12 PERIMENOPAUSE SYMPTOMS THAT NO ONE TALKS ABOUT AND HOW TO DEAL WITH THEM

Medically Reviewed and Updated by Dr. Sony Sherpa (MBBS) - August 13, 2024

Perimenopause is the transition period before menopause, when hormone levels fluctuate and give rise to many unpleasant symptoms.^[1] It can start as early as your mid-30s or as late as your 50s and can last from a few months to 10 years. Even when expected, the reality of perimenopause takes many women by surprise due to the sudden changes that start happening.

Occasional hot flashes, extreme mood swings, irritation, irregular and heavier periods, as well as vaginal dryness are among some of the most well-known symptoms of perimenopause. While these are not necessarily the easiest to contend with, there are a whole host of other perimenopause symptoms that most women have never even heard about. Uncommon symptoms of perimenopause are often overlooked or overly worried about and may lead to a misdiagnosis or unnecessary treatment. 

In this post, uncommon perimenopause symptoms are explained alongside tips for how to cope with them. These include when to see a doctor and whether hormone replacement therapy can help women with perimenopause to treat these symptoms and to make a smoother transition through menopause.

12 Uncommon Perimenopause Symptoms You Should Know

The following 12 symptoms constitute some of the strangest aspects of perimenopause. From electric shocks to ringing in the ears^[2], find out how you can better deal with these uncommon perimenopause symptoms.

Note: In addition to managing these symptoms with various medications and self-care practices, hormone replacement therapy (HRT) may be beneficial for alleviating some of these symptoms. Before opting for HRT, it is important to assess the pros and cons, as well as what forms are available to you, whether topical, oral, synthetic, or natural (see the HRT section of the blog below).

1. Burning Mouth Syndrome

Burning mouth syndrome is a painful, burning sensation in the tongue, lips, gums, or other parts of the mouth that feels like scalding, tingling, or numbness, and hot or spicy foods may make it worse. 

The exact cause of BMS is unknown, but some studies suggest that hormonal changes during menopause may be a factor. This is because estrogen plays a role in the development and maintenance of the nerves and tissues in the mouth. A decline in estrogen levels during menopause may affect nerve function and cause inflammation, dryness, and pain in the mouth.

To relieve burning mouth syndrome, you can try sucking on ice chips, avoiding acidic foods, drink plenty of water, and consult a doctor for medication or therapy. For extreme cases, treatments for BMS include hormone replacement therapy, antidepressants, anticonvulsants, and topical pain relief.

2. Electric Shock Sensations

Electric shock sensations are sudden, sharp sensations that feel like electric shocks. There might be zapping, tingling, or jolts in various parts of the body, including the head, neck, and limbs. They can be harmless and temporary, or they can be a sign of a more serious condition.^[3]

Some women experience ESS during menopause, which may be related to fluctuations in estrogen levels. Estrogen works with the central nervous system to send messages along the nerves to the brain. When hormones start to change, the signals may get distorted, amplified, or short-circuited, causing an electric shock or tingling sensation. Other possible contributing factors include stress, anxiety, or withdrawal from certain medications. Estrogen is also known to enhance the action of serotonin and norepinephrine in the brain, and when it declines, it can lead to depression^[4] and other neurological symptoms in vulnerable women due to lowered serotonin efficiency.

To prevent or reduce electric shock sensations, you can practice relaxation techniques, avoid caffeine and other stimulants, try to get enough sleep (HRT may help relieve other symptoms that promote sleep deprivation), and consult a doctor for medication or supplements.

3. Tinnitus

Tinnitus is a ringing, buzzing, hissing, or clicking sound in the ears that may be constant or intermittent.

Estrogen plays a role in the development and maintenance of the auditory pathways in the brain. A decline in estrogen levels during menopause may affect the nerve tissue and the blood flow to the inner ear, causing tinnitus. Estrogen also modulates the immune system and the inflammatory response, which may be involved in infection-based cases of tinnitus.^[5]

To manage tinnitus, you can avoid loud noises, minimize stress, get enough sleep and maintain optimal blood glucose and blood pressure. You may want to wear earplugs or make use of sound therapy, which involves listening to sound to make tinnitus less irritating or to relax^[6]. HRT may reduce or even resolve tinnitus in some women^[7], whereas, in other women, synthetic hormone use (specifically progestin) has been associated with tinnitus onset^[8].

If it is not resolved, consult a doctor for medication or surgery.

4. Skin Itching and Sensitivity

When hormones decline during perimenopause, the skin can itch and feel extra sensitive for several reasons. The main ones would be reduced production of collagen and natural oils in the skin, which contributes towards keeping the skin strong and elastic, as well as smooth and hydrated. Skin that is deficient in natural oils and collagen may be sensitive, dry, and thin, which can lead to thinner skin, wrinkles, itching, and irritation.^[9] Some studies suggest this sensitivity only truly applies to the skin on the face and the feet.^[10]

To soothe itchy skin, try applying moisturizer regularly, use mild soap and lukewarm water when washing the face daily, avoid scratching, and make use of cold compresses and natural masks, such as oatmeal, clay, or aloe vera gel. Calamine lotion and topical hormone replacement therapy are also known to help, especially if suffering from other perimenopausal symptoms. If you have a rash or hives, you should try to get an antihistamine.

5. Duct Ectasia and Nipple Discharge

Duct ectasia is a benign (non-cancerous) condition that arises when a breast milk duct expands and its walls thicken. This may result in a blockage of the duct, which could then cause fluid to accumulate and leak. The discharge may be white, green, or brown and is often accompanied by other symptoms, such as tender breasts, breast lumps, and an inverted nipple.

Duct ectasia is thought to be caused by the deterioration of a milk duct, which usually occurs due to fatty involution. This means that as the duct deteriorates, the damaged parts change into fatty tissue. This eventually hardens over to give rise to the classic symptoms. The condition most often occurs in perimenopausal women and may persist until menopause is over, although it tends to go away sooner and on its own.

It is unclear whether hormonal decline is involved in causing duct ectasia or whether hormone replacement therapy (HRT) can help, yet the higher prevalence at perimenopause suggests HRT may have a protective benefit.

It does not increase one’s risk of breast cancer, although breast cancer might cause similar symptoms, and therefore duct ectasia, may need a diagnosis.^[11]

There is no specific treatment for duct ectasia, although one can treat the symptoms. If the breast is tender, a warm compress might help. Many women turn to painkillers for relief. The condition might increase the risk of infection, for which antibiotics are frequently prescribed.^[12]

6. Gum Disease

Gum disease is an inflammation and infection of the gums, which may cause bleeding, swelling, redness, or pain. Hormonal changes increase the risk of gum disease in women, especially during perimenopause. This is because hormones affect the blood supply to the gums and the body’s response to plaque buildup. Plaque is a sticky film of bacteria that forms on the teeth and can cause tooth decay and gum inflammation. Hormones can make the gums more sensitive and reactive to plaque, leading to gingivitis and periodontitis. 

Gum disease can be prevented through immaculate hygiene and regular visits to the dentist’s office. If you are still struggling with gum disease and other signs of infections, such as UTIs, you may want to consider HRT.

7. Hormonal Acne

If you think all the problems associated with puberty left you behind a couple of decades ago, think again! Hormonal acne is known to affect women undergoing perimenopause due to the decrease in estrogen and progesterone. This is thought to lead to a relative increase in testosterone levels, resulting in excess sebum (skin oil) production and acne, especially along the jawline.

Luckily, hormonal acne can be treated in a similar way to the itchy, sensitive skin that perimenopausal women often contend with. This includes washing one’s face daily with mild soap for sensitive skin and applying moisturizer after using a toner. Gentle natural face masks and astringents can help to reduce the amount of oil present on the skin and lower acne.

8. Urinary Tract Infections

Urinary tract infections (UTIs) are infections in any part of the urinary system, such as the kidneys, bladder, or urethra. They can cause pain, burning, urgency, and frequency when urinating, as well as cloudy, bloody, or smelly urine.

Women are more prone to UTIs than men because they have shorter urethras that are in closer proximity to the rectum. Due to hormonal changes, perimenopausal women are at a higher risk for UTIs than usual. The decline in estrogen levels typically affects the lining of the bladder, vaginal wall, and the urethra and makes them more susceptible to opportunistic infection. 

If suffering from a UTI during perimenopause, it is important to see a doctor and get a proper course of antibiotics. Probiotics, drinking plenty of water, wiping from front to back, and keeping the area clean can all help to treat and prevent UTIs. There is evidence to suggest that cranberry juice and vitamin C inhibit the ability of pathogens to adhere to the urinary tract wall, which is why they are so often recommended for fighting UTIs. HRT may help over the long term, especially if infections are recurrent even with preventive measures, as estrogen improves immunity, lowers inflammation, and helps to promote the adherence of beneficial bacteria in the gut and vagina.

9. Changes in Body Odor

Some women may notice that their body odor changes during perimenopause, becoming more intense, unpleasant, or different from usual. This is because hormonal changes have a slight yet pronounced effect on the composition of sweat and the bacteria that live on the skin, which are responsible for producing body odor. Estrogen and progesterone also influence the pH level of the skin, which can affect the growth of odor-causing bacteria.

Some tips to reduce body odor include bathing regularly, using deodorant or antiperspirant, wearing breathable fabrics, and avoiding pungent foods.

10. Hair Loss or Thinning

For some women, head hair becomes thinner, weaker, or falls out more easily during perimenopause. This is because estrogen and progesterone, which are essential for hair growth and health, decline during this phase, leading to higher relative testosterone, a common cause of female hair loss^[13]. Low estrogen levels can also affect blood circulation to the scalp, reducing the supply of nutrients and oxygen to the hair follicles.

Some treatments for hair loss or thinning include topical minoxidil, biotin supplements, hormone replacement therapy, and hair transplantation.

11. Dry Eye Syndrome

According to some sources, up to 61% of women are affected by dry eye syndrome, where the eyes are dry, itchy, and may burn as well. This is because estrogen and progesterone help maintain the moisture and elasticity of the eyes, as well as the production of tears and mucus. When hormones decline, the eyes may become drier, inflamed, and more prone to infections or injuries.^[14] Artificial tears or lubricating eye drops are amongst the best treatments available for dry eyes.

12. Heart Palpitations

Some women go on to experience heart palpitations, which are a sign of an irregular heartbeat. Perimenopause heart palpitations are caused by reductions and fluctuations in estrogen, which helps to regulate electrical impulses and enhance blood flow in the heart. When estrogen levels drop, the heart may become overstimulated, inflamed, or irregular, causing palpitations.

Perimenopause heart palpitations are usually harmless and temporary, but they can sometimes indicate a more serious condition, such as arrhythmia, hyperthyroidism, or heart disease. Therefore, it is important to consult a doctor if you experience frequent, prolonged, or severe palpitations, especially if they are accompanied by chest pain, shortness of breath, dizziness, or fainting. 

Some ways to prevent or reduce perimenopause heart palpitations include avoiding stress, caffeine, alcohol, and nicotine, practicing relaxation techniques, taking hormone replacement therapy or supplements, and maintaining a healthy lifestyle.

HRT for Perimenopause

Hormone replacement therapy (HRT) can help women who are going through perimenopause to more easily manage their symptoms. It is a medical treatment in which one supplements their hormones through natural or synthetic versions of estrogen or progesterone. While not a substitute for the ovary’s natural supply, it is a well known option to help women cope with menopause, especially when dealing with the more severe and uncomfortable symptoms.

The benefits of HRT for perimenopausal women are as follows^[15]:

• Relief from common symptoms of perimenopause, such as hot flashes, night sweats, mood swings, sleep problems, and vaginal dryness. HRT can improve the quality of life and well-being of women who suffer from these symptoms.
• It helps to prevent osteoporosis, a condition that causes the bones to become weak and brittle. HRT can increase bone density and reduce the risk of fractures in postmenopausal women.
• Reducing the risk of cardiovascular disease^[16], such as heart attack. HRT can lower cholesterol levels and improve the blood flow in the heart and blood vessels.
• Maintaining muscle strength and mass. HRT can prevent the loss of muscle that occurs with aging and menopause. HRT can also enhance the effects of exercise and physical activity.

HRT may be able to provide relief for many unexpected symptoms of menopause as well by offering hormonal stability through the menopausal transition. You might find several other symptoms spontaneously resolve with the use of HRT, including joint aches and pains, digestive issues, and allergies, due to the way reproductive hormones assist in immune function and how they affect the nervous and cardiovascular system.

However, HRT is not suitable for everyone, and it may also have some risks and side effects, depending on the type, dose, and duration of HRT, as well as the individual health factors of the woman.

In some cases, HRT also has certain associated risks, as mentioned below:

• HRT may increase the risk of stroke^[17] as it induces a hypercoagulable state.
• Some forms of HRT can increase the risk of reproductive and breast cancers, as well as endometriosis.^[18]

Before starting HRT, it is important to consult a doctor and weigh the benefits and risks for your specific situation. It is recommended to follow the doctor's advice on the best type ^[19], dose, and duration of HRT and go for regular check-ups and screenings. HRT is not a one-size-fits-all solution, and it should be tailored to your individual needs and preferences.

When to See a Doctor

Perimenopause is a natural and normal phase of life. Most women cope with it by taking care of themselves, treating their symptoms properly, and finding support from others. It is advisable to opt for regular check-ups and screenings while going through perimenopause if struggling with severe symptoms or wanting to explore treatment options like HRT.

The following symptoms or situations warrant seeing a doctor regarding perimenopause:

• Your periods are abnormally heavy, or they include blood clots
• Your periods last longer than seven days
• You experience bleeding between periods or after intercourse
• Your periods happen closer together or farther apart than usual
• You have severe or frequent hot flashes, night sweats, mood swings, sleep problems, or vaginal dryness that interfere with your daily life or well-being
• You have signs of infection or inflammation in your vagina, bladder, or breasts, such as pain, burning, itching, discharge, or odor
• You are over 45 years old and have atypical symptoms
• You are younger than 40 years old with a suspected diagnosis of premature ovarian insufficiency
• You want to get pregnant or avoid pregnancy during perimenopause
• You want to explore different treatment options for perimenopause, such as hormone therapy, antidepressants, or natural remedies

Seeing a doctor about symptoms of perimenopause can help you get a proper diagnosis, treatment, and advice for your specific situation. Your doctor may consider several factors, such as your age, menstrual history, symptoms, physical exam, and hormone levels, to evaluate your perimenopausal status. They may also order tests, prescribe medications, or recommend lifestyle changes to help ease your symptoms and promote your health.

Conclusion

In conclusion, perimenopause can cause some uncommon symptoms that may not be widely discussed or recognized. These symptoms include burning mouth syndrome, electric shock sensations, tinnitus, itchy skin, gum disease, and urinary tract infections. It is important to be aware of these symptoms and seek medical advice if they interfere with your daily life or well-being. Perimenopause is a natural and normal phase of life, and you can cope with it by taking care of yourself and finding support from others.

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