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The Signs of Peri-Menopause and Menopause

for Women and Their Health Care Providers

The purpose of this list of signs is to inform women and their health care providers about menopause so that appropriate action can be taken. That action may include evaluating the effectiveness of various herbs, hormones, drugs, vitamin supplements or simply waiting it out.

Menopause is not just hot flashes. The hot flash is a cardinal sign, but not the only one, nor does it occur in everyone. Varying subsets of signs occur in each individual. A common experience of the women who developed this list is a misdiagnosis by a physician or psychiatrist and often years of anxiety about the symptoms, and/or inappropriate treatment. The sudden onset of these signs can be very disturbing. The realization that ìthis is menopauseî can be a healing relief. An estimated 15 out of 100 women between the ages of 45 and 55 will have debilitating symptoms caused by lowered ovarian hormones and they will consult a physician or other health care provider for help. However, most women will not have a difficult menopause and will enjoy entering a new phase of their lives.

One goal of the women who developed this list is that every health care provider have a card in their top desk drawer with these 34 signs. The list should be scanned whenever a woman over 30 consults any health care provider. The primary goal is that this list, and the notes that follow, reach every woman so that it is there when, and if, she needs it.

Signs 1-14 are the major, most common signs of peri-menopause and menopause; the signs that a woman most often consults a physician or other health care provider about. Signs 1-16 are the most responsive to estrogen replacement therapy, progesterone or testosterone. These signs are not simply a matter of aging. They are also seen in young women after the ovaries are removed.

  1. Hot flashes, flushes, night sweats and/or cold flashes, clammy feeling (see note)
  2. Bouts of rapid heart beat
  3. Irritability
  4. Mood swings, sudden tears
  5. Trouble sleeping through the night (with or without night sweats)
  6. Irregular periods; shorter, lighter periods; heavier periods, flooding; phantom periods
  7. Loss of libido
  8. Dry vagina (see note)
  9. Crashing fatigue
  10. Anxiety, feeling ill at ease
  11. Feelings of dread, apprehension, doom (see note)
  12. Difficulty concentrating, disorientation, mental confusion
  13. Disturbing memory lapses
  14. Incontinence, especially upon sneezing, laughing; urge incontinence (see note)
  15. Itchy, crawly skin (see note)
  16. Aching, sore joints, muscles and tendons (see note)
  17. Increased tension in muscles
  18. Breast tenderness
  19. Headache change: increase or decrease
  20. Gastrointestinal distress, indigestion, flatulence, gas pain, nausea
  21. Sudden bouts of bloat
  22. Depression (see note)
  23. Exacerbation of existing conditions
  24. Increase in allergies
  25. Weight gain (see note)
  26. Hair loss or thinning, head, pubic, or whole body; increase in facial hair
  27. Dizziness, light-headedness, episodes of loss of balance
  28. Changes in body odor
  29. Electric shock sensation under the skin and in the head (see note)
  30. Tingling in the extremities (see note)
  31. Gum problems, increased bleeding
  32. Burning tongue, burning roof of mouth, bad taste in mouth
  33. Osteoporosis (after several years)
  34. Changes in fingernails: softer, crack or break easier


Symptom 1 (flashes) Hot flashes are due to the hypothalamic response to declining ovarian estrogen production. The declining estrogen state induces hypophysiotropic neurons in the arcuate nucleas of the hypothalamus to release gonadotropin-releasing hormone (GnRH) in a pulsatile fashion, which in turn stimulates release of luteinizing hormone (LH). Extremely high pulses of LH occur during the period of declining estrogen production. The LH has vasodilatory effects, which leads to flushing.

Symptom 8 (dry vagina) results in painful intercourse

Symptom 11 (doom thoughts) includes thoughts of death, picturing oneís own death

Symptom 14 (incontinence) reflects a general loss of smooth muscle tone Symptom 15 (itchy, crawly skin) feeling of ants crawling under the skin, not just dry itchy skin

Symptom 16 (aching sore joints) may include such problems as carpal tunnel syndrome

Symptom 22 (depression) different from other depression, the inability to cope is overwhelming. There is a feeling of loss of self. Hormone therapy ameliorates the depression dramatically. Symptom 25 (weight gain) often around the waist and thighs, resulting in ëthe disappearing waistlineí Symptom 29 (shock sensation) ìthe feeling of a rubber band snapping in the layer of tissue between skin and muscle. It is a precursor to a hot flashî

Symptom 30 (tingling in extremities) can also be a symptom of B-12 deficiency, diabetes, alterations in the flexibility of blood vessels, or a depletion of potassium or calcium

Some of these signs may be symptoms of medical conditions that should be checked such as hypothyroidism, diabetes or depression with another etiology.

This list of the signs of peri-menopause and menopause was developed by women on the Internet Menopaus mailing list, based at Hershey Medical Center/Penn State University Hospital, Hershey PA. The electronic mailing list has approximately 475 subscribers, with about 230 participating actively at the time the list of menopause signs was developed in January 1996. Contact for more information.

The women who directly contributed text and/or ideas to this list of signs are:

Lucy L. Brown, PH.D., Judy Bayliss, founder & owner of Albert Einstein College of Medicine mailing list: Menopaus, Krista Glickman, Susan Jessen, Betty Clark, Susan Klee, Susan Ariew, Graciela Spivak, Jennifer Hesketh Aviles, Christine Cody, Jean Bauer, Bonnie Dreps Voigtlander, Keri Webb, Joan Starker,Roberta J. Leon, Miriam Biddelman.


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