It is the most-searched menopause list on the internet, it appears on hundreds of sites, and it does not come from a clinical guideline. That does not make it useless — most of what is on it is real. It makes it a starting point rather than an answer, and using it as an answer is how treatable conditions get missed for years.
Where we stand: Menova is an independent publication. We sell no hormones, no supplements and no tests, we are not your doctor, and this is general education, not a diagnosis.
Where the list comes from
Not from NICE, not from ACOG, not from The Menopause Society. There is no official set of thirty-four symptoms and no clinical body that has ratified the number. It is a list that circulates — reproduced from site to site, frequently by companies with something to sell.
That matters for one reason: a list with no threshold cannot tell you anything. Because it is long and includes many non-specific entries, almost any adult can tick several. Ticking eleven of thirty-four feels like evidence and is not.
What is on it
Roughly, in the versions that circulate:
Hot flashes · night sweats · irregular periods · heavy bleeding · mood swings · irritability · anxiety · depression · brain fog · memory lapses · difficulty concentrating · fatigue · insomnia · vaginal dryness · loss of libido · painful sex · urinary urgency · recurrent UTIs · joint pain · muscle aches · headaches and migraines · dizziness · palpitations · breast tenderness · weight gain · bloating · digestive changes · hair thinning · dry or itchy skin · brittle nails · body odour changes · burning mouth · tingling extremities · electric-shock sensations
Some versions add gum problems, tinnitus, allergies, or the crawling-skin sensation.
The three groups it does not distinguish
This is the useful part, and no version of the list does it for you.
Group one: strongly associated with the transition. Hot flashes, night sweats, cycle changes, vaginal dryness and urinary symptoms. If these are your main problems, the picture is fairly clear — see hot flashes, night sweats, irregular periods and GSM and urinary changes.
Group two: real, recognised, and much less specific. Fatigue, brain fog, low mood, joint pain, palpitations, hair thinning, weight change. These genuinely happen in the transition and are exactly what iron deficiency, thyroid disease, B12 deficiency and raised blood sugar produce. The list cannot tell them apart. A blood test can — see symptoms most often misread as menopause, which tests to ask for and our free blood test sheet.
Group three: things that should send you to a clinician, not to a list. Some entries overlap with presentations that need assessment. Palpitations can be an arrhythmia — see palpitations in perimenopause and atrial fibrillation in midlife women. Heavy bleeding is treatable and worth treating — see heavy periods. Dizziness has its own list of causes — see dizziness and vertigo.
What is never on the list, and should be
The list tells you what might be menopause. It does not tell you what is definitely not, and that omission is the dangerous one.
Whatever else is true, these go to a clinician:
- Bleeding after twelve months without periods — any amount; see bleeding after menopause
- A new breast lump, or a skin or nipple change
- Persistent bloating, most days for three weeks or more
- Rectal bleeding, or a lasting change in bowel habit
- Unexplained weight loss
- A changing, bleeding or non-healing skin lesion
- New headache pattern over 50, especially with scalp tenderness or jaw pain on chewing
- Sudden loss of vision, hearing in one ear, or smell
- Any thoughts of harming yourself — seek help immediately
Bloating appears on the thirty-four as a menopause symptom. Persistent bloating is also how ovarian cancer most commonly presents. A list that contains the first and not the second is not a screening tool.
The symptoms nobody warns you about
The list is criticised for being too long. In one respect it is too short — several genuinely common experiences are missing from most versions, and women find them frightening precisely because nobody mentioned them:
- Rage, distinct from irritability — see perimenopause rage
- The crawling-skin sensation — see itchy skin and crawling sensation
- Burning mouth — see burning mouth
- Electric-shock sensations — see electric-shock sensations
- Feeling cold, not hot — see cold flashes and chills
- Frozen shoulder — see frozen shoulder
- Noise becoming unbearable — see sound sensitivity in midlife
- Not feeling like yourself — see the identity part
Our fuller collection is the unexpected symptoms.
What replaces the list
Two things, and they take four weeks.
A pattern, not a tally. Cycle changes plus a cluster that arrived together over months is informative. Eleven ticks on a list is not. Record five things a day — bleeding, hot flashes, wakings, mood out of five, one note. Our free 30-day symptom tracker is exactly that.
The blood tests, to remove the group-two ambiguity: full blood count, ferritin, thyroid, B12, HbA1c, vitamin D, plus blood pressure. Not a hormone panel — for women over 45 those are advised against for diagnosis, because levels swing week to week. See was that my last period.
With those two things, the list becomes unnecessary. Without them, it stays a way of feeling certain without becoming any better informed.
How the list gets used against you
Worth naming. A long symptom list is commercially useful: it lets a product be sold as the answer to almost anything, because almost everyone matches part of it.
If a site presents the thirty-four and then offers you a supplement, a private hormone panel or a subscription, the list is doing marketing work, not clinical work — see spotting misinformation and what the supplement research says.
So is the list useful at all
Yes, for one thing: recognition. A great many women read it and realise that six unrelated complaints they had been carrying separately might belong together. That is genuinely valuable, and it is why the list persists.
Use it to stop dismissing things. Then put it down and do the four weeks of recording and the one blood test, because that is what turns recognition into a plan.
Our practical order is where to start in perimenopause, and the month-by-month version is the first six months. The free 2-minute Menova self-check organizes your symptom picture into something printable — no account, not a diagnosis, and your answers never leave your device. The free printable visit prep sheet is what the appointment runs on.
This article is general education, not medical advice or a diagnosis. The symptoms listed as requiring assessment need prompt review by a licensed clinician regardless of how well the rest of your picture fits menopause.
Sources: NICE NG23 — Menopause, The Menopause Society, ACOG — The Menopause Years, and NHS — Menopause Symptoms.