Any kind of vasomotor symptoms (night sweats, hot flushes, chills), symptoms relating to bladder / urinary tract plus miscellaneous physical symptoms such as aching joints, dry eyes, burning mouth.
My only symptoms are mood related and cyclical (post bleed for a week each month).
I understand what you're saying about blood tests, they are only ever a snapshot, but my estradiol levels were 550 on one occasion and over 800 on the second.
There is more to my story and the specialist had a full history too.
In Europe it is pretty standard practice to provide progesterone only treatment until women's periods have stopped. In the US and here we add in oestrogen as well from the get go. I had a really poor response to extra oestrogen when I trialled a sequential regime for a few months earlier this year.