a role in women being less interested in sex. Urinary incontinence and the associated embarrassment can be another possible reason. Self-consciousness about physical appearance and body image are other possible reasons for a reduced sex drive. In addition, male partners may experience performance problems or a decline in sexual function, which can lead to a decrease in the frequency of intercourse.

Frank conversations with your partner can help you express your needs and expectations. If conversations are difficult, a trained counselor or sex therapist may help.

Menopausal Weight Gain

There is no clear evidence that weight gain during perimenopause results from hormonal changes. The middle-age spread may occur due to reduced physical activity and slowing metabolism. An expanding waistline is linked to an increased risk of high blood pressure and cardiovascular disease (heart disease) in postmenopausal women. 

The most effective strategy for losing weight is a healthy lifestyle, including a healthy diet and regular exercise. Exercise will also help maintain bone density in postmenopausal women.

Urinary Incontinence

Women are far more likely than men to have urinary incontinence because of the differences in anatomy and the effects of vaginal childbirth on the pelvic muscles and tissues. Decreasing estrogen levels can also cause thinning of the urethral lining, causing urinary frequency, urgency, painful urination, and stress urinary incontinence. 

Bladder training can be helpful in postmenopausal women with urge incontinence. Eliminating beverages like tea, coffee, citrus juices, and alcoholwhich are bladder irritants--may also be useful. Kegel exercises can help strengthen the pelvic floor muscles. Estrogen cream may also provide relief from urinary symptoms during menopause.

Dry Skin and Thinning Hair

Decreased estrogen may contribute to thinning hair and dry skin in perimenopausal women. The cumulative effects of sun exposure and smoking over the years also play a role. 

Many treatments are available, but it makes sense to start by protecting your skin from sun exposure and using good quality skin moisturizers and hair conditioners.


  1. https://www.health.harvard.edu/womens-health/dealing-with-the-symptoms-of-menopause