The 34 symptoms of perimenopause (and a few more): a plain-English list

Perimenopause is the time leading up to your last period. Your hormone levels start to go up and down, and it can begin in your late 30s or early 40s (Women's Health Concern). You reach menopause when you haven't had a period for 12 months. For most women this happens between 45 and 55 (NHS).

You may have read that there are "34 symptoms of perimenopause". That isn't an official medical list. The NHS and the NICE menopause guideline describe the symptoms, but neither puts a number on them. The 34 is a popular shorthand that has spread across the internet. The Menopause Charity says there are "over 34", and its own A to Z of symptoms has nearly 80 entries. So below we've listed 57, grouped by part of the body. Each one links to a fuller page.

Nobody gets all of these. Some women breeze through with no symptoms, while others find them very disturbing (Women's Health Concern). Hot flushes and night sweats are the most common, affecting 70 to 80% of women (British Menopause Society). There's no official list of the "worst" symptoms. The worst one is whichever is getting in the way of your life. If you're ticking things off as you read, use our free symptoms checklist: tick yours and print a list for your GP.

Heat and sweating

1. Hot flushes

A sudden wave of heat in your face, neck and chest. It can bring sweating, a racing heart, anxiety or dizziness (NHS). Read more about hot flushes (hot flashes) and why hot flushes are worse at night. Our hypnosis for menopause hot flushes is a relaxation recording with cool, calming imagery, to help you feel calmer when the heat rises.

2. Night sweats

Hot flushes that happen in your sleep, often leaving you and the sheets soaked. The NHS lists menopause as one of the most common causes of night sweats. See a GP if you also have a high temperature or you're losing weight without trying (NHS). Our guide to night sweats has practical tips.

3. Cold flushes and chills

Sudden shivering or feeling icy cold, sometimes straight after a hot sweat. The Menopause Charity includes cold flushes in its list of symptoms. Chills with a fever are different, so speak to your GP if you have both. Read more about cold flushes.

4. Body odour

Some women notice they smell different, or sweat more than they used to. Extra sweat from hot flushes may play a part, but there's very little research on this. Read more about perimenopause body odour (odor).

Sleep and tiredness

5. Trouble sleeping

Finding it hard to get to sleep, waking often, or waking too early. Falling oestrogen affects sleep directly. It also affects it through flushes, sweats, mood changes, aches and needing the loo (Women's Health Concern). Read our guide to menopause insomnia. For bedtime, our menopause sleep hypnosis is a recording to help you relax and drift off.

6. Waking at 3am

Your eyes snap open in the small hours, often hot, with a racing mind. Waking often in the night is one of the sleep problems Women's Health Concern lists for the menopause. Our article on waking at 3am explains why it happens. If it's a pattern, Back to Sleep is a short, easy recording to help you let go and drift back off.

7. Nightmares

Vivid, strange or upsetting dreams. They aren't on the main NHS list, and there's little research on dreams and the menopause. But if it's happening to you, you're not imagining it. Read more about menopause nightmares.

8. Restless legs

A strong urge to move your legs, often with tingling or throbbing, usually when you're resting at night (NHS). Women's Health Concern says it's more common after the menopause. It suggests asking for a blood test to check your iron stores, as low iron can be a cause. Read more about restless legs.

9. Fatigue

Tiredness that a night's sleep doesn't fix. Low energy is one of the symptoms the British Menopause Society lists, and broken sleep makes it worse. If you're suddenly exhausted, your GP may suggest a blood test to rule out other causes. Read more about perimenopause fatigue.

Mood and mind

10. Anxiety

Worry, unease or a sense of dread that seems to come from nowhere. The NHS lists anxiety and mood changes as symptoms of perimenopause. Read our guide to menopause anxiety. If it's anxiety at bedtime, our hypnosis for menopause anxiety is a recording to help you feel calmer.

11. Panic attacks

A sudden rush of intense fear, with a pounding heart, sweating or feeling you can't breathe. The Menopause Charity lists panic attacks and notes they can be new to you. If it's your first one and you have chest pain, call 999 so your heart can be checked. Read more about perimenopause panic attacks.

12. Mood swings and crying

Fine one minute, tearful or snappy the next. The Menopause Charity lists mood swings and crying spells, sometimes set off by small things. Read more about menopause mood swings.

13. Rage and irritability

A short fuse, or anger that feels far bigger than the thing that caused it. Irritability is on the Menopause Charity's list. If your anger ever feels out of control, or you're afraid you might hurt someone, talk to your GP. Read more about perimenopause rage.

14. Low mood and depression

Feeling flat or hopeless, or losing interest in things you used to enjoy. NICE lists low mood as a menopause symptom. It says HRT can be considered when low mood starts around the same time as other menopause symptoms, and CBT is another option (NICE NG23). If you've felt low most days for two weeks or more, see your GP. Read more about perimenopause depression.

15. Brain fog and memory problems

Losing words, forgetting why you walked into a room, struggling to focus. The NHS lists poor memory and brain fog as symptoms. Read our guide to menopause brain fog. Our hypnosis for menopause brain fog and mood is a recording to help you feel calmer and more settled.

16. ADHD feeling harder to manage

If you have ADHD, diagnosed or not, you may find it harder to cope with in perimenopause. A 2026 review for health professionals says the menopause can amplify parts of ADHD that make daily life hard. But research is at an early stage: one UK study found women with ADHD didn't report more menopause symptoms overall. Read more about ADHD and menopause.

Head, ears and senses

17. Headaches and migraines

The NHS lists headaches and migraines that are worse than usual. Its headache page also names menopause as a cause of "hormone headaches" (NHS). A diary can help you spot your triggers. Read more about perimenopause headaches.

18. Dizziness and vertigo

Feeling light-headed, off balance, or as if the room is spinning. The NHS says hot flushes can bring dizziness, and the Menopause Charity lists vertigo too. See a GP if it keeps coming back, or comes with numbness, weakness or changes in your eyesight (NHS). Read more about menopause dizziness.

19. Tinnitus

Ringing, buzzing, humming or whooshing in your ears (NHS). The Menopause Charity includes it, but says it isn't commonly linked to the menopause and can have other causes, so get it checked. Ask for an urgent GP appointment if it beats in time with your pulse. Read more about tinnitus and menopause.

20. Itchy ears

An itch deep in your ears or around them that's hard to leave alone. Falling oestrogen can leave skin drier and itchier (the Menopause Charity), and that may include the skin in your ears. There's little research on this one. Ear pain, discharge or hearing loss need a GP. Read more about itchy ears in menopause.

21. Dry eyes

Gritty, sore, itchy or tired eyes. Dry eyes are on the Menopause Charity's list, and the NHS says being over 50 and long hours at a screen can play a part. A painful red eye needs an urgent GP appointment, and a sudden change in your vision needs A&E (NHS). Read more about dry eyes in menopause.

22. Dry mouth

A sticky, parched mouth, especially at night. The Menopause Charity links it to making less saliva. The NHS says a dry mouth makes tooth decay more likely, and one that won't go away can sometimes be caused by diabetes (NHS). Read more about dry mouth in menopause.

23. Burning mouth, gums and teeth

The NHS lists sensitive teeth, painful gums and other mouth problems. Some women get burning mouth syndrome: a scalding, tingling or numb feeling in the mouth, lips or tongue. It's more common in women over 50 (the Menopause Charity). Read more about mouth changes in menopause.

24. Sore throat

A dry, scratchy throat that doesn't seem to come with a cold. There's little research on the menopause link. See a GP if a sore throat keeps coming back, or you have a lump in your neck or a mouth ulcer lasting more than 3 weeks (NHS). Read more about perimenopause sore throat.

Heart and breathing

25. Heart palpitations

A racing, pounding, fluttering or skipping heartbeat. The NHS says palpitations can sometimes be a sign you're going through the menopause. Call 999 if they don't stop, or come with chest pain, breathlessness or fainting (NHS). Read more about perimenopause heart palpitations.

26. High blood pressure

High blood pressure usually has no symptoms, so the only way to know is to get it checked. Many pharmacies offer free checks if you're 40 or over (NHS). The British Heart Foundation says that after the menopause your blood vessels may not respond as well to change, so your blood pressure could go up (BHF). Read more about menopause and high blood pressure.

Skin, hair and nails

27. Itchy skin

An itch that can be anywhere, and is often worse at night. Less oestrogen means fewer of the skin's natural moisturisers (the Menopause Charity). The NHS says itchy skin is common after the menopause and usually gets better over time. Less often, it can be a sign of a thyroid, liver or kidney problem (NHS). Read more about perimenopause itchy skin.

28. Tingling, crawling skin and electric shocks

Pins and needles, a feeling like insects crawling on your skin, or brief electric shocks. The Menopause Charity lists electric shocks, pins and needles, and tingling hands or feet. Sudden numbness or weakness on one side of your body is different: call 999. Read more about tingling and crawling skin.

29. Dry skin, rashes and nail changes

The NHS lists dry skin as a symptom. The Menopause Charity adds skin that turns oilier or more sensitive, and nails that break, split or peel more easily. Show your GP any mole that changes or a sore that won't heal. Read more about menopause skin changes.

30. Acne

Spots you thought you'd left behind as a teenager. The NHS says changes in hormone levels, including during the menopause, can cause acne (NHS). See a GP if acne comes on suddenly with extra hair growth or a deeper voice. Read more about menopause acne.

31. Itchy scalp

A dry, itchy or tight scalp, sometimes with flakes. It's likely part of the general dryness some women notice, though there's little research on the scalp itself. Scaly patches or hair falling out in patches need a GP. Read more about itchy scalp in menopause.

32. Hair thinning and hair loss

More hair in the brush, or a wider parting. The NHS lists hair thinning and hair loss as menopause symptoms. Stress, illness and low iron can cause hair loss too, so see a GP if you're worried (NHS). Read more about menopause hair loss.

33. Facial hair

Stray hairs on your chin or upper lip. The NHS says most women get more fine, light hair on their face as they get older, especially after the menopause. See a GP if you get thick, dark hair on your face or body (NHS). Read more about menopause facial hair.

Muscles and joints

34. Joint pain

Stiff, aching joints, in one place or several. The NHS lists joint pain and says it can carry on after the menopause. Joints respond to oestrogen, and when it falls, inflammation can go up (the Menopause Charity). Hot, swollen or red joints need a GP. Read more about menopause joint pain.

35. Aches all over

Muscle aches, stiff joints and feeling "creaky" all at once. A 2024 review suggested a new name for this group of problems linked to falling oestrogen: the musculoskeletal syndrome of menopause. It's a new term rather than an official diagnosis. Read more about musculoskeletal syndrome of menopause.

36. Frozen shoulder

Shoulder pain and stiffness that make it hard to lift your arm. The pain can be worse at night, and it can last months or even years, but it usually eases in the end (NHS). The link with menopause is talked about a lot, but the evidence is still limited. Read more about frozen shoulder and menopause.

37. Hip pain

An ache in or around the hip that can make it hard to lie on that side. See a GP if it's affecting your sleep or hasn't improved after 2 weeks. If you can't walk or put weight on your leg, call 999 or go to A&E (NHS). Read more about hip pain in menopause.

38. Back pain

Aches in your lower or upper back. Joint and muscle pain are among the menopause symptoms NICE lists. Back pain with numbness around your bottom or genitals, or new problems controlling your bladder, needs 999. Read more about menopause back pain.

39. Foot and heel pain

Pain under your heel or arch that's worst with your first steps in the morning. That's often plantar fasciitis (NHS). Its link to the menopause hasn't been studied much. Read more about plantar fasciitis and menopause.

Tummy, gut and weight

40. Bloating

A full, tight, swollen tummy that comes and goes. The Menopause Charity lists bloating as a symptom. But bloating that happens often (around 12 or more times a month), or won't go away, can be a sign of ovarian cancer, so see your GP (NHS). Read more about menopause bloating.

41. Nausea

Feeling queasy, sometimes with heartburn or dizziness (the Menopause Charity). You can still get pregnant in perimenopause, which is why you're advised to keep using contraception (Women's Health Concern). So if there's any chance, do a test. Call 999 if you suddenly feel sick and have tight chest pain (NHS). Read more about perimenopause nausea.

42. Heartburn

A burning feeling in your chest or throat, often after eating. See a GP if you have it most days, or food gets stuck, or you're losing weight without trying (NHS). "Heartburn" with chest pain that spreads to your arm or jaw needs 999. Read more about heartburn in menopause.

43. Constipation and other bowel changes

The Menopause Charity lists digestive problems, including wind and changes in your bowels. See a GP if you have blood in your poo, you've lost weight without trying, or you're often bloated (NHS). Read more about perimenopause constipation.

44. Weight gain

The NHS says weight gain is common, often around the stomach and upper body. Poor sleep can increase cravings, and joint pain can make exercise harder (the Menopause Charity). Weight loss you can't explain is a reason to see your GP. Read more about menopause weight gain.

45. Menopause belly

A thicker middle, even if the scales haven't moved much. As hormones change, the Menopause Charity says some women start to develop a "spare tyre". A tummy that stays swollen and doesn't go down is worth showing your GP. Read more about menopause belly.

Periods and bleeding

46. Period changes

Periods may come more or less often, and get heavier or lighter, before they stop altogether (NHS). Periods can be heavier as you approach the menopause. See a GP if they're affecting your life, or you bleed between periods or after sex (NHS). Read more about perimenopause period changes.

47. Spotting

Light bleeding between periods, or a little blood when you wipe. The Menopause Charity says to see a health professional about bleeding that isn't a normal period. Bleeding after sex should always be checked. Read more about perimenopause spotting.

48. Cramps

Period-type cramps, sometimes with no period. There's little research on cramps in perimenopause. Cramps after the menopause, or with bleeding, bloating or a fever, need a GP. Read more about perimenopause cramps.

49. Bleeding after menopause

Any bleeding a year or more after your last period. It's not usually serious, but always see a GP, even if it's light or only happened once. Common causes include thinning of the vaginal lining and small growths called polyps (NHS). Read more about bleeding after menopause.

Breasts

50. Sore breasts

Tender, aching breasts or sore nipples. The NHS lists hormone changes during the menopause as a cause, and says breast pain on its own is unlikely to be cancer. A lump, nipple discharge or dimpled skin needs an urgent GP appointment (NHS). Read more about menopause breast pain.

Vaginal, sexual and bladder health

51. Vaginal dryness

Dryness, burning, irritation or itching, which can make sex painful (NHS). Doctors call this and related bladder changes the genitourinary syndrome of menopause. A pharmacist can advise on moisturisers and lubricants (NHS), and vaginal oestrogen is something to ask your GP about (NICE). Read more about vaginal dryness.

52. Vaginal itching

Itching or burning around the vulva and vagina. The Menopause Charity lists this as part of the genitourinary syndrome of menopause. White, shiny patches, sores or bleeding need a GP. Read more about menopause vaginal itching.

53. Changes in discharge

More or less discharge than usual, or a change in colour or smell. Get advice from NHS 111 or your GP if your discharge changes or you feel itchy or sore (NHS). Brown or blood-stained discharge after the menopause needs a GP. Read more about menopause discharge.

54. Low sex drive

Losing interest in sex, or finding it harder to get in the mood. NICE lists low sexual desire as a menopause symptom. If HRT alone doesn't help, the British Menopause Society says testosterone can be considered, so it's worth asking your GP. Read more about perimenopause sex drive.

55. Painful sex

Soreness, stinging or tightness during or after sex, often because of vaginal dryness (NHS). It's not something you have to put up with, and there are treatments to discuss with your GP. Read more about painful sex after menopause.

56. Urine infections (UTIs)

The NHS says you may get more UTIs, or UTI-like symptoms. For repeat infections, a GP may offer vaginal oestrogen if you're in perimenopause or past the menopause (NHS). A very high temperature or shivering needs an urgent GP appointment or NHS 111. Read more about UTIs in menopause.

57. Bladder leaks and needing to wee more

Leaking when you cough or laugh, or a sudden urge to go. The NHS says to see a GP about any type of bladder leaks, and not to feel embarrassed (NHS). Read more about menopause incontinence.

What to do next

• See your GP or practice nurse if you think you have symptoms and want to know your options (NHS). If you're 45 or over, you usually don't need a blood test. Your symptoms and period changes are enough (NICE NG23).
• If you're under 45, it may be early menopause, and your GP may suggest blood tests (NHS).
• Take a list. Our free symptoms checklist lets you tick yours and print them for your appointment.
• Ask about treatments. HRT is the most effective treatment for menopause symptoms, and for most women it's low risk (Women's Health Concern). CBT and non-hormonal medicines are options too.
• Read more on the NHS menopause pages, Women's Health Concern and the Menopause Charity.

If hot flushes, sleepless nights, 3am waking, anxiety or brain fog are on your list, our five recordings in The Calm Change were made for those moments. Each one is a gentle hypnosis recording to help you relax, unwind or drift off. They're relaxation recordings, not a treatment, and they don't replace advice from your GP. If you'd like to try our style first, our free Ten-Minute Calm Reset is a good place to start.

This page is general information, not medical advice. If you're worried about any symptom, please talk to your GP or pharmacist.