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Many side effects occur early and improve over time, especially when doses are increased gradually, but some people need dose adjustments or a different medication
Heavy perimenopausal bleeding can cause iron-deficiency anemia and may signal fibroids, polyps, or endometrial hyperplasia Sudden, severe headache unlike any you've had before Chest tightness, shortness of breath, or pressure possible cardiac symptoms Hot flashes that begin suddenly years after menopause (not a perimenopausal pattern that has continued) Drenching night sweats with unintentional weight loss, fevers, or new lumps New cognitive decline that is rapid or progressive beyond typical menopausal brain fog Suicidal thoughts or severe depression Any breast lump, nipple change, or new breast pain New, persistent, or symptomatic heart palpitations that don't resolve quickly When It Might Not Be Menopause The same symptoms can be caused by other conditions that share the same age window