There’s 43(ish) Common Symptoms of Perimenopause. Why Do We Know So Few of Them?

Lack of education and plenty of taboo around menopause has left us in the dark when it comes to understanding our midlife symptoms and hormone health. Why don’t we know what to expect of perimenopause? asks Kate Dyson

Whether you are in your late 30s, mid 40s or early 50s, there will come a point when you start to experience symptoms of perimenopause. You may find yourself asking Dr Google all sorts of strange questions like “why do I suddenly stink of BO?” and “why do I feel like I have bugs under my skin?”. As likely as you are to find you have a random tropical disease you may find that occasionally the suggestion that you are perimenopausal pops up too – which may, or may not, come somewhat as a surprise.

Are you in peri? What exactly IS menopause? And why don’t we know what we should be looking for as we get into our late 30s and early 40s and things feel, creaky? Perimenopause is the transitional phase we go through in advance of menopause – which believe it or not, is actually only 24 hours. That one day marks the point where you haven’t had a period for exactly 12 months, and after this one day you are in ‘postmenopause’. Sexy, huh.

So what IS perimenopause and why is it so hush-hush?

Perimenopause can last between one and ten years, with the average length around 4 years. Most women will be menopausal by 51 (although some experience it earlier, some later). This means you could find yourself experiencing symptoms related to perimenopause by your early 40s, easily.

Unfortunately, menopause has been stigmatised forever, and it’s only recently that women have found courage to challenge the midlife taboo and talk openly about their experiences. God forbid we dared discuss ‘the change’ with colleagues even 10 years ago? The problem is that ‘femininity’ is far too enmeshed in the idea of fertility (because of male sexual desire and procreation) so anything that no longer attracts the male gaze is considered untouchable, haggy and if you want to be desirable you best keep it to yourself. Pah! Let’s face it, they just know they’ve met their match with a midlife woman as we put them in their place with nothing more than a withering look.

While the conversation is opening up around menopause and midlife, unfortunately there’s still a serious lack of information entirely about what we should expect during this phase of our lives – especially if you don’t have access to serious cash to manage the symptoms, à la the menopause influencers we see online.

Just a case of hot sweats and brain fog, surely?

If your knowledge of menopause is confined to ‘brain fog, hot sweats and being irritable and snappy with everyone’ then you won’t be alone. Of course, while they are symptoms often reported, there is a surprising array of symptoms commonly experienced. Did you know, for example, that anxiety is one of the first symptoms reported by women to their doctor? Likely not, because historically we’ve been sent on our merry way with a clutch of antidepressants instead of HRT, and told to ‘reduce stress’. Eyeroll.

So how do you know whether you are just a bit knackered and run down – or actually, those headaches, the panic attacks and recurrent UTIs or even the dizziness are all related to perimenopause? While each of us will experience perimenopause differently, there are around 43-ish common peri symptoms to know – and hot flashes and brain fog aren’t as common as you might think.

43 Symptoms of Perimenopause

Here’s a comprehensive list of the 43 confirmed symptoms that are recognised by menopause specialists. If any of these feel familiar, know that you’re not alone, and support is available to help manage them. Wish this was a tick list you could use to manage them? Head over to our resources to download for free.

1. Hot flushes: Sudden feelings of heat, often accompanied by sweating and a flushed face.
2. Night sweats: Intense sweating during sleep, often disrupting rest.
3. Irregular periods: Changes in cycle length, flow, or frequency.
4. Mood swings: Emotional highs and lows that may feel out of character.
5. Anxiety: Feelings of unease or worry that can appear without a clear cause.
6. Irritability: Increased sensitivity to stress or frustration.
7. Fatigue: Persistent tiredness, even after adequate rest.
8. Sleep disturbances: Difficulty falling or staying asleep, often due to night sweats.
9. Brain fog: Struggling with memory, focus, or clarity of thought.
10. Memory problems: Forgetfulness or difficulty recalling information.
11. Weight gain: Particularly around the abdomen, due to hormonal changes.
12. Bloating: Increased abdominal swelling or discomfort.
13. Joint pain: Aching or stiffness in the joints, often worse in the morning.
14. Headaches: New or worsening migraines or tension headaches.
15. Skin changes: Dryness, thinning, or increased sensitivity.
16. Hair thinning: Hair loss or reduced thickness, often on the scalp.
17. Vaginal dryness: Reduced natural lubrication, which can cause discomfort.
18. Low libido: Reduced interest in or desire for intimacy.
19. Urinary incontinence: Leaks when sneezing, coughing, or laughing.
20. Recurrent UTIs: Increased risk of urinary tract infections.
21. Breast tenderness: Soreness or sensitivity, similar to premenstrual changes.
22. Palpitations: Noticeable heartbeats that may feel irregular or rapid.
23. Tinnitus: Ringing or buzzing in the ears.
24. Dizziness: Feeling light-headed or unsteady.
25. Tingling sensations: Pins and needles, particularly in extremities.
26. Increased allergies: Heightened sensitivity to allergens or irritants.
27. Dry eyes: Irritation or a gritty sensation in the eyes.
28. Dry mouth: Reduced saliva production, leading to discomfort.
29. Burning mouth syndrome: A burning sensation in the mouth or tongue.
30. Digestive changes: Altered bowel habits, including bloating or IBS-like symptoms.
31. Loss of confidence: A decline in self-esteem or self-assurance.
32. Panic attacks: Sudden, overwhelming feelings of fear or dread.
33. All-over aches and pains: Generalised muscle or body discomfort.
34. Loss of muscle mass: Reduced strength or tone due to hormonal shifts.
35. Increased body odour: Changes in sweat composition that alter scent.
36. Restless legs syndrome: Uncomfortable sensations in the legs, often at night.
37. Cold hands and feet: Poor circulation or sensitivity to temperature changes.
38. Changes in taste or smell: Altered sensitivity to flavours or scents.
39. Bleeding gums: Inflammation or sensitivity in the mouth.
40. Thinning skin: Loss of elasticity or increased fragility.
41. Acne: Breakouts due to hormonal fluctuations.
42. Hair growth in new areas: Increased facial or body hair.
43. Loss of bladder control: Urgency or difficulty holding urine.

Are there more?

Yes, there very well may be. The problem is, there’s not extensive research into all the symptoms of perimenopause and menopause, but we starting to understand that the impact of hormone imbalance and gradual decline during our peri years can have a significant impact on our whole health, including our brain and cognitive health, too. While these 43 symptoms are widely recognised, many of us report additional changes that feel tied to perimenopause.

These can include increased sensitivity to noise, a heightened sense of smell, or changes in our emotional resilience and possibly (and anecdotally at present), up around 80 or more symptoms connected to menopause. As we’re all unique, it can be helpful to record anything that you think is affecting you individually using a journal, or an app like Balance Menopause.

Managing Perimenopause Symptoms

In the UK, the ‘gold standard’ – aka the most common and effective treatment – for perimenopause symptoms is hormone replacement therapy (HRT). By replenishing oestrogen and progesterone, HRT can address many of the symptoms listed above, including hot flushes, night sweats, mood changes and vaginal dryness. It’s important to note that the NICE Guidelines for menopause are clear that a diagnosis should be offered on the basis of reported symptoms alone, and not dependent on hormonal testing. Saying that, your GP may request blood work for other reasons, and to ensure an up to date medical history as you start treatment for menopause.

HRT is available in various forms, including patches, gels, tablets, and vaginal treatments, providing plenty of choice for you to work out what works best for you. Dosage should be individually agreed with your doctor after taking into consideration your medical history, any other medications or conditions you have, and your current symptoms.

HRT is only available via prescription, so the first step is to speak to your GP. They will assess your symptoms and discuss your options. If your symptoms are complex or if you prefer more specialised advice, you may be referred to a menopause specialist. The British Menopause Society offers a list of accredited specialists, including private options if needed.

For those unable or would prefer not to use HRT, ‘natural’ options include changes to your lifestyle, supplementation (always check the ingredients for bulking agents or fillers), and Cognitive Behavioural Therapy (CBT) could help to manage some of the symptoms such as anxiety, as can yoga or other mindful activities, too.

Keep talking (and talking)

The more we share our experiences, the more we’ll learn and understand menopause. Ultimately, it’s a natural life stage that women go through, but being prepared for perimenopause can help you manage symptoms, find support and empower your choices. The more we understand about perimenopause, the better equipped we are to advocate for ourselves and access the care we need. Always remember that your experience of peri will be individual, and to speak to your GP before starting to take any new medication or supplement.