Menopause symptoms: everything you need to know about signs and solutions

The menopause is officially a fact 12 months after your last period. On average, you are then 51 years old (Gezondheid en Wetenschap, 2023). The perimenopause is the broader period surrounding that moment: the years during which your hormones change and symptoms can arise.

In this article, you will read about the phases you go through, which hormones change, and which symptoms are common, from hot flashes to joint pain. You will also discover what you can do yourself with diet, exercise, and stress management, and what role hormone replacement therapy can play. This information does not replace medical advice. Always discuss your symptoms with your GP or gynecologist.

What is menopause?

Menopause is the moment when a woman's menstrual cycle stops permanently. It is a natural life stage that usually occurs around the age of 51.

Officially, we speak of menopause when you have not had a period for 12 consecutive months. The moment itself is actually just a point in time. The period before it is called perimenopause, the periode after postmenopause. During this time, hormonal changes cause a wide range of symptoms, and this period can last for years.

During this phase, the production of the sex hormones estrogen and progesterone in the ovaries decreases. This affects all kinds of processes in the body: from your temperature regulation to your bone density, from your mood to the condition of your skin.

Not only the physical, but also the emotional and social impact can be significant. Some women experience barely any symptoms, while others have to deal with hot flashes, insomnia, mood swings, weight gain, vaginal dryness, fatigue, or even feelings of depression and panic attacks.

As nutritional scientist Amandine De Paepe puts it:

"I always compare menopause to a reversed puberty. As a teenage girl, you suddenly have to deal with a massive production of hormones and your body searches for balance. With menopause, it's the same process, but in the opposite direction."

The 4 phases of menopause

Menopause does not arrive suddenly. Your body goes through four phases, although it is different for every woman.

1. Premenopause

The premenopause runs from your first period to the start of the perimenopause. In these fertile years, your ovaries mature egg cells every month and regularly produce estrogen and progesterone. Your cycle is usually predictable in this phase.

2. Perimenopause

The perimenopause starts on average around age 47.5 (McKinlay et al., 1992). Your ovaries contain fewer and fewer egg cells and your hormone levels become more erratic. This phase lasts until your period stops permanently.

3. Menopause

The menopause is the moment when you have not had a period for 12 months. For most women, this falls between age 45 and 55, on average at 51 (Gezondheid en Wetenschap, 2023). You only know in hindsight that you have reached the menopause.

4. Postmenopause

The postmenopause begins after the menopause and lasts for the rest of your life. Your estrogen and progesterone levels remain permanently low. Symptoms such as hot flashes usually decrease from 5 years after your last period (Thuisarts, 2026). In this phase, your bones do become weaker, which increases the risk of osteoporosis (Thuisarts, 2026).

Hormones in balance

Hormones are chemical messengers that control all kinds of functions in your body via the blood. During the (peri)menopause, it is mainly the balance between estrogen, progesterone, and testosterone that changes.

Estrogen is stimulating; it makes you glow and is important for your bone health, skin protection, metabolism, cognitive functions, immunity, fertility, and cardiovascular health.

Progesterone has a calming effect and helps with temperature regulation. It plays a role in calmness and cheerfulness. In that sense, it is somewhat of a happiness hormone.

Testosterone, on the other hand, is responsible for sexual drive. It supports energy, vitality, libido, and self-confidence. It also plays a role in the muscles.

In the perimenopause, progesterone often drops first, while estrogen fluctuates strongly and sometimes even peaks temporarily (Santoro, 2016). After the menopause, estrogen and progesterone remain permanently low. When the production of these hormones declines or becomes unbalanced, symptoms can occur.

As Dr. Marijke Aerts summarizes it:

"The most important thing is that your hormones are in balance; otherwise, quite a few complaints can arise."

Common symptoms during the menopause

There are quite a few uncomfortable symptoms that women may encounter during the transition. Below, we list a number of symptoms that occur frequently.

These are the 9 transition symptoms we discuss below:

1. Hot flashes and night sweats: sudden heat, often with heavy sweating.
2. Mood swings: irritability, sadness, or feelings of anxiety.
3. Insomnia: difficulty falling asleep or waking up often.
4. Difficulty concentrating: forgetfulness and a feeling of "brain fog."
5. Vaginal dryness and atrophy: thinner and drier mucous membranes.
6. Reduced libido: less desire for sex.
7. Weight gain: more belly fat and a slower metabolism.
8. Hair loss and skin changes: thinner hair and drier skin.
9. Joint pain and stiff muscles: pain and stiffness, often in the morning.

Hot flashes and night sweats

Hot flashes and night sweats are for many women the first clear signs that their body is entering the transition. These annoying symptoms can be quite drastic and significantly disrupt daily functioning.

A hot flash usually feels like a sudden attack of heat that spreads from the chest area or face. The skin can turn red, the heart starts beating faster, and sweating often begins very suddenly. Sometimes they last only briefly, sometimes they linger for a few minutes. How often they occur varies greatly: for some women only occasionally, for others multiple times a day and night.

At night, we refer to 'night sweats'. These hot flashes often manifest as heavy sweating, causing you to wake up in damp pajamas or wet bedding. These night sweats can seriously affect sleep quality. Sleep problems, in turn, lead to fatigue, irritability, and concentration problems during the day.

The cause of hot flashes is the declining estrogen level. This hormone plays a role in, among other things, the body's temperature regulation. With this lack of estrogen, the body becomes confused, as it were, and thinks it needs to cool down, even if that is not necessary.

Although hot flashes and night sweats are typical of the menopause, they are not equally severe or frequent for everyone. Some women experience mild symptoms, while others can suffer from them for years.

Fortunately, there are ways to limit the impact. Think of breathing exercises, avoiding certain foods (such as spicy food or caffeine), and ensuring a cool sleeping environment. Wear loose, breathable clothing and use light bedding.
If the symptoms persist or become very disruptive, a doctor can help with advice on medications or natural alternatives.

Mood swings

During the transition, many women notice that their emotions change. You usually don't see it coming. The irritation, the sadness, or the feeling that everything is becoming too much for you. It seems to come out of nowhere. Mood swings are one of the most common symptoms in the transition years. Many women no longer recognize themselves for a moment.

Sleeping poorly does not help with this. Night sweats or other sleep disorders ensure that you wake up tired. That fatigue can intensify moods. If you also have physical complaints, such as headaches or muscle aches, it is logical that you are more irritable. That is not a weakness. That is your body indicating that it is changing.

The realization that your last period is over can also be emotional. It is a transition in several respects. For some women, it evokes depressed feelings or feelings of anxiety or loss. While others actually experience it as liberating.

And that difference? That is normal. No two women experience the menopause in the same way. One woman is barely bothered by it, the other struggles for months or sometimes years with emotional fluctuations.

The important thing is: you don't have to carry this alone. Talk about it, seek support, see what works for you. Sometimes an open conversation with your GP is enough to get some clarity. And sometimes a lifestyle adjustment – nutrition, exercise, rest – can make all the difference.

Your body is doing what it has to do. It is not broken. It is simply searching for a new balance.

Listen to our podcast: Mood swings and brain fog, with Katja Retsin

Insomnia

Sleep is something you never thought about before. You would lie down, fall asleep, and wake up hours later just fine. But somewhere, without warning, that changes. You sometimes lie awake for hours. Or you wake up constantly in between, for no reason. Insomnia is a silent, exhausting complaint for many women in the (peri)menopause.

The annoying thing is: you are tired, but you don't find rest. Your body wants to sleep, your head does not. Or vice versa. You lie tossing and turning, thinking, waiting. And the next day you just have to be there and perform.

Those sleep problems are often related to the hormonal changes you are going through. Declining estrogen levels play a role in this, as does the shift in other processes that you have taken for granted for years. Your temperature fluctuates, your mood changes, and your sleep rhythm becomes scrambled.

As we mentioned above, insomnia also has a mental impact. It makes you more emotional, more sensitive, sometimes even a bit more anxious. Your memory fails more easily, and forgetfulness creeps in. Some women even fear that they are losing control of their lives. Or they think about depression, simply because they no longer recognize themselves.

Your age also plays a role in this. Not because it is "getting older," but because it merges with other changes: children moving out, your body feeling different, or your skin becoming less supple. It is quite a transition, literally and figuratively.

What can help? Rhythm. Quiet evenings. Less screen time before bedtime. Choosing light food in the evening. And sometimes just accepting that your body needs time. That it is going through something that is not your fault, but does require attention. You can read more practical tips in our article about sleeping better.

Note: insomnia is not just something to ignore. Sleep deprivation increases the risk of other complaints, both physical and mental. So don't just live with it. Discuss it with your doctor or a specialist. There are gentle remedies, and in some cases, HRT (hormone replacement therapy) can be considered.
Listen to your body. It gives signals for a reason.

Difficulty concentrating

You are in the middle of a conversation and you suddenly don't know what you wanted to say anymore. Or you are scrolling through a document, reading the words, but it doesn't really sink in. Finding focus suddenly becomes difficult. Thoughts wander. Suddenly, even simple tasks seem to cost you a lot of energy.

Difficulty concentrating is one of those symptoms that isn't often talked about. Yet it occurs regularly in women in the transition. It creeps in. At first, you notice it occasionally, then more and more often. You have no idea why you are so forgetful. Or you worry whether something serious is going on.

In many cases, this is a result of hormonal fluctuations. The precise cause is not always identifiable, but the declining estrogen level does indeed appear to have an influence on how your brain functions. Your mental clarity is simply... cloudier than it used to be. That is not imagination; it is a real change.

Fatigue, poor sleep, and mood swings can also have an influence. Everything is interconnected. The whole course of your day changes if you constantly struggle to keep your attention on things. And that, in turn, affects your self-confidence. You wonder if you are still sharp enough, if you can still handle everything.

Some women describe it as "fog in their head" or brain fog. It is not just about forgetting, but about a kind of mental slowness. Shifting gears less quickly. Less overview. That can be difficult if you are in a busy life, combining work with caring for others, and your environment is unaware of it or does not understand.

These forms of memory and concentration problems occur more often than you think. It says nothing about your intelligence or capabilities. It is simply a different way of functioning during a period full of changes.

What helps? Structure. Taking breaks. Doing one thing at a time. Not being too hard on yourself. If you notice that it really affects your daily functioning, you can also look into support.

Sometimes a medical check is sensible; certainly if other complaints pile up. In other cases, relaxation, exercise, or mindfulness can make a difference in how clear you feel.

Vaginal dryness and atrophy

It is not a subject people talk about easily. Yet quite a few women experience complaints after the menopause such as vaginal dryness, burning, or painful intercourse. What many people don't know: this is not only annoying, it also has a name: vaginal atrophy. A medical term, but the experience itself is very personal.

The drop in estrogen has an effect on the mucous membranes in the vagina. They become thinner, drier, and less elastic. What used to feel natural now sometimes feels stinging or uncomfortable. Even daily things like sitting, exercising, and playing sports can suddenly cause a burning sensation.

It can also have an effect on how you feel as a woman. After all, the intimate area cannot be separated from your self-image, your relationship, or your sexuality. Many women remain silent about it. Out of shame, or because they think it "is part of it." But these complaints can deeply cut into the feeling of connection; with yourself and with your partner.

There are also other factors that increase the discomfort. Think of drier skin, less natural lubrication, or changes in the bacterial balance. That combination increases the risk of irritation or small tears, especially during sex.

The term "atrophy" sounds severe. In practice, fortunately, there are many ways to deal with this. Vaginal lubricants and vaginal gels can provide relief. There are also specific creams or hormonal applications that work locally, without influencing the rest of your body.

For women who have severe complaints, a doctor can consider a vaginal estrogen treatment. That can be in the form of a suppository, cream, or ring.

What is important: you do not have to keep walking around with this. And you are certainly not the only one. The more women talk about this, with each other or with their doctor, the more normal it becomes.

Reduced libido

A decreased desire for sex or reduced libido is another very common complaint. During and after the menopause, many women notice that their libido changes. What used to feel natural is now a vague memory. And the annoying thing is: you don't always know why.

Sometimes it is a matter of physical change. The vagina feels different; drier, less sensitive. But mentally, too, all kinds of things are at play. Your body is changing, your mood is fluctuating, and you are experiencing a different kind of contact with yourself. It is not always visible to the outside world, but the loss of desire can quietly gnaw at your self-confidence.

Psychological changes also play a role. Think of less spontaneity, insecurity about your appearance, or reduced energy. You really do not necessarily have to have problems in your relationship to feel it. It is often deeper, in your own experience of intimacy.

In addition, the quality of your sleep is often poorer, you may have other complaints, and daily life just keeps going. Little room is left for relaxation. Let alone for desire. The combination of physical and mental strain makes it so that your libido no longer seems like a priority.

Yet this is not the end of your sex life. There are therapies that help to reconnect with your body and your partner. Sometimes that happens through conversations, sometimes with exercises, sometimes with medical support. Think of local products that can soften vaginal changes or lifestyle adjustments that support general health and hormonal balance.

Which form of help is appropriate varies from woman to woman. For some, talking is enough. For others, a treatment option, such as vaginal therapy or a natural remedy, provides a solution.

What counts is that you give yourself the space to take this seriously. You are not 'less of a woman' because of a reduced libido. Your body is simply speaking a different language than before. Listen to it, without judgment.

Listen to our podcast: Sex during menopause, with Chloe De Bie

Weight gain and metabolic changes

We have discussed a number of uncomfortable symptoms by now. However, weight gain is one of the most talked-about and frustrating symptoms on the list.

The pounds creep on without you suddenly eating more, and you feel powerless. Whereas you used to see a difference after just a few weeks of being careful, now nothing happens.

The cause isn't one single thing. It is a combination. The metabolism slows down, which means you burn calories less efficiently. Your fat storage also changes. Fat settles more quickly around your abdomen and waist, even if your eating and exercise patterns remain the same. The typical female pear shape changes into an apple shape.

All of this happens at a time when your body is already busy adapting to fluctuating hormones. Around this period, the ratio between muscle mass and fat mass changes, and that influences your metabolism.

Sleep deprivation, stress, and mood swings can also lead to changes in eating behavior. So, it is not just a physical story, but a mental one as well.

There are ways to deal with this consciously. Light strength training helps to maintain muscle mass. Healthy foods, such as plenty of fiber, green vegetables, and proteins, support your metabolism. Fewer simple sugars, more rest in your day. Every little bit helps.

For some women, hormone replacement therapy (HRT) is an option, especially if there are other complaints such as hot flashes or sleep disorders. The goal is not necessarily weight loss, but a better balance in the body as a whole.

A healthy BMI is a guideline, but not an all-decisive number. Body composition, such as the ratio of fat versus muscle, is much more important.

Important: keep in mind that weight gain can also increase the risk of certain conditions, such as heart disease or diabetes. Taking action in time, in a gentle and realistic way, can make a big difference.

Complete 4-in-1 approach with extra activation of your resting metabolism and fat burning.

Listen to our podcast: "When estrogen drops, with Dr. Isabel De Smet."

Hair loss and skin changes

You look in the mirror and suddenly notice it: your hair seems thinner. Your skin feels drier than you are used to. Or you suddenly have small spots, flakes, or a tight feeling. These are changes that you might not immediately link to menopause.

Hair loss is a common complaint, although few women talk about it. The hair becomes finer, falls out more easily, and grows back more slowly. It often starts at the hairline or on top of the head. Although it is not sudden baldness, it is quite confronting.

The reason? Once again, those declining estrogen levels. Estrogen protects hair follicles and stimulates hair growth. When that drops, other hormones (such as androgens) gain more influence. That can lead to hair loss or changes in hair growth; sometimes even in unwanted places such as the face.

The skin also undergoes changes. Less collagen means less elasticity. Your skin loses volume and feels tight or dry more quickly. Some people develop pigment spots or sensitive skin. All of this can be frustrating; especially if you never had problems with your skin before.

Did you know? In the first 5 years after the start of menopause, the collagen content in the skin decreases by as much as 30%.

10g of collagen to support skin structure and firmness.

Joint pain and stiff muscles

Stiff joints when getting up, painful knees or hands, or muscles that recover more slowly after exercise: this can also be part of the transition. Estrogen plays a role in the health of your joints, cartilage, and muscles. When it drops, pain and stiffness can increase (Watt, 2018). Exercise, strength training, and a healthy weight support your joints.

In our article on menopause and joint pain, you can read more about the causes and what you can do yourself.

Liver health and the transition

Did you know that your liver plays a crucial role in your hormonal balance? The organ breaks down excess hormones, among other things, and helps remove them from the body. This also applies to estrogen, which is largely broken down in the liver (Delgado et al., 2025). Alcohol, lots of sugar, and being overweight can strain your liver (EASL-EASD-EASO, 2024). Thus, your lifestyle may also play a role in how your body processes hormones.

According to Dr. Marijke Aerts, gynecologist:

"A healthy liver is crucial to staying in balance during your (peri)menopause. Although the liver itself does not produce hormones, this organ does play a role in maintaining hormonal balance."

A healthy liver not only supports your hormone balance but also helps with the breakdown of waste products, regulates your blood sugar level, and contributes to healthy skin.

The health of your liver gives a very good picture of how healthy your lifestyle is: stress, overly large portions, too many fats and sugars, alcohol... These are all factors that have an impact on your liver.

Also read how you can support your liver through diet and lifestyle.

"If you adjust your lifestyle, your liver health will automatically improve. That will ultimately have an impact on your hormonal balance during (peri)menopause."
Everything starts with the liver.

Discover the Peri Menopause pack with the Detox Boost, for liver support.

Am I in menopause? Menopause symptoms checklist

Do you suspect that you are in the transition? This checklist helps you to identify typical symptoms. Filling it out can also be useful as preparation for a consultation with your GP, gynecologist, or menopause consultant.

A blood test cannot reliably show whether you are in the transition (Thuisarts, 2026). Your complaints, your age, and the pattern of your menstruation say much more.

• I often crave sweets.
• I suffer from weight gain, especially around the abdomen.
• I suffer from hair loss.
• I often have headaches.
• I suffer from hot flashes.
• I often feel very tired, even when I have slept well.
• I cannot get my weight under control. I am gaining weight, even though I exercise and watch my diet.
• I experience a decreased desire for sex/loss of libido.
• I am 42 years or older.
• I suffer from vaginal dryness.
• I suffer from mood swings/mood disorders or am easily irritated.
• I have sensitive breasts.
• My menstrual cycle is less regular than before.
• It seems like there is a mist in my head, also known as 'brain fog'.
• I cannot concentrate as well anymore or suffer from forgetfulness.
• I look much older than I am or have other skin problems.
• I regularly wake up at night (whether or not due to night sweats). I feel like I am not sleeping deeply.
• My face seems less muscular and more wrinkled than before.
• I get sick more easily than before; I feel less resilient.
• I have muscle and joint complaints, such as stiffness or pain.

Now count the number of statements that apply to you:

1) Fewer than 3 symptoms: no or barely any complaints.
It seems that you are currently experiencing no or barely any complaints that are characteristic of the transition.
Are you 45 or older? Then it could be that you are experiencing the transition without complaints. Lucky you! Because in general, it is estimated that about 75-85% of women will experience some form of menopausal symptoms.

2) More than 3 symptoms: It could be that you are in the first stage of your transition.
But you are not alone! In general, it is estimated that about 75-85% of women will experience some form of menopausal complaints.

3) More than 9 symptoms: clear imbalance.
There is a clear hormonal imbalance. In some cases, the complaints can have a strong influence on your quality of life. In that case, we always recommend consulting your doctor.

Support and advice for menopausal complaints

As mentioned earlier, HRT can be effective for severe complaints. This consists of estrogen, sometimes in combination with progesterone or an LNG-IUD. It can reduce hot flashes, vaginal dryness, sleep disorders, and bone loss. However, it is important to discuss risks and benefits with your GP or gynecologist.

Hormone replacement therapy (HRT)

With hormone replacement therapy, you replenish the estrogen that your body is producing less of. If you still have a uterus, you also receive a progestogen to protect the uterine lining. This treatment is the most effective approach for hot flashes, night sweats, and vaginal complaints (The North American Menopause Society, 2022). This does not apply to all menopausal complaints.

The balance between benefits and risks is more favorable if you are younger than 60 or if your menopause was less than 10 years ago (Gezondheid en Wetenschap, 2023).

Hormone therapy also has risks, such as an increased chance of thrombosis and a stroke. With certain conditions, such as breast cancer or clotting problems, it is discouraged. Discuss this with your doctor: together you will look at whether HRT is right for you, in what form, and for how long.

Do you want to know more about the role of bio-identical hormones during menopause? Then listen to our podcast episode on this subject.

Non-hormonal treatments

Alternatives include cognitive behavioral therapy, plant-based aids such as phytoestrogens (soy, red clover), and specific medication against hot flashes. For vaginal dryness, there are lubricants or local estrogens. Discuss the possibilities with your doctor.

Dietary adjustments

Dr. Aerts:

"In terms of dietary habits, I recommend not only looking at an adjusted quantity. Because muscle mass decreases, for example, it is important to also check whether you are consuming enough protein. I also always recommend eating enough fiber. I am thinking of enough vegetables and whole-grain products."

• Eat enough protein to maintain muscle mass. Opt for high-quality protein sources. Try replacing the carbohydrates in your meal with quinoa. After all, this food contains all essential amino acids. Other healthy protein sources are: chicken breast, fish, eggs, soy products, nuts...
• Fill half of your plate with vegetables to ensure that your meal contains enough greens. That way, you create a meal full of fiber, vitamins, and minerals.
• Limit sugar, alcohol, and processed foods.
• Limit your salt intake. Salt contains sodium, which is important for regulating your blood pressure, the proper functioning of your nerve and muscle cells, and good fluid balance regulation. But too much salt can lead to high blood pressure and thus increase the risk of cardiovascular disease. It is also not good for your bones because it lowers your calcium levels. So use it in moderation.
• Too much coffee or tea can also be a trigger for even more hot flashes or night sweats. Therefore, it is advisable not to drink too much coffee or tea, especially after the afternoon.

Sometimes we are so strict with ourselves that it causes us stress when we "sin" for once. A simple rule to help you with this is the 80/20 rule. If you are doing responsibly 80% of the time, you can enjoy that cookie with your coffee or a glass of wine with dinner during the other 20%.

Do you want to delve deeper into this? In our article on nutrition during the transition, you will find extensive tips. If you want to supplement your diet, also take a look at our menopause supplements.

Regular physical exercise

• Combine cardio (walking, cycling, swimming) with strength training to support bone density, muscle mass, and metabolism.
• Find a few good strength exercises and repeat them at home every day. You don't need more than a mat or a towel!
• Try to incorporate exercise at a fixed time. Only in this way can you easily learn new habits. For example, we are fans of daily movement after a meal: go for a 20-minute walk. Moreover, in this way, you boost your digestion. Win-win!

Also think about your bones. After menopause, your bones become weaker. Strength and endurance training together support your bone health. Sufficient calcium and vitamin D contribute to the maintenance of normal bones.

Stress management and mindfulness

Reduce stress through breathing exercises, meditation, yoga, or walks in nature. Stress can worsen hot flashes and insomnia.

Prof. Dr. Herman Depypere, gynecologist at the women's clinic of Ghent University Hospital and author of the book "Hoe blijf ik gezond tijdens de menopauze?" (How do I stay healthy during menopause?), was a guest on our podcast.

According to him, you stay healthy through a combination of a healthy diet, regular physical exercise, and, where necessary, bio-identical hormones. He also emphasizes that women in menopause should get regular check-ups, even if they feel good.

When to see the GP?

Make an appointment with your GP if your menopausal complaints disrupt your daily life, for example, due to severe hot flashes. Also go if you have very heavy bleeding, if you have complaints before your 40th, or if you have renewed bleeding after you have not had a period for a year (Thuisarts, 2026).

Are you in doubt about whether hormone therapy is right for you, or do you just want to know what is happening in your body? In that case, too, your GP is a good first point of contact.

Menopause brings changes with it; both physically and mentally. But you don't have to go through it alone. With small adjustments and the right support, you will get a long way.

Our supplements offer targeted support during this phase. Practical, natural, and tailored to the needs of women in the transition.

Be sure to discuss treatment options such as hormonal therapies with your doctor for very severe complaints. As said at the beginning: menopause requires a multidisciplinary approach.

Give your body what it needs. This way, you help your body stay in balance, even when everything is changing.

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