Menopause stages and Unusual Symptoms

Menopause does not happen overnight. It unfolds in stages and affects far more than your periods or temperature. This guide to Menopause Stages and Unusual Symptoms looks beyond hot flushes, night sweats and mood changes to explain how many other systems shift during this time and why the transition can feel so unpredictable.

This guide walks you through the basics of what happens, when it happens and why your body reacts the way it does. It also highlights symptoms that rarely make it into public conversations but are common in clinics and everyday life. The aim is simple. You deserve explanations that make sense and support that feels grounded in evidence, not guesswork.

The Stages

1. Perimenopause

Perimenopause is the transition leading up to menopause. It is when hormones begin to fluctuate and symptoms often appear.

According to the British Menopause Society, perimenopause commonly begins around age 47 in the UK. Evidence from the Cleveland Clinic shows an average duration of around 4 years, while the Mayo Clinic reports a wider range of 2 to 8 years. Some people experience symptoms for as long as 10 years if their cycles begin changing earlier.

During perimenopause your periods may become irregular, heavier, lighter or unpredictable. Hot flushes, sleep disruption, digestive changes, mood shifts and sensory symptoms often begin during this stage because hormones start to vary sharply.

2. Menopause

Menopause is confirmed once you have gone 12 consecutive months without a period with no other medical explanation. This definition is used by the NHS, the World Health Organisation and menopause specialists.

Most women in the UK reach natural menopause at around age 51, based on national population data and British Menopause Society guidance.

• Natural Early Menopause

Some people reach menopause naturally before age 45. This is called early menopause. When it happens before age 40, it is known as premature ovarian insufficiency.

Research shows that early menopause can be genetic. Ovarian ageing patterns and the number of follicles you are born with are partly inherited. Some women naturally have fewer viable follicles, so hormone production changes earlier. Autoimmune conditions, chromosomal differences such as Turner syndrome and environmental factors can also contribute. In many cases there is no clear identifiable cause and the ovaries simply age more quickly because of inherited biology.

• Induced Menopause

Menopause can also occur earlier for medical reasons.

• Surgical menopause happens when both ovaries are removed, which stops oestrogen production immediately.

• Treatment induced menopause can follow certain chemotherapy drugs or pelvic radiotherapy.

• A hysterectomy, even when ovaries remain, can bring menopause forward because blood flow to the ovaries is reduced.

During menopause oestrogen levels fall to their lowest point and symptoms often intensify. This stage marks the end of reproductive hormone cycling.

3. Post-menopause

You reach menopause once you have gone 12 consecutive months without a period.

The time after you reach that point is called post-menopause, and this stage lasts for the rest of your life.

Your hormones now remain low and steady rather than fluctuating as they did during perimenopause. Some symptoms settle because the hormonal swings stop. Others continue or shift because your body is now living in a long term low oestrogen state. Bone density can decline faster, cardiovascular risk rises and joint or sleep changes can persist. Some people experience hot flushes for several years while others see them ease.

Post-menopause is your new hormonal baseline. How you feel in this stage depends on your general health, your hormone levels and the support or treatment you choose.

Menopause Stages and Widely Known Symptoms

Hot flushes and night sweats

The brain area that regulates temperature becomes more reactive when oestrogen falls. Small shifts in body temperature trigger an exaggerated cooling response which causes sudden waves of heat, sweating and disrupted sleep.

Mood changes

Oestrogen influences serotonin and dopamine. When hormone levels fluctuate the brain becomes less efficient at regulating emotional responses which can lead to irritability, anxiety or sudden drops in mood.

Sleep problems

Hormone changes affect the body clock and the depth of your sleep. Lower oestrogen fragments sleep cycles and lower progesterone removes a natural calming effect. Night sweats and cortisol spikes further disrupt your sleep and leave you exhausted.

Brain fog

Oestrogen supports areas of the brain responsible for attention and memory. When levels fall your brain processes information more slowly which makes you lose your train of thought or forget everyday details. Stress and poor sleep intensify this.

Weight changes

Lower oestrogen reduces muscle mass and changes the way your body stores fat. Muscle burns energy even at rest. When muscle declines your metabolic rate drops which increases abdominal fat even if nothing else changes. Oestrogen also affects insulin sensitivity which contributes to these shifts.

Menopause Stages and Unusual Symptoms

Digestive changes

Oestrogen helps regulate bowel movement, gut motility and the balance of bacteria in your digestive system. When levels fall digestion slows and the gut becomes more reactive to food, stress and hormonal fluctuations. This can create bloating, constipation, reflux, cramping and IBS like symptoms that appear for the first time in midlife. Changes in gut bacteria during perimenopause also affect how your body tolerates fibre, fats and certain carbohydrates which makes digestion feel more unpredictable than before.

Mouth and oral discomfort

The tissues in your mouth contain oestrogen receptors and rely on steady hormone levels to maintain saliva, moisture and nerve sensitivity. When oestrogen drops you may notice dry mouth, burning sensations, altered taste, increased sensitivity to spicy or acidic food and gum tenderness. Lower saliva also increases the risk of cavities and oral infections. Burning mouth syndrome becomes more common during the menopausal transition because nerve signalling changes alongside reduced moisture.

Dry eyes

Your tear glands and the surface of the eye rely on balanced oestrogen and androgens to produce a stable tear film. When hormone levels fall the tear film evaporates more quickly which causes dryness, irritation, redness and light sensitivity. Some women notice blurred vision after long screen use or a gritty feeling in the eyes that was never there before. Dry eyes often appear alongside dry mouth and vaginal dryness because the same hormonal shifts affect all mucosal tissues.

Balance sensitivity, dizziness and vertigo

Your inner ear and vestibular system control balance, spatial orientation and movement awareness. These systems rely on consistent fluid pressure and stable nerve signals which are influenced by oestrogen. When hormone levels fall the inner ear becomes more reactive and the brain receives slightly altered signals about movement. This can lead to unsteadiness, sudden dizziness, a sense of motion when still or brief vertigo when you turn your head quickly. These symptoms often fluctuate in step with hormonal changes.

Tinnitus and sound sensitivity

The auditory system includes oestrogen receptors that help the brain filter sound efficiently. When levels fall these pathways become less precise which can increase tinnitus or make everyday noises feel sharper or more intrusive. Some people notice a new awareness of background hums, buzzing or ringing. Others find busy environments harder to tolerate even when hearing tests appear normal. This heightened sound sensitivity usually tracks alongside other sensory changes during perimenopause.

Difficulty hearing in noisy places

Separating speech from background noise requires fast processing in the auditory cortex and strong connections between the ears and the brain. Oestrogen supports these pathways. When levels fall the brain struggles to prioritise voices over surrounding noise which makes restaurants, meetings or group conversations harder to follow. This is not traditional hearing loss. It is a change in how the brain filters competing sounds and it often appears suddenly during perimenopause.

Adult onset asthma

Adult onset asthma becomes more common during perimenopause and menopause. Large population studies show the risk of developing new asthma symptoms rises after age 45 which matches the period when oestrogen levels begin to decline. Oestrogen normally stabilises immune pathways that regulate airway inflammation. When levels fall the airways become more reactive to allergens, cold air, pollution or viral infections. Lower oestrogen also affects smooth muscle in the bronchial tubes which makes them tighten more easily. Some women who never struggled with breathing before develop wheeze, breathlessness or chest tightness for the first time in midlife.

Thyroid problems

Thyroid dysfunction is more common in midlife partly because autoimmune thyroid disease increases during perimenopause. Falling oestrogen alters immune behaviour which can make the immune system more likely to attack the thyroid gland. Oestrogen also interacts with how the body converts and uses thyroid hormones so low oestrogen can worsen symptoms such as fatigue, cold intolerance, low mood, dry skin and weight change. These symptoms overlap strongly with menopause so thyroid problems often go unnoticed unless specifically checked. Studies show a high rate of thyroid imbalance in peri and postmenopausal women.

Joint pain and stiffness

Joint discomfort is one of the most common but least discussed menopause symptoms. Oestrogen has an anti inflammatory effect and plays a direct role in protecting cartilage, maintaining lubrication and supporting collagen. When levels fall the joints become less hydrated and more prone to inflammation which leads to stiffness in the hands, hips, knees and spine. Research shows higher rates of bursitis, tendon irritation and muscle tightness during perimenopause. Lower oestrogen also changes the way the brain processes pain which amplifies stiffness or aching even when imaging looks normal. Symptoms often fluctuate with hormone shifts.

Did You Know Menopause Can Change Your Sense of Temperature in Both Directions. Everyone talks about hot flushes, but fewer people realise that falling oestrogen can also make you feel colder than usual. The same brain centres that overreact to heat can underreact to cold, so your temperature comfort range becomes narrower. This is why some menopausal women need layers even when others feel warm

Managing Symptoms

You cannot control the hormonal changes but you can control how supported your body is. Evidence consistently shows that three approaches make the biggest difference: medical options where appropriate, everyday health habits and complementary therapies that support the nervous system.

1. Hormone Replacement Therapy

HRT is the most effective treatment for hot flushes, sleep disruption, low mood, vaginal dryness and bone loss. It replaces the hormone your body no longer produces consistently.

Many people remain cautious because of old breast cancer fears. These fears came from earlier studies using types of HRT that are no longer prescribed. Newer research shows the risks were overstated. In the United States regulators have recently instructed manufacturers to remove outdated warnings from HRT information leaflets because they were no longer supported by evidence.

HRT is not suitable for everyone but it should not be dismissed because of misinformation. If symptoms are affecting your quality of life you deserve a balanced discussion about whether HRT is right for you.

2. Your General Health

Daily habits carry more weight during menopause because the body becomes more sensitive to stress, inflammation and blood sugar changes.

Nutrition

Lower oestrogen affects gut bacteria, blood sugar control, bone health and energy regulation. A diet built around protein, vegetables, whole grains and healthy fats helps stabilise blood sugar and reduce digestive sensitivity.

Exercise

Strength training protects bone density and muscle mass. Cardiovascular exercise supports mood, sleep and heart health. Consistency matters more than intensity.

Mental Health

Hormonal changes affect emotional regulation. Anxiety, irritability and low mood are common. Talking therapies, structured routines and stress reduction techniques can ease the emotional load and prevent symptom escalation.

3. Complementary Therapies

Complementary therapies help your body cope with the physical and emotional load of menopause by calming the nervous system and reducing pain signals.

Massage

Hands on therapy reduces tension, improves circulation and supports deeper sleep. During menopause many people carry tension in the jaw, neck, shoulders, abdomen and lower back. At Khoo Massage Therapies your Menopause Massage is a full body treatment with targeted pressure point work designed to ease hot flushes, headaches, digestive discomfort and fatigue.

TCM (Traditional Chinese Medicine) And Acupuncture

Acupuncture has been known to help with hot flushes, sleep disruption and anxiety by influencing the autonomic nervous system. Traditional Chinese medicine can also support digestion and stress regulation during perimenopause. I will be writing another blog in the future exploring this.

Mind Body Therapies

Meditation, breathwork and gentle movement practices reduce cortisol and support emotional regulation. Lower cortisol often leads to fewer night sweats, calmer digestion and more predictable sleep patterns.

Menopause Is A Full Body Change

It deserves support that reflects your symptoms, your lifestyle and your goals. Whether you choose medical treatment, lifestyle changes, complementary therapies or community support, you do not have to navigate this alone.

Did You Know You Do Not Need Hormone Blood Tests To Be Taken Seriously. If you are age 45 or older and showing clear symptoms of perimenopause or menopause, you should be offered support without needing hormone blood tests. Both the British Menopause Society and NICE state that diagnosis in this age group must be based on symptoms alone because hormone levels fluctuate too much to give reliable results. Younger women can also be diagnosed by symptoms, especially if their cycles are changing or they have typical perimenopausal signs. Hormone tests may be used sometimes in women under age 45, but they are not required for your symptoms to be recognised or taken seriously. This guidance is designed to prevent women being dismissed, delayed or told that “your tests look normal” despite experiencing real menopausal symptoms.

Support Beyond Treatment

Menopause is overwhelming when you do not have the right information or people around you. This is why I created an online community called Bite Club for peri and menopausal women who want evidence based guidance, connection and real peer support. It gives you a place to share experiences, learn from others and feel understood at a time when your body and priorities are shifting.

If you'd like to book a Menopause Massage with Carolyn, please click one of her services below:

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References

Menopause physiology and stages

Cleveland Clinic. Perimenopause overview.

Mayo Clinic. Menopause overview.

British Menopause Society. What Is The Menopause.

Oral and digestive changes

Ciesielska A et al. Int J Environ Res Public Health. 2022. https://doi.org/10.3390/ijerph19010253

Dutt P et al. Ann Med Health Sci Res. 2013. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3793432/

Peters BA et al. mSystems. 2022. https://doi.org/10.1128/msystems.00273-22

Vestibular, dizziness, auditory symptoms

Jeong SH et al. Front Neurol. 2020. https://doi.org/10.3389/fneur.2020.589605

Chen HC et al. Oncotarget. 2018. https://doi.org/10.18632/oncotarget.24452

Asthma and immune changes

Triebner K et al. J Allergy Clin Clin Immunol. 2016. https://doi.org/10.1016/j.jaci.2015.08.019

Cognitive and mood changes

Cho JM et al. Brain Sciences. 2025.   https://doi.org/10.3390/brainsci15091003

Thyroid health

Frank Raue K et al. Cureus. 2023. https://doi.org/10.7759/cureus.41235

Duration of vasomotor symptoms

Avis NE et al. JAMA Intern Med. 2015. https://doi.org/10.1001/jamainternmed.2014.8063

HRT safety and regulatory updates

Faubion SS et al. Menopause. 2022. https://doi.org/10.1097/GME.0000000000002028

Associated Press. FDA removes outdated menopause drug warnings. 2025.

Nutrition, exercise, mental health, lifestyle

Cortés TM et al. Nutrients. 2024. https://doi.org/10.3390/nu16091329

Shojaa M et al. Front Physiol. 2020. https://doi.org/10.3389/fphys.2020.00652

van Driel CMG et al. BJOG. 2019. https://doi.org/10.1111/1471-0528.15153

Cramer H et al. Maturitas. 2018. https://doi.org/10.1016/j.maturitas.2017.12.005

Massage and complementary therapies

Mak S et al. JAMA Netw Open. 2024. https://doi.org/10.1001/jamanetworkopen.2024.22259

Fang CS et al. J Clin Nurs. 2023. https://doi.org/10.1111/jocn.16660

Avis NE et al. Menopause. 2008. https://doi.org/10.1097/gme.0b013e31816d5b03

to go next.