The 34 Symptoms of Menopause (And Which Ones Are Most Often Misdiagnosed)
Our everyday discussions about menopause generally boil down to a scant handful of symptoms. Hot flushes. Night sweats. Mood swings. End of story. But for women going through it, the reality is much broader, and many women are getting confused by symptoms that are less widely known, because they’re not so clearly specific to hormones (and by extension, our reproductive system).
The “34 symptoms of menopause” were popularised due to a campaign to shame menopause, and although the specific number of symptoms is an arbitrary framework, rather than a medically-defined list, it is really helpful. It allows women to draw some of their own dots together, and it debunks the myth that we only ever understand a few signs and symptoms of menopause.
In this post, I discuss all of the 34 symptoms, categorised into groups, but focusing on those that are most likely to have alternative attributions.
The list of 34 symptoms is based on years of empirical work, patient self-reported symptoms, and discussion with menopause specialists. It’s been boosted considerably by the activities of women’s health champions like Menopause Support UK and menopause specialists who have suggested that the emphasis on hot flushes is contributing to hundreds of thousands of women being missed – and untreated.
The number 34 is not hard and fast. You won’t find a particular list of 34 symptoms in the DSM or any guideline. Instead, the number 34 is an attempt to recognise that menopause affects almost every body system – cardiovascular, nervous, musculoskeletal, skin – and that the symptoms can be widely diverse.
For one woman it may be vasomotor symptoms such as hot flushes. For others, it is psychiatric symptoms, arthritis or forgetfulness. That can only mean one thing, menopause (and it makes it more difficult for a woman and her doctor to overlook the link to hormone changes).
This is a complete list of the well accepted 34 symptoms, grouped according to the body organ involved, to assist with organisation.
Pins and needles sensation (Paraesthesia): Numbness or tingling of the hands, feet and/or face.
The wide range, or plethora, of 34 symptoms often means that menopause might not be the first possibility that springs to mind for the woman herself or in consultation with her treating doctor. There are a number of symptoms that consistently get blamed for other causes, including for many years before a link to hormone fluctuations is identified.
Women presenting to their doctor with new anxiety in their 40s are often evaluated for generalised anxiety disorder, stress at work or in their personal lives, but not menopause. However, anxiety, including panic attacks, can be triggered if a woman who’s previously been free of anxiety experiences perimenopause.
Perimenopause causes levels of stress-related hormones to fluctuate. Oestrogen modulates activity of the neurotransmitters serotonin and GABA, which are important in the control of anxiety. As oestrogen blood levels fluctuate erratically, it could lead to increased anxiety, feelings of imminent catastrophe, or panic attacks, without an obvious external trigger.
Joint pain in the menopause transition period is often put down to the onset of early arthritis, strain or fibromyalgia. The pain is not particularly feminised, and the phenomenon of joint and[Continue reading]
Recent studies on the interaction between oestrogen receptors in the joint and menopause suggest that this hormone plays a direct role in cartilage function and regulation of inflammation. So the testosterone decline that occurs in menopause can play a role in joint symptoms, not simply by coincidence.
A woman who presents with Heart Palpitations in her late 40’s is far more likely to be checked for the possibility of an arrhythmia, a thyroid abnormality or anxiety, rather than menopause. Palpitations are a well recognised vasomotor symptom, associated with the same hormonal changes that are responsible for hot flushes, but are not yet recognised in the community beyond menopause specialists.
Although menopausal palpitations are benign, any new or persistent heart symptoms should be evaluated for other causes.
Cases of low mood during perimenopause may be initially diagnosed as depression, which is treated with an antidepressant without looking at the hormonal background. Antidepressants may be used in some situations, but treating depression without exploring underlying hormonal change may not successfully treat the illness.
Being in the perimenopause transition period seems to be a vulnerable time for some women to develop depression, even if they have not had it previously. Now far more widely acknowledged and accepted, clinical awareness of this remains uneven.
A woman aged 40 to 50 with frequent passing of urine, a need to rush, or recurring urinary tract infections has every chance of finding herself referred to a urologist or checked for infection, bladder dysfunction, or even interstitial (painful) cystitis. Less commonly, the oestrogen drop will be a consideration, which modifies the function of the urethra and bladder and the vagina and it’s support structures.
Genitourinary Syndrome of Menopause is still underrecognised and undertreated. There are so many women who suffer from discomfort urinating that could be improved with the right treatment.
It’s not uncommon for women to mistake the cognitive difficulties of perimenopause for signs of dementia, understandable. Many women experiencing changes in the way that they can think, remember and put words together in sentences will be concerned that something might be happening to their brain.
In reality, cognitive symptoms during menopause appear to be transitory. Large epidemiological studies such as data from the Study of Women’s Health Across the Nation (SWAN) have shown that cognitive ability improves after postmenopause to levels comparable to premenopause. This is a fact not widely communicated.
Burning mouth syndrome and formication (the skin creepy crawly or goose-bump feeling) are two very rare and distressing symptoms from the list, and they are rarely thought to be menopause-related at first. It’s common for women with the symptoms to get shunted to a dermatologist, neurologist or polysomnographer for a work-up before getting an earful about hormones.
Both urticaria and formication are caused by the sensitising effect of oestrogen withdrawal on the peripheral nerve fibres of the skin. There are real mechanisms for them, a physiological cause, and they may be treated by treatment of the underlying hormone change.
There are a number of reasons these symptoms can be misdiagnosed.
Blood Testing: There’s no test that confirms truly you’re in perimenopause. FSH blood test levels vary and can be confused. So diagnosis depends on a medical and symptom history – you need a clinician who is familiar with the symptoms.
If you are in your 40s or early 50s and are experiencing a number of different symptoms that don’t seem to make sense, consider keeping a symptom diary and discussing perimenopause with your GP. Here are some practical steps.
Read good information: Trustworthy sources of information about menopause useful to Australian women include organisations such as the Australasian Menopause Society and the Jean Hailes for Women’s Health website.
The list of 34 menopausal symptoms is not a comprehensive medical textbook, but it is a quick reminder of how systemic these changes to women’s hormones can be. The most bothersome symptoms are not the ones that you expected, nor the ones your doctor expected.
If something feels different in your body but you don’t know what is happening, and you are in the age range where perimenopause may happen, then make the perimenopausal connections. You deserve a health care conversation that considers the big picture.
Menopause is not a niche women’s issue. It’s a major biological event that impacts half the population and it’s worth knowing about to make the experience less unpleasant.