Most of us will have experienced hot flushes and night sweats. Some of us might have come to know anxiety and irritability, while for others it's the dreaded brain fog.
But what if menopause doesn't look like that for you? What if it's unexplained exhaustion, aching joints, persistent headaches or the feeling that you're simply not quite yourself anymore?
At 46, I'm acutely aware of just how confusing this stage of life can be. You might find yourself feeling nothing like the person you once knew so well. And if you're still having periods, it isn't always obvious that hormones could be the reason for this.
The truth is that menopause symptoms extend well beyond the ones most of us recognise. The NHS includes changes to sleep, mood, memory and concentration, alongside joint and muscle pain, palpitations, headaches, skin changes, hair thinning and urinary symptoms. There is no universally agreed number of menopause symptoms, but the range is considerably broader than most of us realise.
In fact, a UK study published in 2023, which examined the experiences of women aged 35–70, found that participants reported an average of 10.7 menopausal symptoms.
More recent research involving Loughborough University and University College London found that 40.6% of women reported chronic pain at age 44, while 12.3% experienced chronic widespread pain. The study also explored how a history of chronic pain was associated with a greater burden of menopause symptoms at age 50. It's a particularly relevant finding given that the International Menopause Society chose 'Chronic Pain at Midlife' as the theme for World Menopause Day 2026.
So, could those new aches and pains, restless nights and sudden bouts of crippling anxiety be connected to perimenopause? We asked Dr Farah Ahmed, a GP and British Menopause Society-accredited menopause specialist at The Medical Chambers Kensington, to explain what women might be missing.
She believes that excellent women’s healthcare begins with understanding each patient’s lifestyle, priorities and goals. Her approach combines the latest evidence-based treatments with a holistic understanding of each woman’s unique needs.
It's not always hot flushes
Sometimes it's not one dramatic symptom that women experience, but a collection of smaller changes that gradually leave you questioning what’s going on. Dr Ahmed says, the experience can be much broader than most women expect.
‘Hot flushes are the symptom most people associate with menopause, but some women notice changes in sleep, mood, concentration or memory, aches and pains,’ she says. ‘Others seek help for symptoms such as palpitations, headaches, changes in their skin or vaginal and urinary symptoms. The thing that I hear most often from the women I meet in my clinics is “I just don't feel like myself anymore.”
Of course, not every symptom can be attributed to peri-menopause so Dr Ahmed stresses the importance of not automatically assuming everything is hormonal and seeking medical advice to better understand what's happening in your body and make informed decisions about your health.
However, if brain fog is something you're struggling with, we've explored the possible connection between gut health, oestrogen and perimenopausal brain fog, including what you can do to support your gut.
Could a better night's sleep make a difference?
When you're waking up through the night, whether from night sweats or anxiety, it's hardly surprising you're feeling the effects the following day. Poor sleep has a knock-on effect and can leave you irritable, affect concentration and make it harder to cope with everyday life.
‘Hormonal changes can coincide with sleep disturbance, changes in mood and what many women describe as brain fog - difficulty concentrating, recalling words or keeping track of several things at once,’ she says.
So, if you're struggling, start by looking at your sleep routine and making rest a priority where you can. Improving your sleep may help ease some of the daytime effects, but if symptoms persist, are affecting your daily life or you're concerned, don't simply put them down to tiredness. If you're constantly running on empty, take a look at our guide to why you feel tired all the time and five ways to boost your energy naturally.
Dr Farah Ahmed, menopause specialist at The Medical Chambers Kensington
You don't have to stop having periods
One of the biggest misconceptions about menopause is that symptoms only start when periods become irregular or stop altogether. In reality, perimenopause can begin while you're still menstruating, and the transition can last several years. Symptoms certainly don't arrive in a predictable order, making it harder to recognise what's happening.
‘The menopause transition can last up to 8 years in some women,’ she explains. ‘A change in the cycle can be an early sign, but symptoms don’t always arrive in a neat order, and some women notice changes while their periods still seem regular. Over time, periods may become more or less frequent, or change in flow. Symptoms can also vary: some may settle while others continue.’
Therefore, she advises keeping a simple record of periods and symptoms to help you see a pattern.
Why it can take so long to join the dots
It's easy to dismiss one bad night's sleep, but when several things start happening at once, it can be difficult to work out whether they're connected. There is also considerable overlap between menopause symptoms and other age related health conditions, which can leave women second guessing themselves for months and even years.
‘Many of the symptoms associated with perimenopause overlap with stress, low mood, sleep problems and other health conditions, she says. ‘Women may not connect them with hormonal change, particularly if they’re still having periods. Some may also feel that their concerns are being dismissed. A useful starting point is to describe what has changed, when it began, and how it’s affecting you - including any changes to your periods.’
When should you seek medical advice?
Dr Ahmed recommends looking at the overall picture. ‘Think about your age, any changes in your periods, when symptoms began, and whether several changes have appeared around the same time,’ she says. ‘In otherwise healthy women aged 45 or over, a clinician will usually identify perimenopause from symptoms and menstrual changes rather than a hormone blood test. At younger ages, or when the picture is unclear, assessment may include tests or checks for other possible causes.’
There are also symptoms that should never automatically be put down to menopause. ‘Heavy or persistent changes in bleeding, bleeding between periods or after sex should be discussed with a clinician,’ she adds. ‘Any vaginal bleeding after 12 months without a period needs checking, even if it happens once or is only spotting.’
Don't put up with it
You don't need to wait for your periods to stop, or for hot flushes to begin, before asking for help. ‘Women shouldn’t feel they have to manage symptoms alone,’ she says. ‘Small changes may help with general wellbeing such as regular movement, a balanced diet, a consistent sleep routine, but women shouldn’t feel they have to manage significant symptoms alone.’
Strength training is definitely worth making part of your midlife routine because maintaining muscle can help support your body as you age. Nutrition matters, too. Protein plays an important role in maintaining muscle and our midlife guide to protein explains how much you need and the best food sources.
Finally, if you suspect perimenopause but feel your concerns aren't being taken seriously, Dr Ahmed's advice is to go back with a symptom and period diary. ‘It’s also reasonable to seek another appointment or ask to speak to a menopause specialist. Your symptoms and concerns deserve a proper conversation.’
