The list nobody hands you.
Most women can name three. There are more than 130 on this list, and being told each one is a separate problem is how women lose years.
Ask most women to name the symptoms of perimenopause and you will get hot flashes, night sweats, and irregular periods. Three. Ask a woman who is actually in it and she will give you a list of things she has never once connected to each other: the shoulder that will not free up, the 3am waking, the migraine that now arrives with her period, the flooding, the rage, the words that go missing mid-sentence.
There are more than 130 of them. We have gathered 135 on this page.
The problem was never that the list is long. The problem is that nobody hands it to you, so each item gets taken to a different appointment, gets a different explanation, and gets treated as its own small failure. The shoulder goes to physio. The mood goes to a prescription. The bleeding gets a scan. The tiredness gets a shrug.
Two that belong on this list more loudly than they are
Heavy bleeding. Bleeding that soaks through a pad or a tampon in an hour, that lasts longer than it used to, or that arrives with clots is extremely common in perimenopause, and it is one of the most under-raised. As estrogen swings and ovulation becomes unreliable, the lining can build up further than it used to before it comes away. Two things follow from that. It is worth naming to a doctor rather than absorbing, and it is a common route to low ferritin, which produces its own exhaustion on top of everything else.
Migraine. Migraine attacks often become more frequent or more severe in perimenopause, including in women whose migraine was settled for years, and they commonly cluster around the period. That is the estrogen drop, not a new brain problem. Heavy bleeding makes it worse, because the iron loss and the migraine feed each other.
Neither of these is a footnote. They are two of the most disruptive things on the whole list and two of the most likely to be handled as though they had nothing to do with the rest.
All 135, grouped
Read it the way you would read a list of names, looking for your own. You are not meant to have all of these, and nobody does. Most women recognise somewhere between six and twenty.
Your periods16
The cycle usually changes first, and it rarely changes tidily.
- Cycles getting shorter
- Cycles getting longer
- Cycles that stopped being predictable
- Skipped months
- Two periods in one month
- Much heavier bleeding
- Flooding, through a pad or a tampon in under an hour
- Large clots
- Periods that last longer than they used to
- Spotting between periods
- Cramps that got worse
- Cramps where there never were any
- PMS that is suddenly worse
- PMS that is new
- Sore breasts
- Breast pain that is new
Heat, and cold8
The one everybody knows, and the ones nobody mentions.
- Hot flashes
- Night sweats
- Waking up soaked
- Sudden chills
- Cold flushes
- Feeling hot when nobody else in the room is
- Clammy skin
- Flushing across the face, neck and chest
Sleep8
Not only less sleep. Sleep that has stopped working.
- Trouble falling asleep
- Waking at 3am
- Waking and not getting back
- Sleep that leaves you as tired as you went in
- Restless legs
- Anxiety that arrives at night
- Snoring that is new
- Vivid dreams, or nightmares
Mood13
Most often read as stress, or as a personality problem.
- Anxiety that is new
- Anxiety that is louder than it was
- Panic attacks
- Low mood
- Crying at things that would not have touched you
- Irritability
- Rage that arrives in seconds
- Losing confidence
- Losing motivation
- Ordinary things feeling like too much
- Worrying about your health
- Feeling flat
- Not feeling like yourself
Memory and concentration8
The one women are most frightened by, and least often told about.
- Brain fog
- Losing words mid-sentence
- Forgetting names you have known for years
- Walking into a room and forgetting why
- Losing the thread in a meeting
- Not being able to concentrate
- Not being able to hold two things at once
- Reading the same line three times
Head and nerves14
These are the ones that send women for scans.
- Migraine that is new
- Migraine that got worse
- Headaches that arrive with your period
- Dizziness
- Vertigo
- Light-headedness on standing
- Ringing in the ears
- Sounds that feel too loud
- Electric shock sensations
- Skin that feels like something is crawling on it
- Tingling in the hands or feet
- Numbness
- A burning feeling in the mouth
- A metallic taste
Joints and muscles10
Frequently put down to age, or to the gym.
- Joint pain
- Stiffness in the morning
- Frozen shoulder
- Aching hands
- Aching hips
- Muscle aches
- Losing strength you had
- Heel or foot pain
- Back pain
- Injuries taking much longer to heal
Heart and chest6
Worth a doctor's eye, and often perfectly explainable.
- Palpitations
- A racing heart while sitting still
- Skipped beats
- Getting breathless on stairs you used to run up
- Blood pressure creeping up
- Cholesterol creeping up
Skin, hair and nails12
The changes that show, and are read as vanity when raised.
- Dry skin
- Itchy skin
- Itchy ears
- Acne after twenty years without it
- Hair thinning
- Hair coming out in the shower
- Hair arriving on your face
- Brittle nails
- Bruising easily
- Cuts healing slowly
- Skin that has lost its bounce
- A change in how you smell
Eyes, mouth and teeth8
Rarely connected to hormones by anyone in the room.
- Dry eyes
- Gritty eyes
- Contact lenses becoming unbearable
- Blurred vision
- Dry mouth
- Bleeding gums
- Receding gums
- Teeth that have gone sensitive
Digestion and weight10
The same food, the same walk, a different result.
- Weight settling around the middle
- Bloating
- Nausea
- Indigestion
- Foods you used to be fine with
- Alcohol hitting far harder
- Constipation
- Looser bowels
- Appetite that has changed
- Sugar cravings
Bladder and pelvic floor7
Common, treatable, and almost never raised out loud.
- Needing to go far more often
- Urgency that arrives with no warning
- Getting up in the night to go
- Urine infections that keep coming back
- Leaking when you cough or laugh
- Leaking when you run or lift
- A feeling of heaviness or dragging
Sex and intimacy7
The most under-reported group on this page, and among the most treatable.
- Vaginal dryness
- Pain during sex
- Burning or irritation
- Less sensation
- Lower libido
- Loss of interest that upsets you
- Tissue that feels thinner or more fragile
Energy, and the rest8
The ones with no category, which is why they get dismissed.
- Tiredness that sleep does not fix
- No stamina
- Workouts that used to be easy
- Needing days to recover
- Allergies arriving out of nowhere
- Reacting to things you never reacted to
- Feeling cold all the time
- A body that is not doing what you tell it
What a long list does not mean
A list is not a diagnosis, and a long list is not a stronger one. Several things here have other causes that matter more than perimenopause and need ruling out properly: thyroid disease, anaemia, diabetes, depression, and sleep apnoea all overlap with this page.
Three things on this list are not for a checklist at all and should be taken to a doctor promptly rather than added up: bleeding between periods or after sex, any bleeding after a full year without periods, and a new lump. Those are not perimenopause questions. They are questions for an appointment.
So the list is not the answer. What it is for is the connection, because the connection is the thing no one gives you: these are not eleven separate problems arriving in the same decade of your life.
What to do with it
Take the ones that are true of you and write them down together, on one page, in one list. Not the shoulder to physio and the mood to the GP. All of it, in front of one person, at one appointment, with roughly when each one started and how much it is costing you.
That single page is the thing that changes appointments, and it is the thing most women have never had. It is also, more or less exactly, what a read produces: six questions, ninety seconds, and a verdict on your own pattern rather than a population average, written so you can print it and hand it over.
If you want the longer explanation of what is actually happening underneath all of this, start here. If a doctor has already told you your bloodwork is normal, this one is for you.
A few quick questions
- How many symptoms does perimenopause have?
- Published A-Z lists from menopause charities and clinicians run well past a hundred. This page gathers 135, grouped. No one has all of them, and most women recognise between six and twenty.
- Is heavy bleeding normal in perimenopause?
- It is common, which is not the same as something to put up with. Bleeding that soaks a pad or tampon within an hour, lasts longer than it used to, or comes with large clots is worth raising with a doctor, both because it is treatable and because it is a common cause of low iron. Bleeding between periods, after sex, or after a year with no periods is different again and needs an appointment soon.
- Can perimenopause cause migraines?
- Yes, and it commonly makes existing migraine worse. Attacks often cluster around the period, when estrogen drops most sharply. Women who had migraine under control for years frequently see it return in perimenopause.
- How many of these do I need to have?
- There is no number that makes it official. Perimenopause is recognised mostly from your symptoms and your age taken together, not from one test result. That is why the pattern matters more than the count.
Almost every woman who reads a list like this one has the same reaction, and it is not relief. It is anger, that it took this long, and that nobody said any of it out loud. That reaction is the correct one.
You were not failing at eleven separate things. You were never given the one page that would have made them make sense together.
Stree Sense writes to help you understand your body, not to diagnose or treat. For anything that worries you, take it to a doctor.
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