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If you are in your 40s and feel like your body or brain is quietly changing, it isn't "just stress." Perimenopause can begin up to 8 years before periods stop, and there are up to 48 recognised signs, from joint aches and brain fog to sleep disruption not just hot flushes.
Most Australians can only name a handful. This October, for Menopause Awareness Month, our message is simple: Know the signs so you can speak to your GP with confidence, and look for the MTick on pharmacy shelves to find certified, menopause-friendly support without the guesswork.
Got a bit more time? Here’s the full story.
Picture it. You are 46. Your sleep has gone strange, your knees have started making their opinions known, you cried at a bank ad yesterday and you have walked into the kitchen three times this morning without remembering why.
Naturally, you come up with an explanation for each one. You are busy. You are tired. Work is ridiculous. Maybe you need more exercise, less screen time, magnesium, a holiday or simply to accept that this is what ‘getting older’ feels like.
Except there is something nobody mentioned.
Every one of those things can show up during perimenopause.
That does not make them a diagnosis, and it does not mean every ache, mood change or forgotten word after 40 should be blamed on hormones. What it does mean is that the picture is much bigger than most of us were ever taught, and when you do not know what you are looking for, it is incredibly easy to miss the pattern.
Which is exactly why October matters.
Before you read on: take the two-minute perimenopause quiz
Answer a few quick questions about what you have been noticing. You will get your result straight away, something clear to take to your GP, and, subject to confirmation, our Menopause Awareness Month series in your inbox every week of October. No diagnosis, no jargon, no late-night Google spiral.
What is Menopause Awareness Month?
Every October is Menopause Awareness Month, and 18 October is World Menopause Day, led by the International Menopause Society.⁵ It is a month for saying the word out loud at home, at work and at the pharmacy counter, and for talking about the whole experience rather than the punchline version we have been served for decades.
Because menopause has had a slightly unfortunate PR problem.
For years, the public version has basically been hot flushes, night sweats and periods stopping, perhaps with a woman dramatically fanning herself thrown in for visual effect. Meanwhile, everything from brain fog and joint pain to dry eyes, anxiety, vaginal changes and heart palpitations has been quietly sitting outside the main conversation.
This year feels a little different in Australia because it is the first Menopause Awareness Month since the MTick arrived in Australian pharmacies in February.⁶ For the first time, there is a simple symbol on the shelf designed to help women identify menopause-friendly products more easily.
That is where our theme for the month comes from: Know the Sign. Look for the MTick.
First, know the signs so you have a better chance of recognising what may be changing. Then, when you are standing in a pharmacy trying to work out what is actually relevant to menopause, look for the MTick as a place to start.
Here is what we are covering this October:
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This week: the 48 signs, including the ones nobody squeezed into the hot-flush conversation
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Next week: menopause at work, and the conversations nobody quite knows how to start
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World Menopause Day, 18 October: our big piece on knowing the sign
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Later in the month: menopause and intimacy, plus what the MTick actually means when you see it on pack
If you take the quiz above and the email series is confirmed, these pieces will land in your inbox as we publish them.
How many signs of menopause are there?
It depends on who is counting, which tells you something on its own.
Different frameworks, one shared point: menopause reaches far beyond the thermostat.
The growing lists also reflect something important. We are talking more openly about what women actually experience and getting better at recording the parts that historically did not get much attention.
For years, hot flushes were basically the Beyoncé of menopause symptoms. They got the headlines, the sitcom cameos, the greeting cards and the office jokes, while the rest of the group barely made it onto the poster.
Why can most of us only name a handful?
The research makes the knowledge gap pretty difficult to ignore.
In a 2025 YouGov survey for Priceline, Australians could name an average of just 7 of 34 menopause symptoms. Seventeen per cent could not name a single one, while only 37% of women could explain the difference between perimenopause and menopause.³
And that gap matters because when a sign has no name, we tend to give it another explanation.
Poor sleep becomes stress. Joint pain becomes age. Brain fog becomes ‘I’m losing it’. A drop in confidence becomes something you need to snap yourself out of. Changes in sex drive become a relationship issue. You can end up treating each change as its own little mystery without ever being given a reason to wonder whether some of them might be connected.
When a sign has no name, it gets filed under ‘probably nothing’, ‘I’m just tired’ or, worst of all, ‘maybe it’s just me’.
That is what knowing the signs can change.
The 48 signs, grouped so they actually make sense
GenM lists its 48 signs alphabetically.¹ Very organised. Bodies, unfortunately, do not tend to present information in A to Z order.
We find it easier to understand the bigger picture when the signs are grouped by the areas of life and body they can affect, so here is our version.
Temperature
Hot flushes, night sweats and, yes, cold flushes.
Same internal thermostat, apparently now swinging in both directions because consistency would have been far too convenient.
Mood and mind
Anxiety, irritability, low mood, mood swings, loss of confidence, panic attacks and a flat lack of motivation can all feature.
Then there is the thinking side of things: brain fog, memory lapses and trouble concentrating.
If you have ever been halfway through a completely normal sentence only to discover that the equally normal word you need has apparently packed a suitcase and left the country, you will know how unsettling that can feel.
Sleep and energy
Trouble falling asleep, trouble staying asleep and tiredness that does not always disappear because you finally managed one decent night.
Sleep disruption can also have a lovely domino effect across concentration, mood, patience and general enthusiasm for anyone suggesting that perhaps you should ‘just get more sleep’.
Skin, hair, nails, eyes and mouth
This is where the list starts producing quite a few ‘wait, THAT can be a thing?’ moments.
Adult acne, itchy skin, changes in skin texture, altered skin sensations that can feel like crawling or tingling, thinning hair and brittle nails all appear on the list. So do dry eyes, dry mouth, burning mouth, changes in smell and taste, and changes in body odour.
None of these automatically means perimenopause or menopause. The useful part is knowing that they exist in the wider picture, particularly if several changes seem to arrive around the same time.
Muscles, joints and bones
Joint pain, muscle tension, headaches, tingling hands and feet, and changes in bone density can all feature.
So if your knees have recently started producing their own soundtrack every time you stand up, you are not necessarily imagining that something has changed.
You are also not required to diagnose it yourself.
Heart, head and breathing
Heart palpitations, breathing difficulties, dizziness and ringing in the ears are also on the list.
These are a useful reminder that ‘know the signs’ does not mean ‘assume everything is menopause’. Palpitations, chest discomfort, breathlessness, dizziness or anything else new or worrying should be discussed with your GP rather than automatically written off as hormonal.
Knowing more should help you ask better questions, not stop you asking them.
Cycle and breasts
Irregular periods, worsening PMS, sore or tender breasts and changes in breast size or shape can all show up during this transition.
For some women, changes to their cycle are the obvious clue. For others, their periods continue while an assortment of seemingly unrelated symptoms starts appearing elsewhere.
Which brings us to one of the bigger misunderstandings around perimenopause: you can absolutely still be having periods while you are in it.
Bladder, gut, vaginal and sexual health
Bladder weakness, recurring urinary tract infections, bloating, nausea, digestive changes, vaginal dryness and changes in sex drive can all form part of the wider picture.
They also happen to be exactly the kinds of things people are less likely to casually mention over coffee, which can make very common experiences feel far more unusual than they are.
Silence has a funny way of doing that.
Weight and shape
Weight gain, often around the middle, is another commonly reported change.
And while lifestyle remains part of the health conversation, midlife body changes are not automatically proof that you have suddenly forgotten how food, movement or your own body works. Hormones, ageing, stress, sleep and other factors can all be part of the picture.
You do not need to collect all 48
This is not menopause bingo.
Most women will experience some signs, not every sign, and the combination can shift over time.⁷ One woman may be dealing mainly with hot flushes and broken sleep, while another is wondering why her joints ache, her concentration has vanished and her skin suddenly feels different.
The point of knowing the list is not to make you suspicious of every twitch, ache and forgotten password.
It is to give the less-famous changes a name.
Because once you know something can be part of perimenopause or menopause, you are better placed to notice patterns, keep track of what is changing and have a more useful conversation with a health professional.
When do the signs start?
Often earlier than people expect.
Perimenopause usually begins between 45 and 55 and lasts around 4 to 8 years before menopause is confirmed, which happens after 12 months without a period.⁴ The average age of menopause in Australia is 51.⁸
That means the lead-up can last for years, and you do not need to have stopped menstruating before signs can start appearing.
A 2025 Monash University study involving more than 5,500 Australian women found that hot flushes, night sweats and vaginal dryness were among the signs most clearly linked with the menopause transition. Symptoms such as poor memory and low mood were common across life stages, which helps explain why they can be so easy to miss or put down to something else.⁹
So if you are in your forties and several things have started feeling slightly off at once, it is reasonable to wonder whether perimenopause might be part of the picture.
Reasonable to wonder does not mean responsible for diagnosing yourself.
Is it perimenopause, or something else?
Honestly, it can be hard to tell on your own, and that is not your job.
Many of these signs overlap with other health issues, including thyroid changes, low iron, stress and sleep problems. That is why recognising a symptom should be the beginning of a conversation rather than the end of one.
See your GP if symptoms are bothering you or getting in the way of daily life, if bleeding becomes very heavy or unusual, or if anything is new, worrying or getting worse.⁴ Palpitations, chest discomfort, breathlessness and dizziness are also worth getting checked rather than automatically chalking them up to hormones.
One very simple thing that can make an appointment more useful is keeping a note of what has changed and roughly when.
‘I feel weird’ is valid, but ‘my sleep changed in March, my periods became less predictable in May and I have had palpitations three times this month’ gives both you and your doctor a clearer place to start.
What does ‘Look for the MTick’ mean?
Knowing the sign is one half of it. The other half is knowing where to go next when you are standing in a pharmacy aisle looking at a heroic number of boxes, labels and claims.
The MTick is an independent certification symbol created by GenM in the UK and first piloted with Boots in 2022.¹⁰ Products carrying it have been assessed against GenM’s menopause-friendly criteria, which can include evidence such as authorised claims or trials involving menopausal women.¹⁰
The MTick arrived in Australia in February 2026 across more than 620 TerryWhite Chemmart pharmacies.⁶
It does not mean a product is right for everyone, and it is not a substitute for reading the label or getting individual health advice when you need it.
What it does mean is that someone has checked the product against GenM’s criteria for menopause relevance, which makes the shelf a little less confusing.
And frankly, most of us have enough decisions to make without conducting a small research project in aisle seven.
Where to start: the two-minute check
If you read the list above and found yourself nodding more often than expected, our perimenopause quiz is a simple place to start.
It takes a couple of minutes and helps you pull together what you have been noticing, so you can see the bigger picture and have something more concrete to take into a conversation with your GP.
It is not a diagnosis, and it does not need to be.
Sometimes the first useful step is simply moving from ‘Is this just me?’ to ‘These are the changes I have noticed.’
The bit we can help with
At Hey Sister!, we are interested in the whole conversation, not just the famous few.
Across October we will be talking about the signs that tend to get less airtime, from brain fog and joint pain to sex drive, intimacy, menopause at work and the practical question of how to find menopause-friendly products when you need them.
We will also be talking more about the MTick, what it means, what it does not mean and where you might start seeing it.
Because the point is not to memorise all 48 signs or suddenly become the menopause expert in your friendship group.
It is to know enough that when something changes, you have a better chance of recognising it, naming it and deciding what you want to do next.
The short version
There are dozens of signs, not three, and many can
Frequently Asked Questions
When is Menopause Awareness Month?
Every October. World Menopause Day falls on 18 October and is led by the International Menopause Society.
How many symptoms of menopause are there?
GenM, the organisation behind the MTick, recognises 48 signs of menopause. Dr Mary Claire Haver describes more than 70 in The New Menopause. Many surveys still use a shorter list of 34.
What are the first signs of perimenopause?
Common early signs include changes to your cycle, hot flushes, night sweats, sleep changes, mood changes and brain fog. Perimenopause usually starts between 45 and 55.
How long does perimenopause last?
Usually around 4 to 8 years, ending when you have gone 12 months without a period.
What is the MTick?
An independent certification symbol from GenM for menopause-friendly products. It launched in Australia in February 2026 across TerryWhite Chemmart pharmacies.
When should I see a GP about menopause symptoms?
When symptoms bother you or affect daily life, if bleeding is very heavy or unusual, or if anything is new, worrying or getting worse.
References
- GenM. Menopause signs: we've identified all 48.
https://gen-m.com/signs/
- Haver, M.C. (2024). The New Menopause. Rodale Books.
https://www.penguinrandomhouse.com/books/738539/the-new-menopause-by-mary-claire-haver-md/
- Priceline Pharmacy and YouGov (September 2025). Australia faces a menopause knowledge crisis.
https://www.wesfarmershealth.com.au/australia-faces-a-menopause-knowledge-crisis
- healthdirect. Perimenopause.
https://www.healthdirect.gov.au/perimenopause
- International Menopause Society. World Menopause Day. https://www.imsociety.org/education/world-menopause-day-2026/
- Retail Times (February 2026). GenM enters Australian market, partnering with TerryWhite Chemmart.
https://retailtimes.co.uk/genm-enters-australian-market-in-landmark-expansion-partnering-with-terrywhite-chemmart-to-roll-out-mtick-nationwide/ - Jean Hailes (2024). The impact of symptoms attributed to menopause by Australian women.
https://www.jeanhailes.org.au/reports/the-impact-of-symptoms-attributed-to-menopause-by-australian-women/ - Jean Hailes. Menopause: symptoms, causes and management. https://www.jeanhailes.org.au/health-topics/menopause/
- Islam, R. et al. (2025). The Lancet Diabetes & Endocrinology, Monash University. https://www.monash.edu/news/articles/first-of-its-kind-study-explores-symptom-prevalence-across-the-menopause-transition
- GenM. The MTick.
https://gen-m.com/the-mtick/
