What does normal menopause look like?

However, that doesn’t mean that ‘anything goes.’ Let’s go through the most common menopause symptoms, and answer some of the most common questions about what is, or isn’t, normal during menopause.

What are normal menopause symptoms?

There are 34 (seriously!) symptoms that you may experience during menopause. You may experience none of them, all of them, or just a few. And the severity of each symptom will be different from person to person.  

The 34 symptoms of menopause

1. Hot flashes
2. Night sweats
3. Vaginal dryness
4. Decreased sex drive
5. Breast soreness
6. Irregular periods
7. Bloating
8. Headaches
9. Mood swings
10. Fatigue
11. Depression
12. Anxiety
13. Irritability
14. Panic disorder
15. Joint pain
16. Sense of taste
17. Itchiness
18. Tingling extremities
19. Electric sensations
20. Burning mouth
21. Digestion changes
22. Muscle aches
23. Disrupted sleep
24. Thinning hair
25. Osteoporosis
26. Irregular heartbeat
27. Weight gain
28. Memory lapses
29. Concentration lapses
30. Brittle nails
31. Incontinence
32. Dizziness
33. Allergies
34. Body odor

An important note⸺just because these symptoms are considered normal during menopause doesn’t mean you must put up with them.

There are many options available to reduce their severity and the impact they may be having on your quality of life. Make sure to talk to your doctor about your symptoms and see what management options are available.

What is the normal age for menopause?

You have reached menopause when you have not menstruated for 12 months; normally, this occurs in the early 50s. However, the transition to menopause can start well before then. This transition phase is known as perimenopause. It normally starts in the mid-40s and lasts, four and a half years, on average. Saying that, perimenopause has been known to last for up to 10 years, so the age range is quite large.

Reaching menopause before the age of 40 is called premature menopause.

Reaching menopause before the age of 45 is called early menopause.

Menopause that has occurred at any age due to surgery (such as a hysterectomy) or medication is induced or surgical menopause.

It’s during perimenopause that those 34 symptoms start to present themselves. Some of them, like hot flashes and breast soreness, may become less common postmenopause, while others, such as osteoporosis, may become more common.

How many hot flashes a day is normal?

Hot flashes typically last between two and four minutes at a time. They can happen as frequently as 10 times a day. It is quite difficult to define a normal frequency of hot flashes. Some women experience them once or twice a week, while others experience them once or twice an hour.

Hypnotherapy for hot flashes researcher, Dr. Gary Elkins, created the following classification to help women understand how severe their hot flashes are:

• Mild - Lasts <5 minutes; uncomfortable warmth; mild discomfort; no need for action.
• Moderate - Up to 15 minutes; warm, clammy skin; increased heart rate; some sweating; agitated; embarrassed; use fan, remove clothes.
• Severe - Up to 20 minutes; very hot; increased heart rate; unusual sensation over skin; sweating; anxiety; embarrassment; activity interruption.
• Very severe - Up to 45 minutes; extreme heat; rolling perspiration; increased heart rate; nausea; extreme distress; difficulty functioning; need to take a cold shower or hold ice on skin.

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What are normal hormone levels during menopause?

To understand hormone changes during menopause, it’s helpful to know the role each hormone plays in your body.

During your menstrual cycle, your body produces some key hormones: FSH (follicle-stimulating hormones), estrogen, and progesterone. The levels of each of these hormones changes naturally depending on where you are in your cycle.

FSH stimulates the growth of ovarian follicles, ready for the release of an egg. As the follicles grow, your body increases the amount of estrogen (in the form of estradiol) it produces. Once the egg is ready to be released, your estrogen peaks, and your FSH levels fall.

After you ovulate, your body produces progesterone to prepare your uterine lining for the implantation of a fertilized egg. If there is no implantation, then your progesterone levels decrease, and your body sheds the uterine lining⸺this is your period.

On the first day of your period, your estrogen levels are at their lowest; this is a trigger for the body to start producing increased levels of FSH to stimulate new follicles ready to release the next cycle’s egg.

Normal FSH levels in menopause

Doctors often test FSH levels to determine where you may be in your menopause journey. This is because FSH can increase during perimenopause.

This happens because, over time, there are less viable follicles to release eggs. This means your body naturally releases less estrogen.

Just like it does during your menstrual cycle, lower estrogen levels in menopause signal your body to produce more FSH.

• Before puberty - 0 to 4.0 mIU/mL (0 to 4.0 IU/L)
• During puberty - 0.3 to 10.0 mIU/mL (0.3 to 10.0 IU/L)
• Women who are still menstruating - 4.7 to 21.5 mIU/mL (4.5 to 21.5 IU/L)
• After menopause - 25.8 to 134.8 mIU/mL (25.8 to 134.8 IU/L).

Testing for menopause through FSH levels is not an exact science, as your hormones will fluctuate during your cycle, and some cycles will produce more estrogen than others. However, an FSH level of more than 30 IU/L would indicate perimenopause. And a consistently higher FSH level (accompanied by no periods) would indicate menopause.

Normal estrogen (estradiol) levels in menopause

The ovaries produce the female hormone estrogen, more specifically estradiol. As women progress through perimenopause and there are fewer eggs available to release, the body slows down its hormone production.

Before menopause, a normal level would be 30-400 picograms per milliliter (pg/mL).

After menopause, it falls below 30 pg/mL.

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The fluctuating amount of estradiol released into the body is responsible for many physical and psychological changes during menopause, which is why some women explore hormone replacement therapy.

Is it normal to bleed during menopause?

While menopause is signaled by twelve months without a period, having lighter or heavier periods during perimenopause is quite normal.

If you are spotting or bleeding post-menopause, then be sure to talk to your doctor as there may be underlying health concerns that need to be addressed.

Heavy bleeding in perimenopause

Some women are surprised to find they bleed more during perimenopause. Once again, it has to do with your changing hormone levels.

Estrogen plays a role in creating the uterine lining. While estradiol helps grow the uterine lining, progesterone controls its thickness. More progesterone relative to estrogen means a thinner lining and lighter periods. Less progesterone relative to estrogen means a thicker lining and heavier periods.

Although estradiol and progesterone levels fall during perimenopause, progesterone levels may fall faster (as fewer eggs are released). This means there is more estrogen to build up the uterine lining than progesterone to keep its thickness in check. This can result in heavier and longer periods.

Over time the balance between progesterone and estradiol becomes more balanced, and the uterine lining thins. At this time, your periods should become lighter.

Irregular cycles in perimenopause

While there is an overall trend of estrogen and other hormones reducing during perimenopause, it doesn’t happen linearly, and you are likely to experience hormone fluctuations. This means that you can expect changes to your cycle as well. It is perfectly normal during perimenopause for your periods to become:

• Shorter
• Longer
• Heavier
• Lighter.

Or any combination of the above.

Spotting in perimenopause

Spotting during perimenopause may also happen every now and then, but if you are experiencing regular spotting, then be sure to discuss this with your doctor.

What is a normal libido for menopause?

Even before perimenopause, there is no ‘normal’ libido. Your sex drive and preferences are as unique as you are. So if you feel that during menopause your libidio is lower, or higher, than other people⸺don’t be too quick to judge!

Research shows that around half of all women experience a reduction in their sex drive during this time, partly due to the changing levels of estrogen.

Other menopause symptoms can also play their part. Weight gain, thinning hair and increased facial hair can all affect feelings of desirability. Hot flashes and vaginal symptoms such as dryness can also impact the desire to be intimate.

Not everyone experiences a lowering of their libido though. Interestingly, some women report a renewal in their sex drive post-menopause. This is thought to be driven by lifestyle factors such as no risk of pregnancy and time for relationship building, once children have grown.

What is normal blood pressure during menopause?

Estrogen is thought to play a protective from in women from cardiovascular disease. One school of thought is that as estrogen reduces, the risk of hypertension, or high blood pressure, increases.

Other studies have shown that lifestyle factors such as diet, smoking, and body mass index may have an equal or greater influence on blood pressure than hormone changes.

In general, blood pressure is classified as:

• Low blood pressure is below 90/60 mmHg
• Normal blood pressure is below 120/80 mmHg
• Elevated blood pressure is 120-129/80-89 mmHg
• High blood pressure is above 130/90 mmHg.

It’s important to see your doctor if you have any concerns about your blood pressure.

What if my menopause isn’t normal?

If you are experiencing any menopause symptoms that cause you concern, affect your quality of life, or you are just not sure of, then it is important that you talk to your healthcare practitioner. They will be able to give you advice on what is or isn’t normal and will be able to recommend appropriate treatments and menopause management tools.

The Wrap Up

There is no ‘one-size fits all’ menopause experience. However, many symptoms are considered ‘normal’ to experience. The perimenopause stage commonly starts in the mid-40s, and the time of menopause (your last period) usually occurs in the early 50s. There are 34 different symptoms that are considered normal during menopause, but just because they can be expected, doesn’t mean you need to this doesn’t mean you have to ‘put up with them.’ There are treatments and management tools available to help you navigate this time of life. If you are ever unsure of whether your symptoms should be of concern, talk to your healthcare practitioner.