At age 55, Anne got her last period. In the months that followed, she found herself feeling increasingly anxious and irritable. The pandemic, work-related stress, and caring for aging parents from afar, all added to her irritability. “I was short-tempered with friends and family. I hated being that person,” Anne says.

While it was easy to think her mood swings were stress-related, she sensed something else was going on. “I had always had mood changes with my period,” says Anne, who for professional reasons asked that only her first name be used. “In menopause, however, they seemed to be even worse.”

After meeting with Samantha M. Dunham, MD, co-director at the Center for Midlife Health and Menopause, part of the obstetrics and gynecology services at NYU Langone, Anne learned that menopause, a time when falling estrogen levels trigger changes throughout the entire body, causes more than just hot flashes. It can also cause a host of other troublesome symptoms, including insomnia, muscle aches, vaginal dryness, heart palpitations, and mood changes.

Starting in your mid-40s, watch out for these lesser-known menopause symptoms—and seek treatment if they impact your quality of life.

Mental Health Challenges

Mood swings, anxiety, and depression are some of the most overlooked symptoms of menopause. Women with a history of anxiety and depression, including postpartum depression, or who had premenstrual dysphoric disorder, a severe form of premenstrual syndrome, may be especially hard-hit during perimenopause and menopause, compared to women without a history of these conditions. Depression or anxiety can also affect women for the first time in menopause.

“Any hormonal transition, whether it’s puberty, pregnancy, the postpartum period, perimenopause, or menopause, creates a window of vulnerability for anxiety and depression,” says Laurie S. Jeffers, NP, DNP, co-director of the Center for Midlife Health and Menopause.

Treatment Options

Several studies have shown hormone therapy to be helpful in improving mood during the menopausal transition. In addition, selective serotonin reuptake inhibitors (SSRIs) or serotonin-norepinephrine reuptake inhibitors (SNRIs), typically known as antidepressants, can also be effective menopause mood boosters and are a proven treatment for hot flashes and night sweats.

To make an appointment with one of our certified menopause practitioners, please visit the Center for Midlife Health and Menopause.

For Anne, taking a small dose of the SSRI Paxil (paroxetine) in menopause proved to be life changing. “My sleep is much better, and there has been an improvement in my irritability, mood, and anxiety,” she says.

Sleep Problems

Speaking of sleep, research shows that as many as 60 percent of women in midlife report sleep problems, and hormones can be one reason why. Changing estrogen levels may cause insomnia or trigger night sweats—a type of nocturnal hot flash that can leave you damp, chilled, sweaty, and uncomfortable enough that you need to get up and change in the middle of the night. A consistent lack of sleep—most people need a solid seven hours to feel rested—can cause physical and mental exhaustion and lead to trouble remembering things, difficulty concentrating, and feeling emotionally overwhelmed.

Treatment Options

If you experience night sweats, “try keeping your bedroom temperature a little lower. Use a fan. Some patients also report relief with moisture-wicking bedding,” says Dr. Dunham. Watch caffeine and alcohol intake too. Caffeine can be a trigger for hot flashes and night sweats and disrupt sleep. Alcohol can cause you to sleep lighter and shorter. Hormone therapy may help improve sleep, especially if you’re experiencing night sweats.

Joint and Muscle Discomfort

If you’ve never complained about joint stiffness, back pain, or body aches before, there’s a good chance you might in menopause. That’s because the drop in estrogen can affect your muscles and joints.

Treatment Options

During menopause and for women of all ages, it’s important stay active with regular aerobic exercise, strength training, and flexibility training. “We don’t have a magic bullet for joint and muscle pain in menopause, but movement helps,” Dr. Dunham says.

Painful Sex and Urinary Tract Infections

Declining estrogen levels can cause tissue in the vagina, vulva, and urethra to atrophy, or shrink. This can lead to vaginal dryness, painful sex, and frequent urinary tract infections (UTIs). These symptoms are known as the genitourinary syndrome of menopause.

Treatment Options

“Vaginal estrogen is a great option for women with moderate to severe vaginal atrophy, pain with sex, and recurrent UTIs,” Dr. Dunham says. The topical estrogen helps the vagina, which is loaded with estrogen receptors, restore the elasticity of vaginal tissue and ease symptoms. For mild symptoms, over-the-counter treatments, such as a vaginal moisturizer, may be all that’s needed to ease discomfort.

New Heart Sensations

Chest tightness, a new awareness of your heartbeat, or the sensation of heart skipping or racing, can occur in perimenopause and menopause. “There are estrogen receptors throughout the body, including the heart,” Jeffers says. “When estrogen levels fluctuate and withdraw from cardiac tissue, it can cause palpitations.”

Treatment Options

New heart sensations at the time of menopause may be related to the changing estrogen levels, or something else. Don’t ignore them. A woman’s risk of cardiovascular disease can increase starting at age 50, so it’s important to see a doctor and explain what you’re feeling. Testing or a referral to a cardiologist may be needed to determine the cause.

Seek a Menopause Expert

If you are searching for relief from the symptoms of menopause, a certified menopause practitioner can help. During your first visit at the Center for Midlife Health and Menopause, located at NYU Langone Obstetrics and Gynecology Associates, Jeffers and Dr. Dunham spend 45 minutes focusing on which menopause symptoms are most bothersome and address solutions. “Menopause is highly individual. We want to get the whole picture to tailor treatment recommendations,” Jeffers says.