Perimenopause, which means ‘around menopause’ and menopause are both transitional phases in a woman’s reproductive cycle. Perimenopause is the stage before menopause when hormones start to fluctuate and many women start to experience menopause like symptoms.

Menopause, when the ovaries produce no eggs and your periods stop, is categorised as when you haven’t had a period for 12 consecutive months. Most women will be in their early 50s when they reach menopause, with the average age being 51. The most common menopause symptoms are key indicators of the transition women experience during menopause.

Many of the menopause symptoms can occur in perimenopause, and it’s very likely there will be an overlap of symptoms.

Women will differ both in the symptoms they experience, when they experience them, and for how long. One symptom might disappear, only to come back again down the line.

• 20% of women will have no menopause symptoms.
• 60% of women have mild to moderate symptoms.
• 20% of women have severe symptoms that impact their daily lives. 

Maintaining midlife health during the menopause transition and beyond is crucial for overall well-being.

Surgical, Medical or Induced Menopause

Some women will go through menopause earlier than they would have naturally because of treatment for a medical condition. This ‘cold turkey’ menopause can cause sudden shifts within the body’s fluctuating hormone levels within days and weeks, rather than years, leading to intense symptoms almost overnight.

Fluctuating hormone levels can also impact blood pressure, influencing heart rates and blood sugar levels, which may contribute to episodes of dizziness.

The Symptomatic Groups of Menopause

The full list of menopause symptoms is separated into the following four symptomatic groups:

1. Psychological: As well as bringing many physical changes, menopause also has a big impact on our mind and emotions. Lower hormone levels can alter how we feel and affect our mental well-being. Symptoms can include low mood and mood swings, panic attacks, low self-esteem, a lack of confidence, anxiety, and anger. Women with a history of premenstrual syndrome may be more susceptible to mood changes during menopause.
2. Physical (Somatic): Changing hormone levels can affect literally every part of your body, from joint pain to headaches, aching muscles, sleep disturbances, itchy skin, and more. We can also experience a change in body shape and weight gain. Physical symptoms of panic disorder, such as chest pain, dizziness, and heart palpitations, can also manifest during this time.
3. Vasomotor: Hot flushes, night sweats, cold sweats, chills, and heart palpitations fall under the category of vasomotor symptoms, mostly triggered by blood vessels dilating or contracting. During perimenopause and menopause, when hormone levels change, your body becomes more sensitive to temperature variations, leading to disruptions in your internal body temperature regulation.
4. Sexual and Urogenital: Declining estrogen can cause sexual, vaginal, and urinary symptoms including dryness, itching, irritation, low libido, and painful sex. Also, frequent urination or incontinence due to a weak pelvic floor muscles can occur, highlighting the importance of maintaining pelvic health.

With so many changes happening to your body, it can be hard to pinpoint what’s a symptom or whether it’s something else that’s happening at the same time, but if symptoms are causing you distress, you should always seek advice from your doctor or menopause specialist.

Menopause Symptom Checklist

1. Hot Flushes: 

One of the most common symptoms of menopause is menopausal hot flashes, which can persist and significantly impact women's lives post-menopause. A sudden and intense feeling of heat, especially in the face, neck, and chest, accompanied by sweating and rapid heartbeat. Some women have chills instead of or after a hot flush.

2. Night Sweats: 

Hot flushes that occur at night. Episodes of excessive sweating during sleep, you may wake up dripping in sweat, have soaking wet bedding, and be shivering cold.

3. Irregular Periods: 

Throughout the menopausal transition, it is normal to have irregular or missed periods and changes in flow, which can be either lighter or heavier. Eventually, periods will stop entirely.

4. Vaginal Dryness: 

Reduced estrogen leads to decreased blood flow and natural lubrication in the vaginal area, leading to dryness and discomfort when having sex. Lower hormone levels also cause the vaginal tissues to become thinner and more at risk of tears and inflammation.  

5. Mood Swings: 

Emotional fluctuations are common during perimenopause and menopause. Unpredictable shifts in mood that can cause you to feel suddenly sad, weepy, or angry are not related to life events. 

6. Sleep Disturbances: 

Sleep can be disturbed for many reasons during the stages of menopause, with various challenges associated with difficulty sleeping. Trouble falling asleep can significantly impact overall well-being, including mood and productivity. Difficulty falling asleep, staying asleep, and waking frequently from night sweats can all leave you feeling exhausted the next day. Sleep difficulties are prevalent among menopausal women, with over 50% experiencing insomnia and about 25% facing sleep problems. Poor sleep not only exacerbates these symptoms but is also linked to more serious health concerns, making it a significant factor during menopause.

7. Fatigue: 

For some women, menopause fatigue can be extreme and feel almost debilitating. It can be characterised by a feeling of constant tiredness, reduced energy levels, and difficulty maintaining daily activities.

8. Weight Gain: 

Many women experience weight gain during menopause due to several factors, including lower amounts of physical activity, mood changes and eating habits, and hormonal changes that can slow metabolism and redistribute fat.

9. Hair Loss or Thinning: 

During menopause, fluctuations in estrogen and progesterone can lead to increased hair loss and thinning hair; lower hormone levels cause the hair follicles to shrink, the hair grows slower, which leads to reduced hair density and hair loss.

10. Decreased Libido: 

A reduced libido or decreased sexual desire is a common symptom of menopause, mainly attributed to lower levels of estrogen and testosterone. However, other symptoms can have a direct impact on libido, including fatigue, mood changes, and insomnia.

11. Anxiety: 

Menopause can bring about feelings of anxiety, characterised by uneasiness, restlessness, nervousness, or worry. It can often be one of the first symptoms women notice and can come and go as the hormones fluctuate.

12. Shifts in Mood: 

Supporting emotional well-being during menopause is essential, as hormonal changes—particularly a drop in estrogen—can influence brain chemicals like dopamine, serotonin, and norepinephrine. This may lead to persistent low moods, fatigue, or a loss of interest in things you once enjoyed. Life transitions and daily stressors can add to these emotional shifts, especially if you’ve experienced similar feelings in the past. If you're finding it hard to cope, reach out to your healthcare provider for guidance and support.

13. Difficulty Concentrating and Brain Fog: 

Memory lapses, difficulty concentrating, and mental fogginess (brain fog) are all symptoms of declining estrogen levels. Other symptoms, such as insomnia and fatigue, may also be contributing factors

14. Joint Pain: 

Estrogen plays an important role in decreasing inflammation and keeping joints lubricated. As a result, when estrogen levels are low, you're prone to more joint pain during menopause joint aches and pains.

15. Headaches: 

Some women may experience more frequent or severe headaches, such as migraines and tension headaches, as a result of hormonal changes that occur during menopause.

16. Breast Tenderness: 

Breast tenderness during menopause can involve soreness, sensitivity, or discomfort in the breast tissue resulting from hormonal changes and fluctuations.

17. Dry Skin: 

Estrogen plays an important role in maintaining the skin's natural hydration mechanisms, so when levels decline, the skin can feel dry, tight, flaky, or itchy.

18. Brittle Nails: 

As we go through the stages of menopause, our bodies may produce less keratin, which is needed for strong nails. Lower keratin levels can lead to weak, brittle nails that break more easily

19. Changes in Body Odor: 

Menopause can bring changes in body odour, which may be related to hormonal fluctuations and shifts in sweat production. Some women notice their sweat smells stronger, which can be exacerbated by hot flushes and night sweats.

20. Bloating and Digestive Changes: 

Bloating, water retention, gassiness, and slower digestion can all be experienced for a number of reasons, including anxiety and stress. Lowering hormones can also affect our microbiome, which can cause changes in digestion..

21. Gum Problems: 

Hormonal changes can affect our oral health, leading to gum problems, including gum sensitivity, receding gums, bleeding, or discomfort.

22. Electric Shocks: 

Some women may experience electric shock sensations during menopause, often described as brief, sharp, tingling sensations. These may occur in various parts of the body and are thought to be related to hormonal fluctuations in the nervous system.

23. Tingling Extremities: 

Tingling sensations, particularly in the hands, feet, arms, and legs, can be a symptom of menopause, brought on by hormonal changes affecting the central nervous system and typically lasting only a couple of minutes at a time.

23. Dizziness: 

A sensation of dizziness, lightheadedness, or unsteadiness may be experienced during menopause as fluctuating hormone levels affect insulin production, making it difficult for the body to maintain blood sugar stability.

24. Increased Allergies: 

During the menopause transition, you may experience spikes in histamine, the chemical that causes allergic reactions, which can lead to new or worsening allergy symptoms

25. Heart Palpitations: 

Palpitations are caused by fluctuating estrogen levels, which can influence the heart's electrical impulse pathways. It can feel like your heartbeat is irregular or beating faster than usual; some describe it as a fluttering sensation, while others feel like their heart is racing out of control

26. Itchy Skin:

Estrogen plays an important role in collagen production and keeping our skin hydrated, so when estrogen declines, you may experience skin irritation, dryness, and itching sensations anywhere on the body.

27. Osteoporosis Risk: 

As women age, we're at an increased risk of bone density loss, which is again linked to the decline in estrogen. In some cases, this can lead to osteoporosis, which causes the bones to become weaker and break more easily.

28. Urinary Incontinence:

Changes in hormone levels as we transition through the stages of menopause can cause the vaginal tissues to become thinner and the pelvic and bladder muscles to become weaker, leading to stress incontinence. This is a common symptom, and you may experience the need to urinate more frequently, or experience leakage, especially when sneezing, coughing, or laughing.

29. Burning Mouth or Tongue:

Our mouths contain lots of estrogen receptors, so it’s not surprising that many women will experience symptoms around the mouth and tongue. These can include a burning sensation, tingling, tenderness, heat, or even a numbing sensation, all of which are significant symptoms resulting from hormonal fluctuations during menopause.

30. Dry Eyes:

You may experience drier eyes that can feel itchy and sore as estrogen levels drop. And even though the eyes feel dry, it's not uncommon to have excessive tear production too.

31. Changes in Taste:

Some women find foods can taste different when hormones are no longer in balance and affecting their taste buds. You may find flavours stronger or experience a metallic taste in the mouth.

32. Gum Bleeding: 

Hormonal changes can make gums more susceptible to irritation and inflammation, which can often result in the gums bleeding when brushing teeth.

33. Low Confidence:

Some women experience lower confidence levels during perimenopause and menopause due to hormones fluctuating and coping with the physical and emotional symptoms, which can reduce self-esteem.

34. Changes in Body Shape: 

Menopause can bring about changes in body shape, typically characterised by an increase in abdominal fat. Hormonal shifts can affect fat distribution, often leading to a more centralised weight gain pattern.

How Many Symptoms Will I Experience? 

We understand that the list of 34 symptoms can seem overwhelming. What's important to remember is that most of us won't experience all of them. Each woman's journey through perimenopause and menopause is unique, with her own combination, frequency, and severity of symptoms. You may experience just a few and even others that aren't on this list.

Because hormone receptors are distributed throughout the body, perimenopause and menopause can affect both the brain and the body in numerous ways. In fact, recent studies suggest there may be over 60, potentially even more than 100 different symptoms, such as restless legs, recurring UTIs, and even sensations of insects crawling on the skin (known as formication), which are not included in the list of 34 mentioned above.

Lifestyle Changes

Lifestyle changes can play a significant role in managing menopause symptoms. Regular exercise, a balanced diet, and stress reduction techniques can help alleviate symptoms such as hot flushes, night sweats, and mood swings. Maintaining a healthy weight, getting enough sleep, and avoiding triggers such as spicy foods and hot beverages can also help reduce the frequency and severity of menopause symptoms. Furthermore, lifestyle changes can also help prevent long-term health consequences associated with menopause, such as osteoporosis and heart disease. By incorporating these healthy habits into daily routines, women can improve their overall quality of life and better manage the symptoms of menopause.

Treatments for Menopause Symptoms 

The good news is that the majority of symptoms can be treated effectively, be it with prescribed menopause medications, support from natural remedies, lifestyle changes, eating well, or practicing self-care, which, whether alone or combined, can all have a big impact on how you are feeling.

Remember, there's no right or wrong; just whatever works for you.

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