You are not imagining things. Your eyes are drier. Your skin is itchier. You’re getting hairs in new places. And the shape of your body is shifting — even if you’re eating less and moving more than you used to. These signs and symptoms are real, and they’re part of the natural transition that your body goes through as your periods come to an end.
You were expecting hot flashes, right? Not joint pain and dry eyes?
You’re definitely not alone.
Many women don’t even think about menopause when odd symptoms first appear. After all, many symptoms of the transition start when your periods are still fairly regular, and many have no obvious connection to hormones. It’s common to worry that something is wrong with your health, instead of recognizing changes as part of a natural process.
Researchers are still learning about all the symptoms associated with menopause. But this is clear: The gradual loss of estrogen in your bloodstream is responsible for a wide range of changes throughout your body — not just in your reproductive system.
What’s causing the changes?
The short answer is hormones.
As you approach your late 30s, your ovaries start making less estrogen and progesterone — the hormones that regulate menstruation — and your fertility declines. In the years before menopause, your hormone levels may rise and fall unevenly, dramatically and unpredictably.
This often causes your menstrual periods to become longer or shorter, heavier or lighter, and more or less frequent, until eventually you have no more periods. (Fun fact: You may have any or all of those variations before your period stops!)
These fluctuations affect more than your menstrual supplies and whether you can get pregnant. Changes in your hormone production can set off a cascade of physical changes throughout your body.
Some possible changes you may not have considered:
Menopause and brain fog
No, you’re not crazy if you feel like you’re struggling more to concentrate or remember where you left your phone. Perimenopause really may affect your memory and processing. Research from several cognitive studies suggests that complaints of brain fog are valid. Among the different mental tasks studied, verbal memory and learning appear to be some of the most common areas of complaint during perimenopause. But despite these common complaints, women still typically have a normal range of function. Studies show that only around 12% of women in perimenopause have cognitive impairment that’s clinically significant.
Brain fog during this time is likely due to a complex combination of factors, including menopause changes and other natural aging in the brain. Fluctuating hormone levels may contribute to trouble concentrating or recalling information, because estrogen and progesterone receptors in the brain are involved in cognitive function. Add in poor sleep, depression or hot flashes — or all of those — and it’s no wonder if you feel like you can’t think straight. For most people, though, brain fog seems to resolve after the transition to menopause.
Menopause and hair growth
Hirsutism is the medical term for excessive hair growth in women. It results in hair on body parts such as the face, chest and back, where men typically grow hair. Many women experience facial hirsutism during menopause — especially on the chin, upper lip and cheeks.
For some women, this manifests as fine hairs or peach fuzz, which can appear on larger areas of the face. Others have lone, dark, quick-growing rogue hairs that curl out of the chin or cheeks. In some cases, facial hair may grow to resemble a faint mustache.
The reason, again, may be related to a change in hormones. At puberty, your ovaries begin to produce a mix of female and male sex hormones. This is what causes hair to grow in your armpits and pubic area. Hirsutism can occur if the mix becomes unbalanced with a high proportion of male sex hormones (androgens). This commonly happens during menopause, as the ratio between estrogen and androgens shifts. Some hair changes may also be part of the natural process of growing older or related to family history and not related to hormones.
Hair changes can be mild or severe, inconvenient, or anxiety inducing. Your healthcare team can talk through options for managing your concerns. If hair changes are affecting your body image and self-esteem, it’s worth doing something about them.
Menopause and eye symptoms
Sex hormone receptors have been found in many of the tissues of the eyes. This includes the colored part of your eye (iris), the clear elliptical structure behind the iris (lens), the protective dome of clear tissue at the front of your eye that helps your eye focus (cornea), and the transparent tissue that covers the white part of your eye (conjunctiva). These hormone receptors are also in the lubricating glands in the eyelids.
Researchers haven’t figured out the exact role of the estrogen and androgen receptors found in those areas. However, it seems that sex hormones are involved in maintaining a state of equilibrium in your eyes in different ways. As a result, you may notice various changes to your eyes as hormones fluctuate throughout your life — during your menstrual cycle, during pregnancy and at the time of menopause.
Women report a host of eye complaints that occur with menopause. These include blurred vision, swollen and reddened eyes, tired eyes, trouble with contact lenses, and vision changes.
One of the most common eye problems around the time of menopause is dry eye syndrome. Dry eyes occur when you can’t produce enough tears or the tears aren’t lubricating well enough (think: aren’t oily enough) to provide enough moisture for your eyes. The medical term for this condition is keratoconjunctivitis sicca. Tear production tends to fall off as you get older. But women tend to report worse dry eyes and more severe effects than men. This may be due in part to hormonal changes.
Menopause and bruising
In addition to keeping skin supple, collagen provides a protective layer between the surface of your skin and your blood vessels. As estrogen decreases and the amount of collagen in your skin changes, your skin may become thinner. As a result, slight injuries may be more likely to cause bruising as you age. You may notice more cuts, bruises and other marks on your skin. It may also take longer for these wounds to heal.
Menopause and your mouth
The drying effects of menopause can be prominent in your mouth as well. The mucous membrane that lines the inside of your mouth (oral mucosa) contains estrogen receptors. So do the glands that produce your saliva (salivary glands). Estrogen seems to support the health of these structures in your mouth, helping to keep your saliva flowing. As a result, saliva production may decrease with estrogen production.
Is less spit in your mouth really a bad thing? Well, yes. Saliva washes away food particles, enhances your ability to taste and helps with digestion. A low flow of saliva may lead to dry mouth and cavities.
Menopause and acne
It may seem completely unfair that you’re growing older and reverting to your teenage skin all at once. Is it really possible to have wrinkles and pimples at the same time?
Unfortunately, yes. It’s very common for women who had pimples in their teen years to experience an encore in midlife. This time around, lumps may be tender and appear deep beneath the surface of the skin.
The problem is androgen circulating throughout your body. As your estrogen levels drop, the ratio of androgen to estrogen in your body can shift. This can cause adult acne, particularly on the chin, jaw line and neck.
This problem can be distressing and frustrating. Be assured that effective treatments are available. They may just take a little time. You may need to work with a dermatologist to find a treatment that works for you.
Menopause and joint problems
Many women notice joint pain for the first time during perimenopause. And, in fact, recent research has shown a connection between joint pain and the loss of estrogen. As it turns out, this joint pain — separate from arthritis — is another common symptom of menopause.
Some studies indicate that women with joint pain or stiffness may get some relief with hormone therapy. It’s important to note hormone therapy isn’t prescribed to treat joint pain in menopause — but this may be a side benefit. The relationship between joints and estrogen isn’t fully understood, and more research is needed in this area.
If your knee feels stiff or you’re having trouble getting your rings over your swollen finger joints, you can be reassured that these symptoms are common. At the same time, don’t be too quick to shrug off new pain without investigating its cause, especially if pain is severe.
There are many reasons for pain in or around your joints. It’s possible that your pain is actually radiating from the bone, ligament, tendon or the small sacs of fluid (bursae) that reduce friction between moving parts in your joint. Pain also may be traced to an injury or mechanical problem.
Arthritis — true joint damage — is more common after you’ve reached menopause, so it’s important to get joint pain checked out early on. Your health care practitioner can help you sort out the cause of your pain and the best treatment. If the cause is an injury, focusing on hormones won’t be the right solution.
Taking action to address menopause symptoms
For some people, understanding all the changes that are happening to the body during menopause is a relief. It’s a much-needed validation that what they’re seeing and feeling is real.
For others, this extensive list of menopause symptoms is daunting.
However you feel, as you notice the symptoms of menopause, talk with your healthcare team. Even though the symptoms discussed are typical and natural, you don’t have to suffer through them. Your healthcare team can help you figure out a plan to deal with any uncomfortable or embarrassing symptoms. More than ever before, as the transition to menopause is better researched and understood, you have options for managing symptoms. These include lifestyle changes, hormone therapy and other medications, as well as holistic and integrative therapies, such as meditation and more. Don’t be afraid to advocate for your needs and seek treatment.
Finally, a word of caution: Take new symptoms seriously, and don’t chalk everything up to hormones or natural aging. Although the transition to menopause can be responsible for a wide range of body changes and sensations, other serious conditions can cause some of the same signs and symptoms — mouth pain, vision changes, bruising or joint pain, for example. It’s important to rule out other causes of new signs and symptoms, particularly if they come on suddenly or are particularly severe.
A version of this text appears in The New Rules of Menopause.
