Learn the science behind 10 surprising hormonal symptoms and get actionable tips to manage your health during the transition.
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Where Are You in Your Menopause Journey?
Take Our QuizIf you’ve ever found yourself lying awake at 2 am and googling something like “Why are my ears itchy?” or “Why is my heart skipping a beat?!” You’re in good company. According to menopause expert Dr. Mary Claire Haver, a board-certified OBGYN and author of The New Perimenopause, many women spend years trying to piece together seemingly random symptoms without realizing they’re all related.
During perimenopause, fluctuating levels of estrogen and progesterone affect everything from your brain and heart to your skin, joints and nervous system. Here’s how those hormonal changes can lead to 10 surprising perimenopause symptoms, and what you can do about them to feel better.
1. Perimenopause symptom: Fatigue, Exhaustion & Tiredness
You may search: “Chronic Fatigue”, “Adrenal fatigue”, “Burnout”, or “Why am I so tired in my 40s?”
Why it happens: Estrogen helps your mitochondria, the tiny “power plants” inside your cells, produce energy efficiently. As estrogen starts to fluctuate and decline in perimenopause, that energy production can slow down, leaving you feeling more fatigued than usual even if nothing about your daily schedule has changed. Declining estrogen levels can also disrupt your body’s ability to stay in deep, restorative sleep and cause stress hormone levels to spike, throwing your sleep-wake cycle off.
What to do about it:
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Start with your sleep environment: keep your bedroom dark, cool, and quiet. On a recent episode of the unPAUSED Podcast, board-certified sleep specialist Dr. Andrea Matsumura explains these are the essentials for better restorative sleep.
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Prioritize protein intake to support energy levels, sleep quality, and help preserve muscle mass.
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Add resistance training to help combat fatigue, improve sleep quality, and protect against muscle loss.
2. Perimenopause Symptom: Heart Palpitations
You may search: "Heart skipping a beat caffeine", "Anxiety or heart attack", or “Heart palpitations perimenopause at night”
Why it happens: Estrogen helps keep your heart and nervous system steady, and plays a role in helping to regulate your autonomic nervous system which controls body functions like heart rate and blood pressure. Fluctuations in estrogen levels can lead to symptoms like feeling as if your heart skips a beat, racing, fluttering or pounding.
What to do about it:
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Have a heart health conversation with your doctor. On a recent episode of the unPAUSED Podcast, research cardiologist Dr. Jayne Morgan explains that major cardiovascular changes happen during perimenopause and menopause.
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Reduce caffeine if it seems to trigger palpitations.
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Manage stress with regular movement, meditation, or breathing exercises.
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Ask your doctor whether menopause hormone therapy may help reduce symptoms and lower cardiovascular disease risk.
3. Perimenopause Symptom: Chin Hairs
You may search: “Sudden chin hairs 40s” or “Hormonal chin hair female”
Why it happens: Estrogen usually keeps the activity of androgens (like testosterone) in check. But when estrogen levels drop, androgens can become dominant and have a stronger effect, which can show up as dark hairs sprouting along your jawline. Androgens can also stimulate hair follicles on the face.
What to do about it:
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Tweezing works as can lasers and pulsed infrared light.
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A prescription-only cream like Vaniqa may help slow facial hair growth.
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If facial hair bothers you or is worsening, talk to your doctor. The Endocrine Society advises testing for elevated androgen levels and discussing treatment for the underlying hormonal shifts.
4. Perimenopause Symptom: Body Odor
You may search: “Why do my armpits smell like onions," "Suddenly sweating more at night," "Best deodorant for perimenopause odor"
Why it happens: During perimenopause, shifting estrogen levels can affect how much you sweat (hello hot flashes) and what’s actually in that sweat. Hormonal fluctuations can make your apocrine glands more active (the type that produces thicker sweat), especially in your underarm area. When the sweat mixes with bacteria on your skin, it can have a stronger odor.
What to do about it:
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Wear breathable fabrics like cotton or moisture-wicking materials to help reduce sweat buildup.
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Change out of damp clothes quickly and shower after heavy sweating.
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Try aluminum-free deodorants designed for odor control, including whole-body options like Lume, developed by Dr. Shannon Klingman.
5. Perimenopause Symptom: Frozen Shoulder
You may search: "Shoulder pain no injury", "Adhesive capsulitis exercises", "Cannot reach behind back pain", or “Frozen shoulder female 45”
Why it happens: Estrogen helps maintain collagen, and when estrogen levels start to drop during perimenopause, so can collagen production. This can make the tissues around your joints, especially the shoulder, stiffer and less elastic. Over time, the loss of flexibility can contribute to a condition called adhesive capsulitis, or frozen shoulder, which is exactly what it sounds like; suddenly reaching over your head or behind your back feels impossible.
What to do about it:
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Don’t wait! Early treatment matters. On a recent episode of the unPAUSED Podcast, orthopedic surgeon Dr. Jocelyn Wittstein explains that early intervention can make a major difference.
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Ask your doctor whether hormone therapy may help lower your risk. Preliminary research suggests women using systemic estradiol may have about half the risk of developing frozen shoulder.
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Physical therapy is still recommended and can help improve mobility, though relief varies by person.
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Deep heat therapy and anti-inflammatory medications may also help improve pain and function.
6. Perimenopause Symptom: Tinnitus (Ear Ringing)
You may search: "Ringing in ears at night", "Ringing in ears and hormones", or "Sudden hearing change"
Why it happens: Ringing, swooshing or buzzing in your ears can feel completely random, but estrogen actually helps support blood flow to your inner ear, including the cochlea, which is the part responsible for translating sound waves into signals your brain understands. When estrogen levels start to fluctuate and decline, the blood flow can become less consistent and the delicate structures in your ear may not function and process sound as well. So that processing may become “noisier” and show up as ringing, pulsing or other sounds.
What to do about it:
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Talk to your doctor about whether hormone therapy may help; research shows that it can help reduce the risk and incidence of tinnitus in menopausal women.
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Avoid exposure to loud noise.
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Use a white noise machine at night if ringing is interfering with sleep.
7. Perimenopause Symptom: Vertigo
You may search: "Dizzy when standing up" or "Lightheadedness 40s."
Why it happens: That lightheaded ‘whoa’ feeling when you stand up can be surprisingly common in perimenopause, and that’s because estrogen helps regulate your blood pressure and circulation. As levels fluctuate, your body can become less efficient at adjusting when you change positions so blood briefly doesn’t reach your brain as quickly; that’s what causes the dizziness. Hormonal changes can also make the fluid balance in your inner ear less stable, which may cause vertigo or Meniere’s-like symptoms.
What to do about it:
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Stay well hydrated to help support inner ear fluid balance.
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Reduce sodium intake if dizziness or vertigo is frequent.
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Limit caffeine and alcohol, which can worsen dehydration.
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Research also shows that hormone therapy may help relieve symptoms of vertigo in postmenopausal women.
8. Perimenopause Symptom: Itchy Ears
You may search: "Dry ear canal relief", "Ear eczema", or "Internal ear itch"
Why it happens: Estrogen plays a key role in keeping skin hydrated and healthy, and that includes the delicate lining of your ear canal. When estrogen levels drop, the skin inside your ears can become thinner, drier and more sensitive, making it more prone to itching. As hormone levels shift, you may be producing less natural oils which act as a built-in moisturizer and protective barrier.
What to do about it:
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Apply a small amount of your regular facial moisturizer to the outside of your ears, but not inside the ear canal.
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Avoid cotton swabs, which can worsen dryness and irritation.
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Dr. Haver’s hack: Apply a small amount of estrogen cream (like estradiol or estriol) to the outer ears and lobes two to three times a week.
9. Perimenopause Symptom: Skin Burning
You may search: "Skin feels like burning but no rash", "Skin feels like sunburn but no redness", or "Small fiber neuropathy"
Why it happens: So you feel like you have a really bad sunburn, but the only thing is … you don’t. So what gives? Blame it on falling estrogen levels: The hormone plays a role in how your nervous system functions and how your body perceives pain. As estrogen levels fluctuate and decline, the signals that regulate nerve sensitivity can become dysregulated, which may make nerves feel more reactive or on edge, resulting in a burning sensation known as paresthesia. Sometimes this shows up in specific forms like burning mouth syndrome, where women experience a burning sensation in their lips, tongue and mouth without an obvious cause.
What to do about it:
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Keep your skin well moisturized and focus on repairing the skin barrier.
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Look for products with ingredients like ceramides, hyaluronic acid, niacinamide, or urea.
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Avoid harsh cleansers and irritating skincare products that can worsen sensitivity.
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Menopause hormone therapy may also help by addressing the low estrogen levels contributing to dryness, collagen loss, and nerve sensitivity.
10. Perimenopause Symptom: Shivering / Cold Flashes
You may search: “Flu symptoms but no fever”, "Chilled to the bone in a warm room", or "Body temperature drops suddenly 40s"
Why it happens: We all know about hot flashes in perimenopause and menopause, and lo and behold, turns out you can get “cold flashes” too. It all comes down to how estrogen interacts with your hypothalamus, which is the part of your brain that acts like a thermostat and your body’s temperature control center. Estrogen helps regulate this, and when estrogen levels start to fluctuate, the hypothalamus becomes sensitive to even small internal or external temperature changes.
What to do about it:
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Dress in layers so you can adjust quickly when your body temperature shifts.
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Keep your bedroom comfortable at night and use bedding layers you can easily add or remove.
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Don’t skip meals. Blood sugar dips can make temperature swings feel worse.
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Build meals around protein, healthy fats, and fiber to help keep blood sugar more stable.
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Since cold flashes are often triggered by rapid shifts in estrogen that impact your hypothalamus, keeping your body as stable as possible can help smooth out the swings.
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