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10 Surprising Symptoms of Perimenopause and Menopause

Here are ten little-known and surprising symptoms of perimenopause and menopause.
10 Surprising Symptoms of Perimenopause and Menopause
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Perimenopause and menopause are significant phases in a woman’s life and can bring about a range of symptoms beyond the widely recognized irregular periods, hot flashes, and mood swings. For a woman with hypothyroidism, many lesser-known symptoms of perimenopause and menopause can significantly impact quality of life. In this article, we look at 10 frequently overlooked symptoms you may experience during your perimenopause or menopause.

Defining perimenopause and menopause

First, it’s important to define these phases in a woman’s reproductive life. Perimenopause is the transitional phase that leads up to menopause. Perimenopause typically starts sometime during a woman’s late 30s or 40s; the average starting age is 47. During perimenopause, the ovaries gradually produce less estrogen, leading to irregular menstrual cycles as well as symptoms such as hot flashes, mood swings, insomnia, and changes in libido. This phase can last for several years. Perimenopause can vary significantly from woman to woman in terms of duration and severity of symptoms, but it averages around 4 years.

Menopause is defined as the point at which a woman has gone 12 consecutive months without a menstrual period. It typically occurs around age 51, although the timing can vary widely. During menopause, the ovaries gradually produce fewer hormones, particularly estrogen and progesterone, leading to various physical and emotional symptoms of menopause, such as hot flashes, night sweats, mood swings, vaginal dryness, and sleep disturbances.

Common symptoms

There are a number of common symptoms of perimenopause and menopause, and they’re discussed in more detail in this Paloma article. They include:

  • Menstrual irregularities
  • Weight gain and weight redistribution
  • Fatigue
  • Sleep problems
  • Hot flashes/night sweats
  • Low sex drive
  • Mood changes

There are other signs and symptoms, however, that are not as well-known. Especially for women with hypothyroidism, it’s easy to assume that these symptoms are related to your thyroid condition. Still, you may not recognize that they may actually be due to perimenopause and menopause. Let’s look at 10 of these lesser-known or overlooked symptoms:

Joint pain

Estrogen helps reduce inflammation in the body, so as estrogen levels drop during perimenopause and menopause, inflammation can increase, leading to more joint pain and stiffness. This joint pain often affects the knees, shoulders, neck, elbows, and hands and can worsen over time. Even after menopause, when hormone levels have stabilized, some women continue to experience joint pain due to the long-term effects of decreased estrogen.

Keep in mind that hypothyroidism can also cause joint pain in some patients, so be sure you consult your healthcare provider to identify the root cause.

Tingling and “electric shocks”

Estrogen helps regulate the central nervous system and nerve function. As estrogen levels drop during perimenopause into menopause, nerve impulses can become misinterpreted, causing tingling, numbness, pins and needles, prickling, and “electric shock sensations” – also known as paresthesia – in the hands, feet, arms, and legs. These sensations are believed to be related to the link between the brain, estrogen, and the central nervous system, as hormonal fluctuations can cause messages to the brain to be short-circuited.

Even after menopause, when hormone levels have stabilized, some women continue to experience paresthesia due to the long-term effects of decreased estrogen. While paresthesia is generally harmless, it can be uncomfortable and disruptive.

Digestive issues

Estrogen helps regulate the digestive system by keeping the stress hormone cortisol in check. However, as estrogen drops in perimenopausal women, cortisol levels can rise, slowing down digestion and leading to digestive issues like bloating, gas, constipation, diarrhea, and acid reflux. The decrease in estrogen can also impact the production of stomach acid and digestive enzymes, further contributing to digestive distress. Even after menopause, some women continue to experience persistent digestive problems due to the long-term effects of decreased estrogen.

Gum problems

Estrogen helps regulate the health of the gums by maintaining proper blood flow and bacterial balance, preventing inflammation, and regulating saliva production. However, as estrogen drops during perimenopause, the gums can become inflamed, swollen, and prone to bleeding, a condition known as menopausal gingivostomatitis. The gums may also appear pale, shiny, or deep red in color. This gum inflammation can lead to increased sensitivity, bleeding gums, gum and tooth pain, and even tooth loss if left untreated. Even after menopause, when hormone levels have stabilized, some women continue to experience persistent gum problems due to the long-term effects of decreased estrogen.

Increased allergies

Estrogen helps regulate the immune system and the release of histamine, a chemical that triggers allergy symptoms. As estrogen levels drop during perimenopause, the body’s histamine response can become exaggerated, leading to more severe reactions to allergens like pollen, pet dander, scents, and certain foods. Interestingly, even women who have never experienced allergies may suddenly develop them during this hormonal transition. Even after menopause, when hormone levels have stabilized, some women continue to struggle with increased allergies due to the long-term effects of decreased estrogen.

Worsening allergies can be confusing for hypothyroid patients, because Hashimoto’s thyroiditis – the autoimmune disease that causes an underactive thyroid – can trigger or worsen allergies.

Changes in body odor

Hormonal shifts during perimenopause can lead to increased sweating due to hot flashes and night sweats, which provides a moist environment for bacteria to thrive. Additionally, the drop in estrogen levels results in a relative increase in testosterone, which can attract more bacteria to the sweat and cause a stronger, more pungent body odor, especially in the armpits and genital areas. Women may also notice their sense of smell becoming more acute during this time, making them more aware of changes in their natural scent. Even after menopause, some women continue to experience persistent changes in body odor due to the long-term effects of decreased estrogen.

Urinary tract infections

Estrogen plays a crucial role in maintaining the health of the urinary tract. It helps keep the tissues of the vagina, urethra, and bladder elastic and moist. However, as estrogen levels drop during perimenopause and menopause, these tissues can become thin, dry, and irritated. This makes it easier for bacteria to enter the urethra and travel up to the bladder, leading to urinary tract infections (UTIs). Additionally, the weakening of the pelvic floor muscles and the decreased ability to fully empty the bladder, both of which are common during menopause, can also contribute to the increased risk of UTIs. Women may experience symptoms such as a sudden and urgent need to urinate, pain or burning during urination, and even incontinence. Recurrent UTIs are particularly common, affecting up to 55% of women after menopause.

Irregular heartbeat

Estrogen helps regulate heart function and maintain a healthy heart rhythm. When a woman is in perimenopause, the ovaries produce less estrogen, leading to an overstimulation of the heart. This can cause an irregular heartbeat, a faster heartbeat (tachycardia), heart palpitations, or sensations of pounding or racing. Palpitations may occur during hot flashes or night sweats or can happen independently. While these irregular heartbeats can feel alarming, they are usually harmless and do not indicate a serious underlying condition. However, it is still essential for women experiencing persistent or worsening palpitations to consult their doctor. The doctor can rule out any other potential causes and determine if the palpitations are directly related to the hormonal changes of menopause.


Estrogen helps regulate blood flow and neurotransmitter levels in the brain and plays a crucial role in the development of migraine. The drops in estrogen that occur during perimenopause and menopause can trigger or exacerbate migraine attacks. During perimenopause, when a woman’s menstrual cycles become more irregular, and estrogen levels start to rise and fall unpredictably, migraine attacks may increase in frequency and intensity. The drop in estrogen levels around the time of menstruation can trigger menstrual migraines, which tend to be longer-lasting and more disabling than migraines at other times of the month. Other menopausal symptoms like hot flashes, night sweats, and sleep disturbances can also contribute to more frequent and severe migraines.

Even after menopause, when estrogen levels are consistently low, some women may continue to experience migraines, though they often improve over time. However, migraines that begin or worsen with surgical menopause, such as after the removal of the ovaries, tend to be more severe and persistent.

If you are experiencing migraine, it’s important to be aware that your thyroid treatment needs to be optimized, because there is a relationship between an underactive thyroid and the risk of migraine.

Changes in vision

Vision changes are a common symptom experienced by women during perimenopause and menopause. These changes can be attributed to the hormonal fluctuations during this transitional period. The decrease in estrogen levels during perimenopause and menopause can lower the salinity of the inner tear film and the oils of the outer tear film, leading to symptoms of dry eye syndrome such as blurred vision, light sensitivity, and swollen or reddened eyelids. This condition is quite prevalent in women over 50, as the risk of developing dry eyes increases with the drop in hormone levels. Additionally, the reduction in estrogen during menopause can cause slight changes in the shape of the cornea, which can affect the fit and comfort of contact lenses, requiring women to switch to a different brand or type of lens. Some women may also experience difficulty reading small text or seeing nearby objects due to the substantial decrease in estrogen and progesterone levels.

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A note from Paloma

As a woman with hypothyroidism, you already know the profound impact that thyroid hormones have on your day-to-day symptoms and overall health. Paloma Health offers a comprehensive approach to treating hypothyroidism and managing related symptoms. Our team of thyroid-savvy practitioners works closely with you to find the optimal dosage of thyroid hormone replacement medication and recommends nutritional and lifestyle changes. Paloma Health takes a holistic approach, with added support from nutritionists and health coaches who can help you incorporate dietary and lifestyle changes that enhance your thyroid health.

The perimenopausal/menopausal transition is also a time when hormonal changes can cause significant symptoms that affect your quality of life. Paloma practitioners can work with you to assess your reproductive hormonal status and prescribe hormone replacement therapy – as well as other lifestyle recommendations – to help balance your reproductive hormones and resolve persistent perimenopausal and menopausal symptoms, including those that may be exacerbated by hypothyroidism. If you’re hypothyroid and in perimenopause or menopause, consider becoming a Paloma member for one-stop comprehensive care for your hormonal health.


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Mary Shomon

Patient Advocate

Mary Shomon is an internationally-recognized writer, award-winning patient advocate, health coach, and activist, and the New York Times bestselling author of 15 books on health and wellness, including the Thyroid Diet Revolution and Living Well With Hypothyroidism. On social media, Mary empowers and informs a community of more than a quarter million patients who have thyroid and hormonal health challenges.

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