The top 4 symptoms of menopause—and why they matter

Here's the good news: Technically, menopause is only one day long. It's the point when you haven't had a period for a year, and after that, you're considered postmenopausal. But the time leading up to that day, perimenopause, can last for years and come with a range of issues that affect physical, mental, and emotional health. Not all of these changes are problematic, many are simply uncomfortable or annoying — like brain fog, dry eyes, or acne. Some, however, can have a ripple effect on your health and quality of life overall, even into your postmenopausal decades. Here are four that tend to be the most disruptive to everyday life.

Hot flashes

Of all menopause symptoms, hot flashes seem the most cliche, but that’s because they’re that common. Up to 80% of women will experience them as they go through the menopause journey, per the National Institute of Aging (NIA), and 10% of those will have more than seven hot flashes daily. Also known as vasomotor symptoms, hot flashes occur because hormones play a role in the body’s temperature regulation, so when hormone levels change, that can lead to sudden and intense temperature shifts.

Hot flashes are very disruptive, especially if they happen at night and mess with your sleep, says Dr. G. Thomas Ruiz, M.D., lead OB/GYN at MemorialCare Orange Coast Medical Center in Fountain Valley, CA. Some factors can make hot flashes more frequent and intense, per the NIA, and these include drinking alcohol, smoking, feeling stressed, and having excess weight or obesity.

These types of perimenopause-related hot flashes often start before a woman's periods stop. The NIA reports that they can significantly impact quality of life — making it difficult to concentrate, reducing energy levels, and affecting mood.

Abdominal weight gain

"Menopause presents a marked change in a woman's body, and one of the most notable changes can be weight gain, particularly in the abdominal area," says Dr. Kecia Gaither, M.D., an OB/GYN and director of perinatal services and maternal fetal medicine at NYC Health + Hospitals in New York City.

This happens, in part, because aging prompts a downshift in the metabolism — that's true for men as well as women — and not only does that slowdown allow for more fat to accumulate, that slower metabolism also makes fat more likely to stick around because you need more significant changes in diet and physical activity to counteract that effect.

Why the belly, though? It's mainly about the hormones, Gaither adds. Reduction in your estrogen and progesterone production causes fat to be stored around the waist more frequently compared to other body areas like the hips or thighs, she says. Those aren't the only hormones, either: The years leading up to menopause also tend to cause an increase in ghrelin — the hormone that signals hunger — and a decrease in leptin, the hormone that provides feelings of fullness. Not only can this type of fat cause frustration, it can present major health challenges, says Gaither.

"The fat that accumulates around the abdomen — known as visceral fat — increases one's risk of cardiovascular disease, because it comes with an increase in cardiometabolic factors like inflammation, insulin resistance, elevated blood pressure, and high cholesterol," she states. "Abdominal fat has also been associated with an increased risk of dementia and certain cancers."

Diabetes is a concern since abdominal obesity is linked to poor insulin regulation, Ruiz adds. He says particularly if someone has fat concentrated mainly in the belly area, and that's accompanied by thin legs, he considers that patient at a higher risk of developing type 2 diabetes.

"These are often women who are surprised by weight gain because they're eating the same amount of calories they have for a long time, but the way the metabolism slows in menopause is causing that abdominal fat accumulation," he says. "The sooner you can address that, the more likely you are to slow the momentum of that weight creeping on."

Sleep disruption

With hot flashes as you're trying to sleep — called night sweats — along with hormonal changes in general, sleep quality can be affected during perimenopause. In addition to feeling groggy and having low energy, poor sleep is another factor for weight gain.

In part, that's because sleep difficulties affect hormonal regulation as well, particularly ghrelin and leptin. Research indicates that sleep is an important modulator for your metabolism, and when it's negatively impacted, that can prompt increased hunger and appetite, and lower levels of fullness. It can also affect insulin sensitivity and how you react to stress, researchers add.

A study in the American Journal of Epidemiology looking at menopausal women specifically found this strong association as well. Researchers noted that participants who slept five hours or fewer per night gained more weight during menopause compared to those who regularly got seven hours or more.

Mood shifts

Hormonal fluctuations affect more than belly fat and your bedtime routine; they can also prompt changes in the brain in profound ways. For example, research in the Journal of Clinical Endocrinology & Metabolism found that shifts in estrogen and progesterone were linked to increased depression symptoms during perimenopause.

Emotions like stress, anxiety, tearfulness, and irritability can also be intense during this time, according to commentary in the American College of Obstetricians and Gynecologists. This is linked to a dip in estrogen and progesterone, but other factors also play a role such as disrupted sleep. Unlike mood changes related to premenstrual syndrome, emotional upheaval during perimenopause isn't tied to a hormonal cycle — instead, it can come and go for years without any kind of pattern, and that can make you feel blindsided, says Dr. Ruiz.

"Handling different emotions during this time can feel overwhelming, especially as you address the physical effects happening at the same time," he notes. "However, awareness that this is tied to menopause is helpful, and being more proactive with healthy behaviors may ease some of those emotional impacts."

What you can do

Although it may seem like menopausal symptoms are inevitable, that's not always the case. There are certain behaviors and factors that can make symptoms like these more likely — for example, smoking, eating a less healthy diet, and being sedentary have been linked to more notable menopause symptoms, Dr. Ruiz says. That's why putting healthy habits into place like focusing on meaningful dietary changes and integrating more physical activity into your daily schedule can be robust for prevention.

If you're already experiencing signs like these, pivoting toward different behaviors can often limit their intensity. For example, Dr. Gaither says engaging in physical activity can build muscle mass, increase bone density, and reduce cortisol (the hormone tied to your stress response), and that can lead to benefits for your metabolism, sleep, overall energy, strength, and body composition. A shift toward meaningful dietary changes — like focusing on increasing protein, fiber, and hydration and decreasing alcohol — can also help with decreasing abdominal fat and lowering health risks, even if hormone levels are fluctuating as you age.

As you implement these type of strategies, Ruiz suggests checking in with your healthcare provider for more tailored advice, including whether it may be beneficial to explore whether hormone replacement therapy (HRT) is a fit for you, as well as other medication such as GLP-1s like Wegovy (semaglutide) or Zepbound (tirzepatide).

"We're seeing that GLP-1s play really well with HRT, particularly in addressing weight gain that comes as a result of menopause," he says. "Overall, the changes that come at this time can be disheartening for many women, but it helps to have a sense of control and the understanding that you can do something about these menopause-related effects."