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SearchChanging hormone levels can bring issues like brittle nails, indigestion, dry skin and new allergies (to name a few!)
You’re probably familiar with some of the most common signs of perimenopause, like hot flashes, period changes and the potential for weight gain. But what about ... well, everything else?
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“During the menopause transition, your body starts to produce less of the hormone estrogen,” explains menopause specialist Zubina Mawji, MD, MPH. “Women have estrogen receptors throughout our bodies. So, it makes sense that menopause can affect nearly every organ system in every part of the body.”
The National Menopause Foundation has identified 36 known symptoms of perimenopause and menopause, including many you may not know about. While you might think of some of them as “weird” symptoms of low estrogen, we prefer to think of them as lesser-known symptoms. Because they’re normal — you just may not realize it yet.
“Women oftentimes know when they’re experiencing the most obvious signs and symptoms of perimenopause, like irregular periods,” Dr. Mawji says. “But it’s only when we start delving into other possible symptoms that they realize it could all be related. I call it a ‘journey of self-awareness,’ learning to tap into the symptoms that we sometimes don’t recognize or pay attention to.”
That doesn’t mean you’ll experience all of these possible symptoms. But it does mean that what you’re going through could be related to this specific time of life.
Dr. Mawji walks us through the perimenopause signs that you might not be aware of.
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Menopause can wreak havoc on your skin, hair and fingernails, causing changes you hadn’t anticipated with age.
Androgens, a group of hormones that stimulate your skin’s oil production (among other things), decline more slowly than estrogen. This sudden imbalance can heighten the effects of androgens, leading to more oil production. And that means more acne.
“Sometimes, women will experience a sudden recurrence of acne they haven't dealt with since they were teenagers,” Dr. Mawji says, “and sometimes, it’s also accompanied by rosacea.”
“Hair can lose some of its shine and consistency during the menopause transition,” Dr. Mawji says. That’s because estrogen contributes to hair growth, fullness and density. Dropping estrogen, paired with the overall effects of aging, can cause:
Hormone fluctuations can affect how much keratin your body makes. This protein keeps your nails strong, so when you don’t make as much as you used to, you can experience brittle nails that crack, split or peel.
Collagen is a natural protein that keeps your skin moisturized and elastic. But as estrogen drops, so does your skin’s collagen production. This can lead to dry skin that’s scaly or flaky.
Dry skin often goes hand-in-hand with itchy skin (pruritus). Dropping estrogen levels can suck moisture from your skin and make it drier, thinner and more susceptible to irritation. Plus, your skin barrier starts to replace itself more slowly, making itchiness, stinging and inflammation more likely.
Got unexpected BO? Perimenopausal hormone shifts can cause hot flashes and night sweats that can make you sweatier than usual. Though sweat itself doesn't smell, it can mix with bacteria on your skin to produce body odor. And more sweat means more opportunity for that to happen.
A 2023 study found that 15% to 50% of perimenopausal and postmenopausal women experienced psychological and emotional symptoms. Here’s what that could entail.
You never had anxiety issues before, so what gives now? In perimenopause and menopause, fluctuating estrogen and progesterone levels can contribute to new or worsening anxiety.
About 20% to 30% of women experience depression during menopause, probably due to hormonal shifts. Your risk is highest if you have a history of major depression and/or experience menopause-related vasomotor symptoms, like hot flashes and night sweats.
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Panic disorder is a type of anxiety disorder characterized by multiple panic attacks. In an estimated 10% of women, this condition develops or worsens around menopause.
There are estrogen receptors in your gastrointestinal (GI) tract, which play a role in your digestive health. Because your gut is sensitive to estrogen, changing levels during perimenopause can cause GI issues.
Hormonal imbalances can affect gut motility, meaning it can cause food to move through your intestines faster or slower than before. This can cause constipation or diarrhea. Plus, the estrogen receptors in your GI tract can become more sensitive during perimenopause, making you more aware of GI issues than you were previously.
One study found that 38% of perimenopausal and postmenopausal women reported changes in bowel habits.
“Weight gain can also affect gastroesophageal reflux,” Dr. Mawji points out. “So, sometimes, changes in fat distribution due to menopausal weight gain have the secondary effect of making you more susceptible to heartburn or acid reflux.”
It’s common to experience bloating during your period, but it’s also common to experience it as your periods start to decline in perimenopause. Unfair, right? The changes menopause brings to your GI system can also cause bloating or make you feel more sensitive to bloating.
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Feel like your energy levels are taking a nosedive as you get older? It may not just be age. It might also be menopause, as fluctuations in estrogen and progesterone can play a huge role.
Menopause can make existing sleep problems worse or play a role in developing new ones. Hormonal changes can mess with your internal clock (circadian rhythm) — and other aspects of perimenopause can get in the way of sleep, too.
“If night sweats keep you up or awaken you throughout the night for months on end, your energy level is definitely going to be affected,” Dr. Mawji says.
Low estrogen levels from menopause can contribute to fatigue, a type of extreme tiredness that can make it difficult for you to get through the day. This fatigue can be made worse by sleep deprivation, stress, anxiety and even lifestyle habits, like your diet or your level of physical activity.
“It can be a cascade of symptoms,” Dr. Mawji notes. “In addition to affecting your energy levels, sleeplessness and fatigue can lead to brain fog, weight gain, stress and anxiety.”
Sometimes, menopause symptoms cause strange sensations that seem to come out of nowhere.
In addition to the memory lapses menopause can bring, it can also cause trouble with focus, concentration and attention. A review of studies showed that American and Canadian women reported concentration problems as one of the most troublesome symptoms of menopause.
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You could experience balance issues like unsteadiness, dizziness or vertigo during perimenopause, though researchers aren’t exactly sure why. It may have to do with the role that hormones like estrogen and progesterone play within your inner ear — a key part of maintaining balance.
“Dizziness can also be a byproduct of menopause-related fatigue and sleep deprivation,” Dr. Mawji clarifies.
Ever feel like little lightning bolts are coursing through your body? “Body zaps” are a type of neuropathic pain thought to be related to changes in estrogen levels. This buzzing sensation is usually fleeting.
“In my experience, some women experience this symptom as a manifestation of their hot flashes,” Dr. Mawji says.
Estrogen plays a role in nerve function, so changes in estrogen levels can cause a “pins and needles” (parasthesia) feeling in your hands, feet, arms and legs. It usually passes quickly.
Lower estrogen levels can affect your body’s ability to produce tears, which can bring dry eyes and other vision changes. Up to 60% of perimenopausal and menopausal women experience symptoms like:
Getting older can bring some aches and pains — and menopause may be to blame for some of them.
Breast tissue is full of estrogen and progesterone receptors, making your boobs sensitive to hormonal changes like pregnancy. The same is true during perimenopause: As hormones fluctuate, breast pain may come and go.
Burning mouth syndrome (BMS) makes your mouth feel like it’s tingling, scalding or burning. It can also cause extreme dry mouth and even numbness. Though it can happen during perimenopause, it’s more common in the postmenopausal period. One study found that up to 33% of postmenopausal women experience BMS.
Hormone fluctuations can cause headaches, and if you’re already prone to migraines, they could become worse. One study found that other health issues associated with perimenopause, like increased anxiety, depression and sleep disturbances, could also make migraines worse.
Estrogen helps protect your joints, so lower estrogen levels can bring joint pain or discomfort throughout your body. The National Menopause Foundation reports that up to 60% of women experience joint aches in menopause. You might also experience inflammation and general soreness.
Estrogen is related to muscle health, so as estrogen declines, you may start to feel more tightness or discomfort in your muscles than before.
With menopause comes changes to your heart — and a rise in your risk for cardiovascular disease.
It can be scary to feel like your heart is racing, fluttering or flip-flopping, but it can be a normal perimenopause symptom. One review found that up to 42% of perimenopausal women felt heart palpitations, likely due to estrogen drops.
“It doesn’t typically cause a dangerous heart rhythm,” Dr. Mawji reassures, “but it can be very unsettling.”
This one isn’t (yet) included on the National Menopause Foundation’s list of known symptoms of menopause. But Dr. Mawji says it’s important to know about the possibility of changes to your cholesterol.
“Losing the protective effects of estrogen changes your cholesterol levels, which can increase your risk of cardiovascular disease,” she warns. “So, never ignore any cardiac symptoms, neck pain, chest pain or palpitations.”
Some possible signs of perimenopause don’t fit neatly into categories. Here’s a look at other miscellaneous symptoms you could experience.
As menopause sets in, your allergies can get worse, or you could develop new ones. And it’s not always allergies, even if it feels like it: Hormonal changes can also cause vasomotor rhinitis, an inflammation of nasal tissue that causes allergy-like symptoms such as congestion and runny nose.
Decreasing estrogen thins your vaginal and urinary tissues and weakens your pelvic floor muscles. You may experience:
As your estrogen levels dip, your desire for sex might, too. Plus, menopause-related issues like fatigue and vaginal dryness can make you even less inclined. The National Menopause Foundation reports that 20% to 40% of women experience some loss of libido.
Osteoporosis weakens your bones, which raises your risk of fractures. Importantly, 10% to 20% of bone loss occurs in your first five years of menopause, so when you sense that menopause is approaching, ask your healthcare provider about getting a baseline bone density test.
To round out the list of perimenopause symptoms, it’s important to include the ones that many people are already familiar with:
Typically, Dr. Mawji says that lesser-known symptoms accompany common, more obvious symptoms. For example, you’re not likely to have burning mouth and terrible acne but not have hot flashes and brain fog.
“I'd say about 80% of my patients present with very typical symptoms,” she shares. “And then about 20% present with symptoms that we wouldn’t immediately think about as being associated with menopause. It’s only when looking at their symptoms through the filter of menopause does it all become apparent.”
Perimenopause shouldn’t make you feel generally unwell. So, if your symptoms are affecting your quality of life, it’s important to talk to a healthcare provider — ideally, one who’s specifically trained in menopause medicine.
First, your provider will want to rule out other health conditions that could be causing your symptoms. If they suspect that menopause is the culprit, there are a variety of treatment options they might suggest. But if your symptoms are moderate or severe, or if they interfere with your quality of life, they may recommend hormone replacement therapy (HRT) for menopause.
“Women are often very relieved to learn that these symptoms aren’t in their head,” Dr. Mawji says, “and they’re also relieved to learn that their symptoms are treatable.”
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