The Menopause Symptoms You Might Not Link to Your Hormones

Ask most people what menopause looks like and they'll say hot flushes. Maybe night sweats, maybe mood swings. That's about where the list ends.

So when your shoulder seizes up, your skin feels like something is crawling on it, your heart starts fluttering on the sofa and your eyes feel like sandpaper, you end up with 4 different appointments for 4 different problems. Nobody puts them together. Sometimes they come from the same place: falling oestrogen.

Oestrogen works on far more than your ovaries. Your joints, skin, heart, brain, eyes, bladder and hair all have places for it to work. So when it changes, all of those can feel it. Here are the symptoms women most often don't link to their hormones, what helps with each, and when it's something that needs checking first.

Achy joints and a stiff shoulder

Joint aches are one of the most common symptoms of perimenopause and menopause, and one of the least recognised. Women describe stiff hands in the morning, sore knees on the stairs, aching hips at night. Frozen shoulder, tendon pain and heel pain (plantar fasciitis) also turn up more often at this age.

Oestrogen helps keep joints, tendons and the tissue around them supple and helps your muscles recover. As it falls, many women find they get stiffer and sorer, and slower to bounce back after exercise.

What can help: keep moving, even when it's sore. Strength training 2 or 3 times a week supports the muscles around the joint. Gentle stretching in the morning helps the stiffness. And for many women, aches that started with perimenopause improve when the hormones are treated, though joint pain on its own isn't usually the main reason for starting HRT.

When it needs checking first: joints that are hot, red or swollen, or stiffness in the morning that lasts more than 30 minutes, can be an inflammatory arthritis. That needs blood tests for inflammation and a prompt rheumatology referral through your GP, even if those bloods come back normal: ask for it by name. Please don't let anyone put that down to "just the menopause".

Itchy, dry or crawly skin

Oestrogen helps your skin hold water and make collagen and oils. As it drops, skin often gets drier, thinner and itchier, and more easily irritated by products it used to cope with.

Some women also get formication, a feeling of insects crawling on or under the skin. It sounds alarming and it's more common than people think. In menopause it's often linked to dry, sensitive skin and changing hormones, not anything sinister.

What can help: warm (not hot) showers, a fragrance-free moisturiser on damp skin, and a richer cream at night with ceramides, glycerin or shea butter. Go easy on exfoliating acids while your skin is stinging. If it's your face that's tight and sore, AllSkin Med Barrier Recovery Cream is made to help repair a damaged skin barrier.

When it needs checking first: itching all over without a rash can also come from low iron, thyroid problems, liver or kidney problems, and some medicines. If moisturising doesn't help within a couple of weeks, it needs bloods.

Palpitations

A fluttering, thumping or racing heart, often when you're sitting still or lying in bed, is common in perimenopause. It can come with a hot flush or on its own. Changing oestrogen can affect the nerves that control your heart rate, and many women notice it most at night.

What can help: cutting back on caffeine and alcohol, keeping an eye on whether it comes with flushes, and treating the flushes themselves if they're the trigger.

When it needs checking first: palpitations always need a heart cause ruled out before anyone calls them hormonal. That means an ECG (a quick, painless recording of your heart's rhythm) and blood tests for thyroid, iron and blood count. And if palpitations come with chest pain, fainting or feeling very breathless, that's 999.

New anxiety, rage or feeling flat

Lots of women who have never been anxious find themselves lying awake with a racing mind at 46. Others notice a short fuse that doesn't feel like them, crying more easily, or losing confidence at work. Oestrogen and progesterone both affect brain chemicals that steady mood and help you sleep, so when they go up and down, mood often does too.

A clue it's hormonal: it's new, it started around the time your periods changed, and in perimenopause it may come and go with your cycle.

What can help: better sleep (which often means treating night sweats), regular movement, cutting back alcohol, and CBT (cognitive behavioural therapy, a talking therapy that teaches practical ways to handle worry). Treating the hormones can help mood symptoms that came with perimenopause. Magnesium won't fix anxiety. It contributes to normal psychological function, and some women prefer to take it in the evening. If you have kidney disease, ask before taking it.

When it needs checking first: if you've felt low most days for 2 weeks or more, it needs to be checked properly, because depression is treated differently. And if you're having thoughts of harming yourself, please call 111, or 999 if you're in danger now.

A few things that can help alongside the steps above:

Dry, gritty eyes

Dry eye is more common after menopause. Hormones help control the oily layer that stops your tears drying out, so as they change, eyes can feel gritty, sore, tired or watery (watering is often the eye's reaction to being dry). Screens and central heating make it worse.

What can help: preservative-free eye drops, a warm compress on closed eyes for a few minutes to loosen the oil glands, blinking breaks from screens, and not sitting in the path of a heater or car vent.

When it needs checking first: a painful red eye, sudden blurred vision or loss of vision needs to be seen the same day: call 111 or go to an urgent eye service.

Vaginal dryness and bladder changes

This is the one women are least likely to mention, and it's the one that responds best to treatment. Its name is GSM (genitourinary syndrome of menopause). Without oestrogen, the tissues of the vagina, vulva and bladder get thinner and drier. That can mean dryness, itching, burning, sex that hurts, needing the loo urgently or often, and urine infections that keep coming back.

Unlike hot flushes, which often settle with time, GSM usually gets worse if it's left alone.

What can help: vaginal moisturisers used a few times a week, and a lubricant for sex. And low-dose vaginal oestrogen, which works where it's put, with very little getting into the rest of your body. It can be used at any age, on its own or alongside HRT, and by many women who can't take HRT. For women with urine infections that keep coming back after menopause, research suggests it can reduce how often they happen. It needs to be kept up, because the dryness comes back when it stops.

When it needs checking first: any bleeding after 12 months without a period needs an urgent GP appointment: ask for an urgent suspected cancer referral by name. Blood you can see in your urine needs an urgent GP appointment too: ask for an urgent referral by name. And a urine infection with a fever, pain in your back or side, or being sick needs treating the same day: call 111.

Thinning hair, and the odd ones

Hair often gets finer after menopause, and some women notice more shedding or a wider parting. Lower oestrogen means the male-type hormones you've always had have more effect on the hair follicles. But thinning hair also has other common causes that can be checked and treated: low iron, low thyroid, not eating enough protein, or a stressful few months. Low vitamin D is often found alongside it too. So thinning hair needs bloods before anyone blames hormones. Eating enough protein through the day helps too.

Some women also report tinnitus (ringing in the ears), a burning mouth, a change in body odour, or migraines that behave differently. The research linking some of these to menopause is weaker, so they get checked for other causes first. But if they turned up alongside your other symptoms, mention them. They're part of what's going on.

Putting it together

Look for the pattern: 3 or 4 of these turning up around the same time. If you're in your 40s or 50s and that's happened alongside changes to your periods or sleep, it makes sense to look at them together. My free Symptom Tracker has space for all of them, so you can see the pattern over a few weeks. And my free Your Options guide goes through what can help.

If you'd like help with it

From Sunday 18 October, World Menopause Day, the clinic's Menopause service looks at all of it together, online by video or in person in Milton Keynes. We go through your history, your symptoms, your cycle, your family history and what you've already tried. Where blood tests will change the plan, we arrange them near you, then go through the results and your treatment options together. If you're already on treatment and it isn't quite right, that includes a full medication review.

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Every Sunday morning I send out my newsletter, Beyond Prescriptions, with 1 women's health lesson and what to do with it. You can sign up here.

Debora Tentis, Women's Health Pharmacist.