Hot flushes and night sweats tend to dominate the conversation around menopause. But for many women, those are not the symptoms that affect them most. Newson research of 674 women attending a specialist menopause clinic found that the most commonly reported symptoms were fatigue, memory problems, irritability, anxiety and difficulty concentrating. Hot flushes ranked significantly lower.

This matters because when the focus stays narrow, women experiencing other symptoms can be left confused, dismissed or misdiagnosed. So here are ten important symptoms that deserve to be part of the conversation.

1. Brain fog

Forgetting words mid-sentence, losing your train of thought, struggling to concentrate – brain fog is one of the most frequently reported and most distressing symptoms of perimenopause and menopause. It can feel alarming, particularly in professional settings. Hormone changes affect brain function directly, and this symptom is not imagined in the way people sometimes imply. It is real, it is common and it often responds well to treatment.

2. Anxiety

Many women who have never experienced significant anxiety find it arriving unexpectedly in perimenopause. A constant sense of unease, a racing mind, feeling overwhelmed by things that never used to be a problem are all recognisable descriptions. Estrogen has a significant influence on brain chemistry, and as levels fluctuate, mood regulation and stress response can be affected. If anxiety has appeared or worsened without an obvious life reason, changes in your hormones may be part of the explanation.

3. Fatigue

We’re not talking about the tiredness that a good night’s sleep fixes. Menopause-related fatigue can be heavy, persistent and disproportionate to what you have actually done that day. Fatigue was the most frequently reported symptom in the Newson research study and one of the most severe. Poor sleep, changing hormone levels and emotional strain all contribute. It is not laziness and it is not ageing. It is a symptom with a specific cause.

4. Irritability and low mood

If you have noticed yourself feeling quicker to anger, more tearful or emotionally flatter than usual, you are not alone. Irritability and low mood are among the most common emotional symptoms linked to hormone change and can have a significant effect on relationships and self-esteem. Many women describe it as feeling unlike themselves and that disconnection can itself be very distressing.

5. Poor concentration

Difficulty staying focused, following conversations or completing tasks that used to feel straightforward is a recognised menopause symptom. Like brain fog, it tends to be underreported because women often attribute it to stress or busyness. When it appears alongside other changes, it is worth considering a hormonal link.

6. Vaginal dryness and discomfort

Many women do not expect this symptom, and many feel uncomfortable raising it with a partner or medical professional. Lower estrogen levels affect the tissues of the vagina and vulva, causing dryness, irritation and sometimes pain during sex or at other times. It is common, it is treatable and there is no reason for you to just put up with it. Vaginal estrogen can often help significantly and can be used alongside or independently of other hormone treatment.

7. Urinary symptoms

Needing to pass urine more often, feeling a sudden urgency, leaking or experiencing discomfort are all linked to menopause, though they are frequently attributed to other causes. The tissues around the bladder and urethra are sensitive to estrogen, and as levels fall, they can become more vulnerable. Recognising the connection can open the door to effective treatment.

8. Heart palpitations

Whilst these are a recognised menopause symptom, they can feel frightening, especially if you don’t know the context. They often appear as fluttering sensations, a sudden awareness of your heartbeat or just a feeling that your heart has skipped. That said, new or frequent palpitations always warrant a conversation with your family doctor to rule out other causes. Knowing they can be hormone-related is useful; ruling out other explanations first is important.

9. Joint pain and muscle aches

Estrogen has an anti-inflammatory effect on the body. As levels fall, some women notice joint stiffness, aching muscles or a general physical discomfort that was not there before. This can easily be put down to ageing. But the connection to your hormones is worth knowing about because, unlike ageing, it is something that can be addressed.

10. Loss of interest in sex

Changes in libido are deeply personal and many women feel reluctant to raise them. In our research, loss of interest in sex was rated the most severe symptom overall. Vaginal discomfort, fatigue, anxiety and changing hormone levels, including testosterone, all contribute. This symptom therefore deserves medical attention, not silence.

What this means

If you recognise several of these symptoms in yourself, take that seriously. The breadth of menopause’s effects on the body and mind is still not fully understood. Either by patients or, at times, by clinicians. Effective treatment exists for all of these symptoms. The first step forwards is to name them.