Menopause is a natural part of aging for women, but doctors say there is no predictable pattern or timeline for the symptoms. 

While hot flashes, irritability and weight gain are generally well known, symptoms like anxiety, hair loss, and incontinence can catch a woman by surprise and cause concern, even though they’re normal, says Dr. Arianna Sholes-Douglas, author of “The Menopause Myth: What Your Mother, Doctor, And Friends Haven’t Told You About Life After 35.”

“Many myths exist about what to expect when going through menopause,” said Sholes-Douglas, founder of Tula Wellness Center in Tucson, Arizona. “It’s important to know your body well enough to know what’s happening and get reassurance that what’s going on is normal.”

Dr. Sholes-Douglas explains five normal menopausal symptoms women can watch for: 

1. Anxiety and depression. Depression and anxiety shouldn’t be ignored; they can appear as your body changes, and need to be treated. Decreasing progesterone and overactive adrenals may be partially responsible for the anxiety you’re feeling, and progesterone has been implicated in depression, too. So don’t think depression and anxiety are just all in your head.”

2. Hair loss and hair growth. Hormone changes can cause hair growth where you least want it, said Sholes-Douglas. At the same time, these hormone changes—specifically, decreasing estrogen and the changing ratio of estrogen to testosterone—are responsible for thinning hair on the scalp, especially on the crown and near the forehead.

3. Behavioral changes can tip off a woman to menopausal symptoms. If you’re not feeling like yourself and your partner has complained about you treating them differently, Sholes-Douglas said it could be an indication of lower estrogen levels. “Estrogen is actually a key driver of women’s nurturing behavior and desire to take care of others,” she said. “When levels decline in perimenopause (the transition), women can find themselves thinking, feeling and behaving in a way that’s unfamiliar. This biological change can have huge consequences for family dynamics.” 

4. Appearance of vagina. Age and hormones affect the appearance of the vagina, said Sholes-Douglas. The pubic hair can go gray, thin or disappear altogether; the skin can change color; and the labia minora can lengthen or sag. All of these changes are completely normal.

5. Incontinence. Decreasing estrogen is responsible for the thinning of the vaginal walls, and that means the urethra doesn’t have the support it used to in order to hold urine in. Urine leakage is very common; around 50 percent of women will experience some form of incontinence in their lifetime.

“Every woman is different, but there’s no need to worry and suffer in silence,” said Sholes-Douglas. “Talk with your gynecologist to learn more about the symptoms, discuss what you’re experiencing and ways to treat them.”