Managing your health at this stage of life can be complex, and every woman needs a menopause savvy clinician who’s there to answer questions.
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Where Are You in Your Menopause Journey?
Take Our QuizThe time leading up to menopause can be confusing. If you’re like many women in this phase of life called perimenopause, you know things are changing.
The menopause journey is unique for every woman. Some women have really heavy periods or their cycle goes AWOL for a few months at a time. You might wake up exhausted after tossing and turning due to night sweats. Maybe your shoulder aches for no reason or you break out in a sweat any time you’re slightly stressed at work.
If you’re in your mid-30s, 40s or early 50s, it’s logical to think that these symptoms are part of the menopause transition. There are more than 45 documented physical, emotional and mental symptoms of menopause, and these variables make it easy for clinicians, especially those who aren’t menopause trained, to miss something.
For women who are good candidates, hormone therapy is the FDA-approved first-line treatment1 for resolving menopausal hot flashes, night sweats and other major symptoms. And as a side benefit, it can also help with others such as mood swings and itchy ears. But, just because you’re going through menopause, doesn’t necessarily mean that’s your whole story. It’s entirely possible to be dealing with a serious health challenge that has similar signs and symptoms.
Here are some symptoms you may want to discuss with your trusted clinician along with some strategies for getting answers you need to find the best solutions for you.
Memory issues and brain fog
When they start forgetting names and losing their train of thought mid-sentence, it’s natural for women who are somewhere in the menopause transition to worry about their brain health. Most of the time, these lapses are just a temporary part of the process, and are often referred to as brain fog. During menopause, the brain adjusts to lower estrogen levels and undergoes structural changes so it can use a different energy source, according to neuroscientist Lisa Mosconi, PhD. However, women who experience early menopause before age 40 do have an increased risk of cognitive issues such as Alzheimer’s dementia.2 Most research indicates that when women start hormone therapy early, it may help lower dementia risk3, though more studies are needed.
How to tell the difference: Cognitive tests can help establish a baseline and indicate if mild cognitive impairment is present. Brain imaging such as an MRI can show if there are white matter lesions, which can indicate that brain areas are damaged. If cognitive issues are ruled out, there’s a good likelihood it’s a menopause symptom.
Weight gain, dry skin and hair loss
Between 60 and 70% of women gain weight4 during the menopause transition, even if their diet and exercise habits haven’t changed. The loss of estrogen can also cause a couple other less common menopause symptoms: dry itchy skin and thinning hair or outright hair loss. However, all of these symptoms can be signs of hypothyroidism, an underactive thyroid. An underactive thyroid slows metabolism which spurs weight gain and also makes it harder for skin to stay hydrated. It also shortens a hair follicle’s growth stage, so it spends more time at rest.
How to tell the difference: A thyroid panel that looks at TSH is the first step, and depending on what the level is, a clinician may also check free T4, thyroid antibodies and free T3. If your levels are within the normal range, then these all may be menopause symptoms.
Painful joints
Musculoskeletal issues like frozen shoulder, foot pain or backaches without any injury are some of the most common menopause symptoms. A 2024 meta-analysis of 321 menopause studies found that the No. 1 complaint was joint and muscle pain, which affected 65% of women.5 This happens because the estradiol form of estrogen is a powerful anti-inflammatory, and when it declines there's more inflammation and friction, which can lead to pain. For these women, hormone therapy can often reduce or resolve their pain. However, there’s also a chance that severe joint pain can be an autoimmune condition like rheumatoid arthritis or lupus. If that is the case, the American College of Rheumatology recommends hormone therapy as a treatment option.
How to tell the difference: After an exam and medical interview, your clinician may order blood tests to measure the rheumatoid factor (RF), an auto-antibody produced by people with rheumatoid arthritis, and C-reactive protein (CRP), which indicates the level of inflammation.
Heart palpitations
Wise women take heart health seriously: cardiovascular disease is the No. 1 killer of women.6 And compared to men, women often have subtle symptoms like jaw pain, fatigue or nausea that can get minimized or dismissed. So heart palpitations, when your heart races or skips beats, can be scary. Dr. Jayne Morgan, a research cardiologist based in Atlanta, says her own heart palpitations were a mystery at first, since her tests didn’t reveal a heart condition. Her doctor put her on beta-blockers, but that made her blood pressure dangerously low. She eventually realized it was a menopause symptom.
How to tell the difference: Morgan says it’s recommended that any woman with heart palpitations go to her doctor for a full cardiac workup like an EKG to rule out undiagnosed cardiovascular disease. Learn more about women’s heart health by listening to Menopause and Heart Disease: What Every Woman Needs to Know with Dr. Jayne Morgan on the unPAUSED podcast.
Anxiety or depression
Though it’s rarely discussed, mood changes are part of the menopause transition for 70% of women.7 The brain is full of estrogen receptors and as levels of this hormone fall, it can cause women to feel anxiety, depression or anger. What’s concerning is that when women go to the doctor about mood changes, they’re much more likely than men to be given an antidepressant8 and sent on their way. Many women are often given SSRIs as a treatment for hot flashes. That may make sense for women who aren’t candidates for hormone therapy, but thousands of other women aren’t being offered hormone therapy, even though it’s very effective at resolving the underlying hormonal imbalance that causes mood changes and anxiety. In a 2025 Cambridge University study, after 107 days on hormone therapy (including transdermal bio-identical estrogen, progesterone and testosterone) 920 women reported improved mood and a significant 44% reduction in depression.9
How to tell the difference: If you’re in perimenopause or menopause age range, complete the free Meno-D scale assessment, which tracks things like anxiety, energy, irritability, and libido and share it with your doctor. Then use this Menopause Quiz to track the frequency and severity of your menopause symptoms so you can share a full picture with your clinician.
Managing your health at this stage of life can be complex, and every woman needs a menopause savvy clinician who’s there to answer questions, discuss the risks and benefits of hormone therapy and figure out the best way to help you thrive. If you need help finding a qualified clinician, download Dr. Haver’s Menopause Empowerment Guide for links to more resources.
