How do I recognise menopause? The 10 most common symptoms

4. Weight gain, even though nothing has changed

Few things unsettle women in menopause as much as the slowly rising numbers on the scale, even though their eating habits haven't changed. The reason lies deep in the metabolism: as estrogen levels drop, fat distribution shifts away from the hips and thighs towards the abdomen, where more metabolically active visceral fat accumulates. At the same time, from the mid-30s onwards, we continuously lose muscle mass, and less muscle means a lower basal metabolic rate, meaning you simply burn fewer calories at rest than before.

In addition, there's a second, often underestimated factor: poor sleep and chronic stress, both common during this phase, shift appetite hormones towards increased hunger and a greater craving for fast carbohydrates. So, it's not a matter of lacking discipline, but a combination of hormones, muscle loss, and everyday life that makes it easier for your body to gain weight than to lose it.

The most effective lever is surprising: strength training. Every bit of preserved or newly built muscle mass supports your basal metabolic rate and makes your body more insulin-sensitive. Supplemented by a protein-rich, nutrient-dense diet with less sugar and alcohol, daily exercise, and good sleep, the trend can be well influenced. Patience, not crash diets, is important, because strict starvation costs you exactly the muscles you need now. You can read how to approach this specifically in our article on Weight Loss in Menopause.

5. Racing heart and palpitations

A suddenly pounding or fluttering heart, often in the middle of a hot flash or at night upon waking, frightens many women. Approximately 40 percent of 45- to 54-year-olds know this feeling. This is usually due to the hormonal change itself: estrogen influences the autonomic nervous system and the width of blood vessels, and when levels fluctuate, the circulatory system reacts more sensitively. During a hot flash, there is also an adrenaline rush, which causes the heart to beat noticeably faster.

In most cases, this heart palpitation is harmless and will pass. Nevertheless, it's worth listening: If your resting heart rate is consistently over 100, if heart palpitations occur frequently, or if they are accompanied by dizziness, shortness of breath, or chest pressure, it should be medically evaluated, also to rule out hyperthyroidism, anemia, or arrhythmias.

In everyday life, it helps to consciously breathe slowly and deeply in an acute moment and to sit down briefly instead of panicking. Less caffeine relieves an irritable heart, and magnesium- and potassium-rich foods such as nuts, bananas, and green vegetables support a calm heart rhythm.

6. Mood swings and frayed nerves

The hormones that control your cycle also work in the brain: estrogen and progesterone influence neurotransmitters such as serotonin and GABA, which are responsible for mood, calmness, and serenity. When these hormones fluctuate strongly during perimenopause, emotional balance also becomes unstable. Many women describe being more irritable, tearful, or restless, and sometimes not recognizing themselves.

Women who have previously reacted strongly to hormonal fluctuations, for example with pronounced PMS or a low mood after childbirth, are particularly susceptible. If poor sleep and everyday stress are added to this, everything intensifies. It's important to remember: these are real, hormonally co-determined changes and not a sign of weakness.

Regular exercise is one of the strongest natural remedies here because it releases endorphins and reduces stress. B vitamins and magnesium from whole grains, nuts, and legumes support nerve function, and conversations with people who do you good provide noticeable relief. However, if you feel persistently down, unmotivated, or anxious for more than two weeks, take it seriously and seek professional support; this is a sign of strength, not failure.

7. Vaginal Dryness and Sensitive Mucous Membranes

Hardly anyone talks about this symptom, yet it affects many women: Estrogen keeps the mucous membranes in the intimate area thick, elastic, and well-supplied with blood. When the level drops, the tissue becomes thinner and drier, loses its elasticity, and reacts more sensitively. Professionally, these changes are summarized as the genitourinary syndrome of menopause.

This manifests as a feeling of dryness, itching, or burning, pain during sex, and sometimes more frequent bladder infections, because the urethra is also affected. Many women then quietly withdraw, even though this particular symptom is especially treatable.

For everyday life, pH-neutral lubricants and moisturizing creams, for example with hyaluronic acid, help to make the tissue more supple. Low-dose, local estrogen preparations are very effective and have few side effects; they work directly on site and are hardly absorbed into the body; they are available by prescription. Regular intimacy or self-stimulation also promotes blood circulation and keeps the tissue elastic. Talk openly about this with your gynecologist; it's worth it.

8. Decreased Libido

The fact that the desire for sex decreases during menopause rarely has only one cause. On the one hand, both estrogen and testosterone, which also influences sexual desire in women, decrease. On the other hand, physical and psychological factors interact: vaginal dryness makes sex unpleasant, fatigue and stress rob energy, and changes in one's own body can gnaw at self-image.

The result is often a desire that has become quieter, and sometimes also less arousal or difficulty reaching orgasm. All of this is common and no reason to doubt yourself.

Often, the first sensible step is to address the physical hurdles, for example, to treat dryness, ensure more sleep, and reduce stress. Intimacy without performance pressure, where the focus is initially only on touch and time for each other, can slowly bring back desire. If the loss of libido bothers you greatly, talk to your doctor about options such as hormone or testosterone therapy.

9. Bladder Weakness and Frequent Urination

The bladder also reacts to the drop in estrogen, because the hormone supports the tissue of the pelvic floor and urethra. When this support diminishes, often additionally weakened by previous births, many women lose a degree of control. Sometimes urine is involuntarily released when sneezing, coughing, or laughing, and sometimes the bladder suddenly signals very urgently, even though it is barely full.

As common as this is, it is rarely discussed, yet much can be done. The most effective remedy is regular pelvic floor training, for example with targeted Kegel exercises, which only develops its full strength with consistent effort over several weeks. A healthy body weight additionally relieves the bladder, and gentle bladder training with fixed toilet times reaccustoms it to larger volumes.

Irritants like caffeine and alcohol can increase urinary urgency, but it is still important to drink enough, because too little fluid will irritate the bladder even more. In more severe cases, local estrogen preparations help the tissue, and specialized physiotherapy can provide targeted support.

10. Joint and Muscle Pain

Many women are surprised that stiff, painful joints could have something to do with hormones. Estrogen has an anti-inflammatory effect and supports joint fluid and cartilage. If it is lost and an estrogen deficiencyoccurs, some women experience symptoms known as menopausal joint pain, especially in the hands, knees, hips, and back.

Typical symptoms include morning stiffness or an ache after prolonged sitting, sometimes accompanied by swelling or restricted mobility. Because the pain can hinder daily life and the desire for movement, a cycle of rest and even more stiffness can easily develop.

This is precisely why gentle, regular movement is so important, as joints that remain active often hurt less. Joint-friendly sports such as swimming, cycling, Nordic walking, or yoga are particularly suitable, complemented by strength training that strengthens the supporting muscles. Warmth and gentle massages relieve tension, and a plant-based, anti-inflammatory diet with plenty of vegetables, nuts, and omega-3 fatty acids also helps. If a single joint swells significantly or hurts constantly, have a doctor clarify whether another cause is behind it.

Your body is talking to you, listen

Menopause is not an end, but the beginning of a new phase in which you can get to know yourself anew, with all your needs, boundaries, and strengths. Symptoms such as hot flashes, sleep disturbances, or mood swings are not a weakness, but signals from your body that you should take seriously.

What counts: You are not alone, and you don't have to just endure everything. There are gentle, scientifically sound ways to support you, from nutrition and exercise to targeted nutrients, and for more severe symptoms, medical options such as hormone therapy. If you would like to classify your own symptoms, our doctors will be happy to accompany you in a free initial consultation.