The symptoms of menopause, and the ones people miss

Most people can name the hot flush. Far fewer know that menopause can show up as anxiety, aching joints, palpitations, recurrent urinary infections, or a memory that suddenly feels unreliable. Because oestrogen receptors sit in tissues all over the body, falling oestrogen can produce a long and varied list of symptoms.

This article runs through the common symptoms and, more usefully, the ones that are routinely missed or blamed on something else.

The vasomotor symptoms

Hot flushes and night sweats are the classic vasomotor symptoms, affecting around three in four women. A flush is a sudden wave of heat, often with reddening of the face and chest and sometimes a racing heart, lasting a few minutes. At night they fragment sleep, which then feeds fatigue, low mood, and poor concentration the next day. For most women these are the symptoms that respond fastest to treatment.

Sleep, mood and the mind

Disturbed sleep is partly the night sweats and partly a direct effect of hormonal change on sleep regulation. Alongside it come mood symptoms: low mood, irritability, tearfulness, and anxiety that can feel new and out of character. Many women describe brain fog, a mix of poor concentration, word-finding difficulty, and forgetfulness. This is real and common, and for most women it improves. It is not early dementia, though it can be unsettling enough to make you wonder.

The symptoms people do not connect

Any one of these in isolation can send you down a different diagnostic path:

• Joint and muscle aches, often in the hands, shoulders and knees, sometimes mistaken for the start of arthritis.

• Palpitations, a sense of the heart racing or skipping, which warrant a check but are frequently hormonal.

• Migraines or headaches that change in pattern around this time.

• Dry or itchy skin, and thinning hair.

• Recurrent urinary infections, urgency, or discomfort passing urine.

• Vaginal dryness, soreness, and discomfort during sex.

Seen together, in a woman in her forties or fifties whose periods are changing, these point clearly at the hormonal transition.

Genitourinary symptoms deserve their own mention

The vaginal and urinary symptoms, grouped together as the genitourinary syndrome of menopause, are the ones women raise least and clinicians ask about least. They tend to start later than flushes and, left alone, get worse rather than better, because the tissues of the vagina, urethra and bladder all depend on oestrogen. They are very treatable, often with a low-dose local treatment, and there is no reason to put up with them.

Why the list matters

The point of naming all of this is not to label every ache as menopause. Thyroid problems, low iron, depression and other conditions can overlap and sometimes coexist, which is exactly why an assessment looks at the whole picture rather than reaching for one explanation. But when a cluster of these symptoms arrives together at the right age, the hormonal transition is the most likely common thread, and it is treatable.

How long symptoms last

There is no fixed timetable. Hot flushes and night sweats last, on average, around seven years, but for some women they settle within a year or two and for others they continue well into their sixties. Mood, sleep and cognitive symptoms often track the most turbulent part of perimenopause and ease as hormone levels settle. The genitourinary symptoms are the exception: they tend to persist and slowly worsen without treatment, because the cause does not resolve on its own.

The practical message is that you do not have to wait it out. If symptoms are affecting your work, your relationships or your sleep, that alone is reason enough to do something, regardless of how long they might otherwise last.

Tracking what you feel

Because symptoms fluctuate, it helps to track them. We use a validated questionnaire called the Greene Climacteric Scale, which scores symptoms across five domains and gives a number we can repeat at every review, so you can see what is improving rather than relying on memory. Even a simple diary of your worst three symptoms is a good place to start before any appointment.

Ready to start?

If you want to move from reading to acting, the next step is a short assessment with a doctor on the GMC GP Register. It takes about ten minutes and tells you whether HRT is right for you.

Begin your assessment at this link. Online or in person at Westfield London.