7 Subtle Signs Of Menopause People Often Miss

Menopause refers to the time period when people who menstruate stop getting their period, generally signaling the end of the reproductive years. For most, this occurs between the ages of 45 and 55, but it varies from individual to individual.

You’ve probably heard of some of the common symptoms of menopause, like hot flashes and weight gain, but there are a number of other symptoms to signal this transition that you might not know.

“Perimenopause can actually start up to an entire decade prior to the onset of menopause, with the most obvious sign of perimenopause as irregular menstrual patterns,” said Dr. Monica Grover, OB-GYN and chief medical officer at VSPOT. “As a result, some early signs of menopause may be missed as [people are] still in the confusing and erratic state of menstrual patterns around this time.”

Here are a few signs you may not immediately recognize as perimenopause or menopause:

Decreased Libido

Fluctuating hormone levels can contribute to a reduced sex drive,” said Dr. Anat Sapan, board-certified OB-GYN and menopause expert. “This is mistakenly attributed to a change in relationship issues, fatigue or other factors, leading to the overlooking of decreased libido as a symptom of peri/menopause.”

According to Dr. Catherine Hansen, an OB-GYN and a menopause expert at Pandia Health, there are no approved, highly effective prescriptions to treat decreased libido. With that said, a conversation with a provider skilled in sexual health is important for guidance at this stage in life.

Vaginal Dryness

It may become apparent that it’s itchier down yonder than it used to be.

“During menopause, reduced estrogen can cause the vaginal and vulval tissue to become thin and more susceptible to irritation and inflammation,” Grover said. “These symptoms may be first diagnosed as bacterial or fungal vaginitis but cultures may continue to appear negative.”

Dr. Jaime Seeman, OB-GYN and host of the “Fit and Fabulous” podcast, added that this vaginal dryness can cause pain with sexual activity and more frequent urinary tract infections, which is something you’ll want to monitor and talk to your physician about.

Breast Tenderness

While those on their periods might experience breast tenderness, this is a symptom of menopause as well.

Many people will complain of increased breast tenderness ― or even just very sore nipples ― when they reach the time in their early to mid-40s when their hormones fluctuate and they are in perimenopause,” said Dr. Shieva Ghofrany OB-GYN and expert at Perry.

Ghofrany recommended trying some lifestyle habit changes, like decreasing caffeine intake and limiting consumption of foods high in sodium, to see if it helps alleviate some of the tenderness. Additionally, always be sure you are up to date on your mammogram and see your provider, especially if the pain persists or is more one-sided.

Sleep Disturbances

You may already have insomnia or difficulty sleeping, but if this arises later in life, then it could be a sign of menopause.

Hormonal changes can lead to disruption in sleep patterns such as difficulties falling asleep or staying asleep,” Sapan said. “Sleep issues are often attributed to stress, aging or lifestyle factors,” so many people often dismiss this particular symptom.

Hansen added that these sleep disturbances may also arise at this stage in your life when there are usually more racing thoughts about increased stressors, whether that’s looking after teenagers, empty-nesting, caring for ailing parents or managing professional obligations.


Dizziness is another common symptom of menopause that often goes overlooked.

“You might experience dizzy spells during perimenopause and menopause because the hormonal changes which take place affect the production of insulin, which can make it difficult for your body to maintain blood sugar stability,” Grover said.

If the dizziness persists and causes disturbances in your daily life, you’ll want to reach out to your doctor to discuss treatment options and rule out any underlying conditions.

Mood Swings

Almost everyone experiences highs and lows over the course of their lives, but this may be more noticeable during menopause, similar to how it is for some when they are on their period.

“Menopause can bring about hormonal fluctuations, leading to mood swings,” Sapan said. “These emotional changes are often misinterpreted to other factors such as stress, work or personal relationships, causing them to be overlooked as a symptom of peri/menopause.”

These mood swings may be manageable on their own with therapy or other coping strategies. However, for more severe mood swings, you may want to look into medication.

Increased Urge To Urinate

While an increased urge to urinate can be a sign of other health issues like diabetes, it can also be a symptom of menopause.

“Often the lack of estrogen to the vagina/vulva and bladder makes the bladder more susceptible to the ‘urgency symptoms’ associated with irritation of the bladder instead of a urinary tract infection,” Ghofrany said. “Common triggers are foods/drinks that are more acidic, like caffeine in coffee/tea, alcohol, citrus foods and tomatoes.”

With that said, you’ll always want to see your provider to ensure there is nothing pushing on your bladder (like an ovarian cyst or a uterine fibroid), which Ghofrany said can occasionally cause the same symptoms.