A head-to-toe guide to the many unexpected symptoms of the midlife transition.

• Dec. 10, 2025Updated 2:40 p.m. ET

You know menopause can cause hot flashes. But did you know it can also lead to a dry mouth, heart palpitations or recurring urinary tract infections?

Though only a handful of them get much attention, there are more than two dozen known symptoms of menopause and perimenopause, the time leading up to and immediately following your last period.

The symptoms are so varied because your ovaries are ramping down production of estrogen and progesterone, sex hormones that have played key roles in all kinds of physiological processes since puberty. Estrogen is the biggest factor: As it declines, tissues in many parts of your body get drier, your bone density decreases and your body changes in lots of other ways.

The direct symptoms of changing hormone levels, like hot flashes, are associated with further effects, including poor sleep and changes to cardiovascular and cognitive health. Other mechanisms, not fully understood, are probably at play, too.

Here’s a guide to the many ways this midlife transition can affect your body, top to bottom — and what you can do about it.

Your Brain

Much of this highly complex organ is sensitive to changes in estrogen levels.

Your Mouth and Throat

Estrogen encourages moisture in various parts of the body, including the mouth.

Your Heart

Premenopausal women generally have a lower risk of heart disease than men, but this starts to shift in perimenopause.

Your Metabolism

Menopause is associated with a redistribution of weight.

Your Genitals and Urinary Tract

Hormonal and vascular changes have major effects on your reproductive organs and surrounding areas.

Your Bones and Muscles

Your body is constantly breaking down old bone and building new bone, and estrogen plays an important role in that process.

None of these symptoms affect all women, and many can be caused by things other than menopause. Your mouth could be dry because of a medication you’re taking. Joint pain could be arthritis. And aging causes plenty of ailments on its own.

Even doctors can’t always confirm whether any one symptom a woman experiences is linked to menopause.

But often, it is menopause. In those cases, some symptoms will fade as your body adjusts to life with less estrogen. Others, sorry to say, will persist.

For many women, systemic hormone therapy can safely alleviate a wide range of symptoms. Local estrogen products applied to the vagina can treat urinary and sexual symptoms. And thanks to recently introduced drugs, nonhormonal options are increasing.

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Sources

We consulted Dr. Stephanie Faubion, the director of the Mayo Clinic’s Center for Women’s Health and medical director of the Menopause Society; Dr. Melissa Kaufman, a professor of urology at Vanderbilt University Medical Center; Dr. Gina Lundberg, the clinical director of the Emory Women’s Heart Center; Pauline Maki, a professor of psychiatry, psychology, obstetrics and gynecology at the University of Illinois Chicago; Dr. Mary Jane Minkin, a clinical professor of obstetrics, gynecology and reproductive sciences at the Yale School of Medicine; Dr. Rachel Rubin, a urologist and sexual medicine specialist; Dr. Jessica Starr, an endocrinologist and bone health expert at the Hospital for Special Surgery; Dr. Lauren Streicher, a clinical professor of obstetrics and gynecology at Northwestern University Feinberg School of Medicine; and Rebecca Thurston, an associate dean for women’s health research and professor of psychiatry at the University of Pittsburgh.

Produced by Deanna Donegan and Claire Merchlinsky.

Maggie Astor covers the intersection of health and politics for The Times.

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