Menopause Changes: Symptoms, Hormones, and Health

Menopause is a natural transition that brings significant hormonal, physical, and mental changes. Understanding what happens during this stage can help you make informed decisions about your health and recognize patterns in how your body responds. This guide explains the symptoms, stages, and hormonal shifts of menopause, and how continuous monitoring can help you navigate this transition with clarity and confidence.

Estrogen is a hormone that plays a critical role in each stage of a woman's life, including driving reproductive development, and it's also the primary hormone responsible for menopause. It stimulates the physical changes characteristic of puberty, regulates the menstrual cycle, and supports a healthy pregnancy.

Estrogen is produced in the ovaries, adrenal glands, and fat cells, and comes in several different forms including estrone, estradiol, and estriol. Estrogen and progesterone are the most influential female reproductive hormones. In addition, smaller amounts of testosterone have an impact on female reproductive health.

One of progesterone's main roles is in menstruation. After ovulation, progesterone levels rise in anticipation of potential fertilization. Progesterone is also vital for pregnancy.

What is menopause and when does it happen?

On average, menopause is usually experienced in a woman's 40s or 50s. The hallmark of menopause is the cessation of monthly menstruation. You are not considered to be officially in menopause until you have gone through 12 successive months without a menstrual cycle.

The three stages of menopause

Menopause is a natural transition that happens in three stages. Perimenopause is the first stage, and it can begin several years before menopause. During this time, your hormone levels fluctuate, which can lead to changes in your menstrual cycle.

Perimenopause can last anywhere from seven to fourteen years. Reproductive function gradually declines and there can be inconsistencies and changes in the monthly menstrual cycle.

Menopause is the point when you have gone 12 consecutive months without a period. By this stage, estrogen levels remain consistently low and ovulation ceases to occur.

Postmenopause includes all of the years after menopause. This term signifies that the menopausal transition has been completed and that ovulation and menstruation will no longer occur. Usually, the symptoms of perimenopause and menopause diminish or go away during postmenopause.

Common symptoms of menopause

The hormonal shifts during the menopausal transition can cause a wide range of physical and mental symptoms. Your experience is unique, but some of the most common symptoms of perimenopause and menopause include:

• Irregular menstruation
• Mood swings
• Night sweats
• Hot flashes
• Chills
• Difficulty sleeping
• Dry skin
• Weight gain

The hormonal changes of menopause

Shifting levels of estrogen and progesterone are behind many of the major changes of each phase of menopause. Perimenopause begins with a decline in estrogen production. Throughout the process of perimenopause, estrogen levels rise and fall.

By the time a woman enters menopause, estrogen levels remain consistently low and ovulation ceases to occur. The majority of the symptoms associated with menopause are due to decreased estrogen levels.

Progesterone also plays a role in menopause. During typical menstruation before perimenopause, estrogen levels increase during the first half of the cycle while progesterone increases in the second half.

The two hormones balance each other, and progesterone in particular keeps estrogen's impact on the reproductive system in check. In perimenopause, estrogen and progesterone levels fluctuate, often resulting in an imbalance. Progesterone levels decrease significantly during menopause.

The physical changes of menopause

The hormonal fluctuations that occur during menopause influence physical health in several ways. Declining levels of estrogen and progesterone have widespread effects on many different bodily systems.

Reduced energy levels

Low energy and fatigue are commonly experienced during menopause, especially during the later stages. One study found that 85.3% of postmenopausal women reported fatigue compared to only 46.5% of perimenopausal women. Low levels of estrogen and progesterone can cause imbalances in other hormones such as adrenal and thyroid hormones, which can increase fatigue.

Everyday tasks and physical activities can be more taxing for those struggling with menopause fatigue, and longer recovery times are typically needed after workouts and exercise sessions.

While getting motivated to exercise can be difficult when menopause fatigue strikes, research has found that postmenopausal individuals who complete moderate to vigorous physical activity on a regular basis actually report higher energy levels. Easing into a workout routine and slowly building up to a regular, higher intensity fitness program can be a useful strategy for dealing with low energy and fatigue.

Insomnia

Sleep issues and insomnia are often a symptom of menopause. Progesterone promotes sleep and when progesterone levels fall during menopause, going to and staying asleep can become more difficult. In addition, several uncomfortable physical symptoms of menopause can cause disruptions in sleep.

Postmenopausal women are also more likely to have the sleep disorder sleep apnea. Given the challenges in getting a good night sleep, many individuals may experience increased menopause fatigue that makes exercise and performance more challenging. Boosting sleep hygiene with strategies such as limiting screen time before bed, sleeping in a cool, dark room, and maintaining consistent sleep and wake times can help improve menopause-related insomnia.

Decreased muscle mass

During menopause, you may experience decreases in muscle mass and muscle strength. Research has found that there's a link between declining levels of the hormone estradiol and declines of skeletal muscle mass in menopausal women. Estrogen is important for muscle growth, recovery, and overall health.

To combat the impact of menopause on muscle mass, regular exercise is key. Strength and resistance training techniques should be implemented to help build muscle and prevent any further loss in muscle mass.

Metabolism changes

Weight gain is commonly listed as a symptom of perimenopause and menopause in general. Women often gain an average of 1.5 pounds per year during their 50s. Hormonal changes impact the body's metabolism, which contributes to increased weight gain.

Decreased muscle mass caused by low estrogen levels slows down the body's metabolism and the rate at which calories are converted into usable energy. Less calorie burning occurs, causing energy to be stored as fat.

Body composition also changes during menopause. Reduced estrogen triggers fat to be stored in the abdomen instead of areas like the hips or thighs. As a result, body fat levels can increase and physical appearance can change, even if there is no increase in the number on the scale.

Weight gain in the abdominal region increases the risk of several health issues, including heart disease, Type 2 diabetes, and breathing difficulties.

There are several lifestyle adjustments that can be made to minimize the impact of metabolism changes due to menopause. Regular aerobic exercise and resistance training sessions are recommended. Subbing out processed foods for whole grains, fruits, and vegetables, and eating fish or poultry instead of red meat is advised.

The mental effects of menopause

Menopause doesn't just affect physical health. It also has a significant impact on mental health. Hormonal fluctuations, changes in physical health, and stress associated with menopause and this stage of life in general all contribute to the emotional and mental symptoms of menopause.

Depression

Research has linked menopause to symptoms of depression. One study found that participants in perimenopause or postmenopause were two to four times more likely than premenopausal women to go through a major depressive episode. Individuals who have dealt with mental health conditions in the past, including depression, are more likely to experience a recurrence or worsening of mental health symptoms during menopause.

Mood swings

Rising and falling levels of estrogen and progesterone in the body contribute to mood swings. These hormonal dips can also result in a drop in serotonin, a neurotransmitter associated with positive emotions. Mood swings can present as irritability, frustration, anxiety, and depression.

In addition, outside factors and stress can worsen mood swings. During this stage of life, there can be many stressors that have to be dealt with, such as taking care of aging parents, parenting older or adult children, going through relationship difficulties, having financial struggles, and dealing with concerns about health and aging oneself.

Hormonal fluctuations can make all of these issues harder to process. Insomnia, sleep disturbances, and increased fatigue can also worsen depression and mental health struggles during menopause.

Cognitive symptoms

Changes in mood are not the only mental changes that can result from menopause. Menopause can also have a significant cognitive impact. Cognitive symptoms that are commonly experienced include brain fog, trouble thinking, difficulty reasoning, and memory impairments.

Experts estimate that as many as 66% of women deal with cognitive symptoms during menopause. It's theorized that low estrogen levels may be at least partly responsible for these changes.

Mental health and exercise

A consistent fitness routine can help counteract the impact of menopause on mental health. Exercise is known to stimulate the release of endorphins, and research has found that low-intensity activities can benefit mood and memory. Studies on physical activity in postmenopausal women have consistently found that continued exercise is linked with reduced instances of cognitive and physical impairment.

How WHOOP helps you navigate menopause

WHOOP helps you understand key physiological changes during important life stages. The Journal feature allows you to toggle through perimenopause and postmenopause so you can record the symptoms you experience in each stage. WHOOP provides personalized recommendations for your Recovery and training based on your body's signals.

You can log the physical and mental symptoms you're experiencing during important life stages and see how key metrics change when you implement strategies like improving sleep hygiene or increasing the consistency of your workout routine.

Frequently asked questions about menopause

What are the 7 early signs of perimenopause?

While every experience is different, some common early signs include irregular periods, sleep problems, mood swings, hot flashes, night sweats, fatigue, and brain fog. These symptoms can vary in intensity and may come and go as hormone levels fluctuate during perimenopause.

At what stage is menopause the worst?

Many women find perimenopause to be the most challenging stage. This is often because hormone levels are fluctuating unpredictably, leading to irregular and sometimes intense symptoms. Once you reach postmenopause, hormone levels stabilize at a new low, and symptoms often become less severe or more manageable.

What were your first signs of menopause?

For most women, the very first sign of the menopausal transition is a change in their menstrual cycle. Your periods might become longer, shorter, heavier, lighter, or less frequent before they stop completely. This irregularity is typically one of the earliest indicators that perimenopause has begun.