You might be aware of the hot flushes, night sweats and general hormonal bedlam but there are a range of things that could happen to you that you might not have linked to the menopause. Like these…

Symptoms you may not associate with menopause

Your teeth can start moving

Menopausal women have to work harder to stave off gum disease as falling oestrogen levels lead to reduced saliva and collagen production putting their dental health at risk. Teeth are held in place in a bed of connective tissue which is mostly collagen and if collagen levels drop, the gums can lose their grip and your teeth can potentially start moving. Effective night-time cleaning is crucial as this is when saliva production drops naturally (saliva helps protect teeth from plaque bacteria and acidic food and drink) and try a gum-strengthening toothpaste. Drink plenty of water and eat vitamin C-rich foods (vitamin C helps with collagen production). A retainer or braces can help prevent teeth moving or correct any changes.

Your skin might get itchy during menopause

Many women report that their skin becomes unusually itchy around the time of menopause. This ranges from mild irritation to full on “ants crawling all over my skin” sensations. This is known as formication where the skin becomes increasingly sensitive due to lack of moisture. Drinking plenty of water and reducing your caffeine and alcohol intake will help. Also get plenty of vitamin C-rich foods in your diet (like citrus fruits, green vegetables, peppers and berries) to help create more skin-cushioning collagen. Plus, as oestrogen helps the body to handle histamine, decreased levels of this hormone means an increase in histamine – which can make you itch.

You might crave more time on your own

Many menopausal women report feeling a bit more introspective and craving more alone time. Maybe this is necessary to help work through this new time of your life. Many also describe themselves as feeling “less maternal”. This tends to be attributed to a fall in the hormone known as oxytocin (sometimes dubbed the ‘cuddle hormone’). The upside of this is that many post-menopausal women find they no longer need to be doing everything for everyone and can spend more time attending to their own needs.

Your feet might get flatter

Although the link between menopause and flattening of feet is not entirely clear research connects it to an increase in body mass index (BMI). A 2010 study of post-menopausal women concluded that as BMI increases feet “flatten” over time and can result in structural changes including the collapse of the medial longitudinal arch (MLA). There is also an increased risk of plantar fasciitis – inflammation of the band of tissue that stretches from the heel to the middle foot bones. Ideally try to exercise more to keep your BMI down. If your feet do feel “flatter” and less cushioned choose supportive footwear with a slight heel that gives enough arch support and cushioning over the heel and ball of foot - or wear supports (called orthotics) in your shoes.

You could experience indigestion and acid reflux

Many perimenopausal and menopausal women say they either start to experience symptoms of acid reflux with uncomfortable burning, upper abdominal pain and bloating, or if they had mild symptoms before, these get significantly worse. This was born out by a 2008 study of nearly 500 women in which 42% who were perimenopausal and 47% who were menopausal complained of increased gastroesophageal reflux disease (known as GERD) suggesting a significant hormonal link between acid reflux. Over the counter antacids are helpful in some cases but if they are not you might need prescription medicine so do talk to your doctor about this. Other advice includes exercising regularly, eating little and often, limiting known triggers including caffeine, fatty foods, chocolate, raw onions, fizzy drinks, alcohol, tobacco and eating too close to bedtime.

Common symptoms of menopause

Anxiety

Fluctuating hormones can create unexplained feelings of worry, dread, edginess and doom; sudden bursts of anger or weepiness and then possibly periods of introspection and wanting to be left alone. Data shows some women are just more sensitive to hormone levels, including reduced oestrogen, than others. What we also know is that anxiety often co-exists with depression and that mid-life events like empty nest syndrome may also have an impact.

A healthy diet , exercise , trying to reduce stress, a good night’s sleep will all help. Avoid self-medicating with alcohol - sadly, it is likely to exacerbate both the physical and psychological symptoms triggered by perimenopause and menopause. The technique of mindfulness meditation has been shown to help with mild anxiety as has inhaling geranium essential oil. Cognitive Behavioural Therapy (CBT) – a way of substituting harmful thought patterns with more positive ones - is also an established and effective way to help reduce the impact of reducing anxious thought patterns. Talk to your doctor about all options.

Brain fog and memory loss

Up to 60% of menopausal women complain of ‘brain fog’. This is not simply about forgetting the name of someone you have worked with for years or misplacing your keys it is more the feeling that their brain is completely cluttered which leads to difficulty retrieving information that they once knew and/or finding it harder to remember or recall new information. For some women these symptoms can be so debilitating that they can actually think they are suffering with dementia. Why does it happen? Research suggests that when oestrogen levels dip the brain must learn to function with less of it and it takes time for your grey matter to get its head around this change. Combine this with other potential symptoms like night sweats, sleeplessness and a general feeling of lethargy and these feelings of muddle-headedness can be compounded.

Few of us make the link between menopause and memory loss but oestrogen plays a major role in brain function and it can take time for your brain to adapt to the dwindling levels of this hormone – and developing a memory like a goldfish is a side effect of this. This problem should be short lived and when your hormones rebalance themselves your ‘woolly’ brain should revert back to normal.

To help you think more clearly keep yourself well hydrated – drinking water and herbal teas will help – evidence shows even very mild dehydration can lead to difficulties concentrating. Avoid alcohol and eat a diet with plenty of water-rich vegetables and fruit. Stress-relieving activities like exercise or meditative techniques can also help you to unwind and declutter your brain. Inhaling peppermint or rosemary essential oils can have a short-term effect in helping with concentration and there is some evidence that the herb ginkgo biloba can help stimulate memory. DHA, one of the compounds found in oily fish, has also been shown to help speed up reaction times in short term memory. If lifestyle changes don’t help do talk to your doctor who may suggest HRT. Be reassured this brain fogginess is temporary and when your hormones regain balance your brain will too.

Breast pain

No-one knows for sure why some women find their breasts can feel sore and tender around the time of menopause but it is thought to be triggered by fluctuating and falling oestrogen and progesterone levels. Just as you would expect during puberty and your normal period patterns. The bigger your breasts the more likely they are to feel heavy, swollen and uncomfortable.

Ideally, try to keep your weight down – the heavier you are the bigger your boobs are likelier to be. Wear a comfortable and supportive bra. Dress in comfortable soft layers like a Become™ vest. Eat a diet high in phytoestrogens. Breast pain should subside once your hormone levels rebalance but if yours is getting in the way of you going about your daily life do get advice and help from your doctor particularly of you notice any changes in shape, size and/or find lumps.

Depression

Fluctuating hormones during perimenopause and menopause can lead to a greater risk of depression. Those who have had a history of depression are at greater risk.

Talk to your doctor and or/mental health professional. Anti-depressants are one option but it could be that HRT and possibly CBT (or other forms of counselling support) could be more appropriate. Discuss this with her or him. There are lifestyle factors that can help like exercising, eating well and avoiding alcohol (which is a depressant). Try to make time for yourself alone to avoid becoming overwhelmed. Take a relaxing bath with added neroli essential oil – there is evidence to show this could go some way to helping alleviate depressive symptoms.

Facial hair

Hormonal changes can trigger a change in hair growth patterns which can result in unwanted hair appearing on your upper lip and/or coarse dark hair sprouting on your chin. You might find your eyebrows and/or eyelashes become thinner and sparser too. At a time when your confidence levels can feel at an all-time low this doesn’t exactly do much to help matters (although if you want to find the silver linings: men tend to start sprouting hair from their nose, ears and shoulders in mid-life…).

Invest in a magnifying mirror and/or tweezers with magnifying mirror attached to pull out the offending hairs (if they bother you). Slanted tweezers tend to be more efficient at grabbing onto stubborn bristly hair. Alternatively, have them waxed or professionally threaded at a salon. For a more long-term solution try electrolysis or laser hair removal which can get rid of the hair semi-permanently. If facial hair starts to affect your self-confidence talk to your doctor about potential treatment options. There are serums available from the chemist that claim to increase the thickness of brows and/or lashes although how effective they are is inconclusive. You can also have your brows dyed to help define them more or use brow make-up to give the illusion they are thicker. A volumizing and lengthening mascara will temporarily help your lashes look longer and thicker.

Hair loss

It is common to notice your hair thinning, weakening and growing more slowly during menopause as oestrogen and progesterone levels fluctuate and fall (these hormones help hair grow faster and stop shedding so quickly) and the testosterone in your body can assume a more dominant position leading to a male pattern hair growth and loss.

Eat a varied, balanced diet with plenty of hair-healthy foods including essential fatty acids like oily fish and nuts and seeds. Taking vitamin B6 and folic acid supplements have been shown to help restore hair growth. Try to reduce your use of hot styling tools (like blow drying, straighteners and curling tongs) which can dry the hair and make it increasingly brittle. When you wash your hair use volumising shampoos and conditioners. Be wary of some types of hair extensions which may make your hair look thicker in the short term but long term are likely to make it even thinner (due to traction caused by sustained tension on the hair follicles). If your thinning hair is severely affecting your confidence levels see your doctor and/or a trichologist who can suggest suitable treatment.

Insomnia

Menopausal night sweats coupled with associated feelings of edginess and anxiety are not exactly a recipe for good night’s sleep. After a night of tossing and turning you then tend to drag yourself through the day feeling not just tired but having increased difficulty concentrating and remembering things.

Exercise regularly –  study after study shows it leads to better quality sleep (just don’t do too vigorous a routine too close to bedtime which can be overstimulating). Activities which involve deep breathing and mediation like yoga can be particularly beneficial. Aim to stick to a routine of going to bed and getting up at roughly the same time each day. Take a bath before bed containing Epsom salts or magnesium flakes which have been shown to help relax muscles and lead to better quality sleep (check with your doctor first if you have High Blood Pressure). Avoid alcohol and sip soothing and soporific bedtime drinks like chamomile tea or tart cherry juice in hot water. Log off from your iPad, laptop or smartphone at least an hour before bed. The blue light from these devices can stimulate the brain precisely at the point when you want to calm it. Wear fabrics in bed like Become™ vests and pants which can cool your raised body temperature. If after incorporating these lifestyle changes you are still struggling to sleep do discuss this with your doctor.

Muscle aches and joint pains

If you increasingly wake up feeling achy and stiff, find it harder to recover after exercise or find your muscles and joints generally feel more sore and inflamed (neck, shoulders, back, knees, ankles and hands tend to bear the brunt) it can be tempting to write this off as simply the signs of old age. Yet this is a classic menopausal symptom that has been dubbed ‘menopausal arthritis’.

Keep your weight down. As a nation we are getting fatter, with levels of obesity more than doubling in the last decade. Carrying extra weight puts you at increased risk of developing joint and muscle pain in the first place and also exacerbates any existing joint problems. Many people credit yoga and Tai Chi with helping not just to get them fitter and slimmer but also with helping manage joint pain and increasing their flexibility. Including anti-inflammatory foods in your diet like omega-3 rich oily fish (compounds like the EPA and DHA found in oily fish have been shown to reduce joint pain and tenderness), nuts, seeds, olive oil and vegetables and fruit can help reduce inflammation. Evidence also shows how some herbs and spices also appear to stimulate anti-inflammatory effects in the body - ginger and turmeric (the root that gives much Indian cooking its distinctive yellow-orange colour) in particular. If you don’t get these in your diet you might benefit from a supplement.

Racing heart

Feeling your heart suddenly start racing, pounding or fluttering inside your chest for no obvious reason (although it also tends to coincide with a hot flush) can be understandably frightening. Couple this with other symptoms like anxiety and you can start to feel extra panicky and stressed which can cause your heart to race all the more. It is however a generally harmless and temporary symptom of the menopause which is attributed to diminishing levels of heart-protective oestrogen.

Eat little and often to prevent your blood sugar levels dropping which can make you feel tired, irritable and anxious. Cut down on stimulants like caffeine (coffee, tea, cola, energy drinks, chocolate) and nicotine which can exacerbate feelings of jitteriness and can cause your heart to race even more. Reduce your stress levels where you can and try to make time for a daily relaxation technique such as mindfulness or yoga. Whatever exercise you normally do, you might prefer to switch to a more laid-back type like walking, Pilates and swimming rather than high intensity activities that are likely to make your heart pound nineteen to the dozen.

Vaginal dryness and discomfort

It’s not something that you necessarily want to talk about but fluctuating and falling hormones do lead to a reduction in vaginal lubrication and cause the vaginal walls to become thinner and less elastic. This can cause irritation, a burning sensation and itchiness that make it difficult for you to go about your daily life. It can also get in the way of you enjoying sex as the lack of lubrication can lead to difficulty becoming aroused and/or reaching orgasm. It can also put you at increased risk of urinary tract infections (UTIs) like cystitis. Understandably all this can put a dampener on your sex drive and doesn’t exactly add to your quality of life.

Keep hydrated. Not drinking enough fluid can leave your body drier generally – skin, eyes, mouth and your vagina. There are a range of vaginal moisturisers available from the chemist which can offer immediate relief. Other options include HRT or vaginal oestrogen (the hormone that naturally keeps the tissues of your vagina lubricated and healthy) so discuss all options with your GP.

Recognising the women

All common menopausal symptoms, both physical and psychological, are associated with the body’s decreasing levels of the female hormone oestrogen. Oestrogen levels can affect the brain and emotional well-being and lead to a whole range of physical and psychological effects including hot flushes, night sweats, anxiety, depression, difficulty concentrating, feeling muddle-headed, general emotional fragility, heart palpitations to reduced skin elasticity and dry eyes and mouth – which can also affect your teeth and gums.

What can make things harder to pinpoint is that some of these symptoms we might also attribute to simply getting older (tiredness, aching joints, decreased libido, brain fog and forgetfulness etc) and the feelings we might be going through (anxiety, depression and loss of confidence etc) might be perfectly natural responses to other things going on in our lives at this time (kids leaving home, parents becoming ill, caring for a sick relative, possible job insecurity and just ageing in general. Sadly, we live in a culture that prizes youthfulness over experience and this can create a lot of conflicting emotions as we age).

Familiarising yourself with the most common perimenopausal and menopausal symptoms can help you to try and unpick whether what you are going through is hormonally-related or not – and ultimately understand what to do about them.