Reference asset
The 34 symptoms of perimenopause
The 34 symptoms of perimenopause is a widely shared list, not an official NHS checklist. Many, including hot flushes, irregular periods, mood changes, sleep problems, brain fog, joint aches and vaginal dryness, are recognised by the NHS. Others are commonly reported with limited specific evidence. Symptoms vary a lot between women. This is information, not medical advice; see your GP if symptoms affect your life.
The "34 symptoms of perimenopause" list is everywhere online, but it is a lay list rather than an official NHS or NICE document, and versions of it vary. Below we set out each of the 34 and grade how well it is recognised: 19 appear on the NHS menopause and perimenopause symptoms page, 5 are recognised in guidance or are an established effect of falling oestrogen, and 10 are commonly reported with more limited specific evidence. The point is not to worry you into spotting all 34, but to help you tell the well-evidenced from the anecdotal.
The 34 symptoms, graded
Grade key: NHS-listed appears on the NHS symptoms page; Recognised is recognised in guidance or an established effect of falling oestrogen; Commonly reported is widely listed with limited specific evidence.
| # | Symptom | Evidence grade | What it is |
|---|---|---|---|
| 1 | Hot flushes | NHS-listed | A sudden feeling of heat in the face, neck and chest. One of the most recognised vasomotor symptoms. |
| 2 | Night sweats | Recognised | Hot flushes that happen at night and disturb sleep; grouped with vasomotor symptoms. |
| 3 | Irregular periods | NHS-listed | Periods becoming more or less frequent, heavier or lighter. The hallmark change of perimenopause. |
| 4 | Mood swings | NHS-listed | Changes to mood are listed by the NHS among the mental-health symptoms. |
| 5 | Low mood or depression | NHS-listed | Low mood is NHS-listed. Persistent low mood is worth raising with your GP, as it is treatable. |
| 6 | Anxiety | NHS-listed | Feelings of anxiety are listed by the NHS among the changes to mood. |
| 7 | Irritability | NHS-listed | Often reported alongside tiredness from disturbed sleep. |
| 8 | Feelings of panic | Commonly reported | Panicky feelings overlap with anxiety; frequent panic has other causes too, so mention it to your GP. |
| 9 | Fatigue and low energy | Recognised | Commonly follows disrupted sleep; the NHS links poor sleep to feeling tired and irritable. |
| 10 | Difficulty sleeping (insomnia) | NHS-listed | Difficulty sleeping is NHS-listed and may be worsened by night sweats. |
| 11 | Brain fog and poor concentration | NHS-listed | Problems with memory or concentration are listed by the NHS. |
| 12 | Memory lapses | NHS-listed | Forgetfulness sits under the NHS memory-and-concentration symptom. |
| 13 | Reduced libido | NHS-listed | A reduced sex drive is NHS-listed. |
| 14 | Vaginal dryness | NHS-listed | NHS-listed; part of what clinicians call genitourinary symptoms. |
| 15 | Pain or discomfort during sex | NHS-listed | Pain, itching or discomfort during sex is listed by the NHS and is treatable, so ask your GP. |
| 16 | Recurrent urinary tract infections | NHS-listed | Recurrent UTIs are NHS-listed among the genitourinary changes. |
| 17 | Urinary urgency or incontinence | Recognised | Part of the genitourinary syndrome of menopause; recognised in clinical guidance and manageable. |
| 18 | Joint aches | NHS-listed | Muscle aches and joint pains are NHS-listed. |
| 19 | Muscle aches and tension | NHS-listed | Listed by the NHS alongside joint pain. |
| 20 | Headaches and migraines | NHS-listed | Headaches and migraines that are worse than usual are NHS-listed. |
| 21 | Palpitations | NHS-listed | Palpitations are NHS-listed. New or severe palpitations should always be checked by a doctor. |
| 22 | Weight gain and changed body shape | NHS-listed | A changed body shape and weight gain are NHS-listed; body composition can shift as oestrogen falls. |
| 23 | Dry and itchy skin | NHS-listed | Skin changes including dry and itchy skin are NHS-listed. |
| 24 | Formication (crawling skin sensation) | Recognised | A sensation of insects crawling on the skin; reported in menopause and linked to skin changes. |
| 25 | Breast tenderness | Commonly reported | Hormonal breast soreness is common. Report any new lump or one-sided change to your GP promptly. |
| 26 | Bloating | Commonly reported | Widely reported; often has dietary or other causes, so persistent bloating is worth checking. |
| 27 | Digestive changes | Commonly reported | Reported in the lists with limited specific evidence; persistent changes have other causes to rule out. |
| 28 | Dizziness | Commonly reported | Commonly listed but non-specific; frequent dizziness should be discussed with your GP. |
| 29 | Tingling extremities | Commonly reported | Pins-and-needles type sensations; limited specific evidence and several possible causes. |
| 30 | Electric shock sensations | Commonly reported | A brief zap-like feeling, often reported before a hot flush; largely anecdotal in the evidence. |
| 31 | Hair thinning or loss | Commonly reported | Frequently reported; evidence tying it specifically to perimenopause is limited, and it has other causes. |
| 32 | Brittle nails | Commonly reported | Commonly listed with limited specific evidence; nutrition and general health also play a part. |
| 33 | Burning mouth or altered taste | Commonly reported | Burning-mouth sensations are reported around menopause; evidence is limited, so ask your GP or dentist. |
| 34 | Reduced bone density | Recognised | Not felt day to day, but falling oestrogen can speed bone loss, raising longer-term osteoporosis risk. This is why vitamin D, calcium and weight-bearing exercise get attention. |
Some circulating versions of the list also mention changes to body odour, taste, gum health or new allergies; these have little specific evidence and several other causes. Grading reflects NHS and NICE guidance as of 2026-06-08; guidance can change, so always check the current NHS page.
The same list as plain text
| # | Symptom | Evidence grade | What it is | |---|---|---|---| | 1 | Hot flushes | NHS-listed | A sudden feeling of heat in the face, neck and chest. One of the most recognised vasomotor symptoms. | | 2 | Night sweats | Recognised | Hot flushes that happen at night and disturb sleep; grouped with vasomotor symptoms. | | 3 | Irregular periods | NHS-listed | Periods becoming more or less frequent, heavier or lighter. The hallmark change of perimenopause. | | 4 | Mood swings | NHS-listed | Changes to mood are listed by the NHS among the mental-health symptoms. | | 5 | Low mood or depression | NHS-listed | Low mood is NHS-listed. Persistent low mood is worth raising with your GP, as it is treatable. | | 6 | Anxiety | NHS-listed | Feelings of anxiety are listed by the NHS among the changes to mood. | | 7 | Irritability | NHS-listed | Often reported alongside tiredness from disturbed sleep. | | 8 | Feelings of panic | Commonly reported | Panicky feelings overlap with anxiety; frequent panic has other causes too, so mention it to your GP. | | 9 | Fatigue and low energy | Recognised | Commonly follows disrupted sleep; the NHS links poor sleep to feeling tired and irritable. | | 10 | Difficulty sleeping (insomnia) | NHS-listed | Difficulty sleeping is NHS-listed and may be worsened by night sweats. | | 11 | Brain fog and poor concentration | NHS-listed | Problems with memory or concentration are listed by the NHS. | | 12 | Memory lapses | NHS-listed | Forgetfulness sits under the NHS memory-and-concentration symptom. | | 13 | Reduced libido | NHS-listed | A reduced sex drive is NHS-listed. | | 14 | Vaginal dryness | NHS-listed | NHS-listed; part of what clinicians call genitourinary symptoms. | | 15 | Pain or discomfort during sex | NHS-listed | Pain, itching or discomfort during sex is listed by the NHS and is treatable, so ask your GP. | | 16 | Recurrent urinary tract infections | NHS-listed | Recurrent UTIs are NHS-listed among the genitourinary changes. | | 17 | Urinary urgency or incontinence | Recognised | Part of the genitourinary syndrome of menopause; recognised in clinical guidance and manageable. | | 18 | Joint aches | NHS-listed | Muscle aches and joint pains are NHS-listed. | | 19 | Muscle aches and tension | NHS-listed | Listed by the NHS alongside joint pain. | | 20 | Headaches and migraines | NHS-listed | Headaches and migraines that are worse than usual are NHS-listed. | | 21 | Palpitations | NHS-listed | Palpitations are NHS-listed. New or severe palpitations should always be checked by a doctor. | | 22 | Weight gain and changed body shape | NHS-listed | A changed body shape and weight gain are NHS-listed; body composition can shift as oestrogen falls. | | 23 | Dry and itchy skin | NHS-listed | Skin changes including dry and itchy skin are NHS-listed. | | 24 | Formication (crawling skin sensation) | Recognised | A sensation of insects crawling on the skin; reported in menopause and linked to skin changes. | | 25 | Breast tenderness | Commonly reported | Hormonal breast soreness is common. Report any new lump or one-sided change to your GP promptly. | | 26 | Bloating | Commonly reported | Widely reported; often has dietary or other causes, so persistent bloating is worth checking. | | 27 | Digestive changes | Commonly reported | Reported in the lists with limited specific evidence; persistent changes have other causes to rule out. | | 28 | Dizziness | Commonly reported | Commonly listed but non-specific; frequent dizziness should be discussed with your GP. | | 29 | Tingling extremities | Commonly reported | Pins-and-needles type sensations; limited specific evidence and several possible causes. | | 30 | Electric shock sensations | Commonly reported | A brief zap-like feeling, often reported before a hot flush; largely anecdotal in the evidence. | | 31 | Hair thinning or loss | Commonly reported | Frequently reported; evidence tying it specifically to perimenopause is limited, and it has other causes. | | 32 | Brittle nails | Commonly reported | Commonly listed with limited specific evidence; nutrition and general health also play a part. | | 33 | Burning mouth or altered taste | Commonly reported | Burning-mouth sensations are reported around menopause; evidence is limited, so ask your GP or dentist. | | 34 | Reduced bone density | Recognised | Not felt day to day, but falling oestrogen can speed bone loss, raising longer-term osteoporosis risk. This is why vitamin D, calcium and weight-bearing exercise get attention. |
How we graded the list
We took the commonly circulated 34-symptom list and compared each entry against the NHS menopause and perimenopause symptoms page and NICE guideline NG23. A symptom is graded NHS-listed only where it appears on that NHS page. It is graded recognised where guidance groups it differently or where it is an established consequence of falling oestrogen, such as reduced bone density. Everything else is graded commonly reported: it appears widely in the lists but with limited evidence tying it specifically to perimenopause, and it often has other possible causes. We have not attached invented percentages or prevalence figures to any symptom, because reliable per-symptom UK figures for a lay list like this do not exist.
This is a reference to help you understand a popular list, not a diagnostic tool. Perimenopause is diagnosed from your symptoms and history by a clinician, and for women over 45 NICE says a blood test is usually not needed. Track what you notice and raise it with your GP, especially anything that affects your daily life.
Related reading
For what helps with each, see perimenopause symptoms and what helps and the symptom-by-symptom menopause and perimenopause symptoms hub, with guides to hot flushes and night sweats, sleep problems, low mood and anxiety, brain fog and joint aches. Where supplements fit is set out in our perimenopause and supplements guide and the evidence-graded perimenopause supplements league table.
Cite this dataset
To reference this grading, please credit Her Vitals and link to this page:
Source: Her Vitals, The 34 symptoms of perimenopause, evidence-graded, https://hervitals.co.uk/34-symptoms-of-perimenopause/. DOI: https://doi.org/10.5281/zenodo.21468053
Archived with a permanent DOI: 10.5281/zenodo.21468053, CC BY 4.0. Download the underlying data: The 34 symptoms of perimenopause, evidence-graded (CSV). The CSV is generated from the same table shown above, so the two cannot diverge.
Frequently asked questions
What are the 34 symptoms of perimenopause?
The "34 symptoms" is a widely shared list that includes hot flushes, night sweats, irregular periods, mood swings, low mood, anxiety, irritability, sleep problems, brain fog, memory lapses, fatigue, reduced libido, vaginal dryness, painful sex, recurrent UTIs, urinary changes, joint aches, muscle aches, headaches, palpitations, weight gain, dry or itchy skin, formication, breast tenderness, bloating, digestive changes, dizziness, tingling, electric shock sensations, hair thinning, brittle nails, burning mouth, panic feelings and reduced bone density. Many are recognised by the NHS; some are commonly reported with limited specific evidence.
Is the 34 symptoms list official?
No. It is a popular list that circulates online, not an official NHS or NICE checklist, and exact versions vary. The NHS lists a core set of menopause and perimenopause symptoms, and this page grades each of the 34 against that guidance so you can see which are well recognised and which are more anecdotal.
How many perimenopause symptoms are there really?
There is no fixed number. Symptoms vary a lot between women, and not everyone gets many of them. The "34" and "100 symptoms" figures are lay lists rather than clinical counts. What matters is whether symptoms are affecting your life, which is the point at which the NHS encourages seeing your GP.
Do I need a test to confirm perimenopause?
Usually not. NICE guidance (NG23) says that for women over 45 with typical symptoms, perimenopause and menopause can be diagnosed from symptoms without a blood test. A test may be considered in younger women or where the picture is unclear. Your GP can advise on your situation.
Can supplements treat these symptoms?
No. Supplements do not treat perimenopause, and products that claim to are overstating what is allowed. Some nutrients support general health that matters in this stage, such as vitamin D and calcium for bones, but that is not symptom treatment. For symptom relief, the main evidence-based option is HRT, discussed with your GP.
This is information, not medical advice, and is not a substitute for a registered clinician. If perimenopause symptoms are affecting your life, or if you have any bleeding after the menopause, speak to your GP.
Editor, Her Vitals
Oliver leads Her Vitals's editorial coverage of women's life-stage health and supplements. He curates and reviews existing branded products across trying to conceive, pregnancy, postnatal, perimenopause, menopause and the senior years, weighing what the evidence supports against guidance from bodies such as EFSA, the NHS and NICE, and is clear that the content is information rather than medical advice.
Last reviewed: 8 June 2026
Reviewed by Oliver Mackman, Editor. Editorial review against published guidance; not a clinical review.