10 perimenopause symptoms you probably don't know yet
Updated on Jun 1, 2026
You have had palpitations while sitting on the sofa, with no apparent reason. Your shoulder has hurt for months, and no physiotherapist has found a clear cause. Your mouth has been burning for weeks, and you cannot explain it. Your ears itch repeatedly.
Each of these signs, taken on its own, seems to have nothing to do with hormones. But if you are going through perimenopause, they could all have a common root: the progressive decline in estrogen and the hormonal fluctuations typical of this stage.
The problem is that no one tells you.
Perimenopause is probably the most underdiagnosed and least discussed stage of female life in medicine. The best-known symptoms, such as hot flashes and night sweats, have received attention in scientific literature and public debate. Everything else has remained in the shadows for decades. Research by CanesMeno found that more than 90% of the women surveyed were unaware that electric shock sensations, frozen shoulder, tinnitus and burning mouth syndrome could be symptoms of perimenopause. The same study showed that more than half of women did not feel prepared to face this stage, yet on average they had already been experiencing symptoms for about a year before recognizing them.
This lack of awareness is not women’s fault. It is the result of decades of medical research that has historically underrepresented female health, of a healthcare system that often does not train primary care doctors on the atypical signs of the menopausal transition, and of a culture that has treated menopause as a topic not to be named out loud.
Knowing what is happening to your own body is a right. And in this article we try to close part of that gap.
What is perimenopause: a longer stage than we think
Before going into the symptoms, it is worth clarifying what we are talking about.
Perimenopause is the transitional stage that comes before menopause itself. It begins when the ovaries start producing estrogen less regularly, and the menstrual cycle begins to change. Menopause, technically, is a precise moment: 12 consecutive months without a period. Everything that comes before, even if your cycle is still present, is perimenopause.
This transition can last from two to ten years. Many women begin it between the ages of 40 and 45, some even earlier. Duration and intensity vary enormously from woman to woman, which makes recognizing the symptoms even more difficult: there is no standard path.
In perimenopause, hormone levels do not decline in a straight line. They fluctuate. There are periods when estrogen rises suddenly and then drops, creating variability that can make symptoms intermittent and difficult to trace back to a clear cause. This is why many women in this stage continue to attribute what they are experiencing to stress, tiredness or age.
To explore what happens to the body during this stage, you can read our complete article on perimenopause and its main symptoms.
The 10 perimenopause symptoms you probably don’t know yet
1. Frozen shoulder
Frozen shoulder, technically known as adhesive capsulitis, is an inflammatory condition in which the shoulder joint capsule progressively stiffens, causing pain and significant loss of mobility. Raising your arm, combing your hair, putting on a jacket: normal movements become painful or impossible.
It affects between 2% and 5% of the global population, and three quarters of patients are women between 40 and 60, exactly the window of the menopausal transition. Research has begun to understand why. Estrogen has an anti-fibrotic role in connective tissues: it suppresses fibroblast activation and pathological collagen deposition. When it declines, the shoulder joint capsule becomes more vulnerable to inflammation and fibrosis.
A narrative review published on PMC in 2025 reclassified frozen shoulder as a manifestation of systemic endocrine, metabolic and immune dysfunction, with estrogen deficiency playing a central role. And a retrospective pilot study published on PubMed found that women who did not use hormone therapy had twice the odds of developing adhesive capsulitis compared with those who did use it (PubMed: 41614260).
If you have persistent shoulder pain that does not respond to usual treatments and you are in the age range of perimenopause, it is worth mentioning it to your doctor in the context of hormonal transition. Read more about frozen shoulder in this article.
2. Heart palpitations
Feeling your heart beat irregularly, speed up or seem to “skip” a beat, often without any obvious physical effort, is one of the least expected symptoms of perimenopause.
Up to 42% of women in perimenopause and 54% of those in postmenopause report palpitations, according to data from Carpenter et al. at the Indiana University School of Nursing. The mechanism involves the sinoatrial node, the heart’s pacemaker: the heart contains estrogen receptors, and estrogen fluctuations alter its electrical stability. Estrogen also has a protective effect on the autonomic nervous system, which regulates heart rate: when it declines, that stability is reduced.
Palpitations in perimenopause are not typically associated with underlying cardiovascular disease, as confirmed by the SWAN study (Study of Women Across the Nation). However, because true arrhythmias can present with the same symptoms, any frequent or intense palpitations deserve medical evaluation to rule out cardiac causes.
3. Burning mouth syndrome
A burning sensation on the tongue or palate, which can range from mild discomfort to intense pain, and persists without visible lesions or infections. This is burning mouth syndrome, also known as stomatodynia.
It affects between 10% and 40% of women in the menopausal stage, according to research published on PMC, with a female incidence three to seven times higher than in men and increasing further with age. The oral mucosa contains estrogen receptors, and hormonal decline alters the neuronal reactivity of pain circuits in this region. A case-control study cited on PMC found higher FSH levels and lower estradiol levels in women with burning mouth syndrome compared with healthy controls. (PMC: 4195183, PMC: 4520363)
Many women with this symptom are referred to dentists or gastroenterologists for years without finding a cause. Knowing the correlation with perimenopause can significantly shorten this path.
4. Itching and ringing in the ears (tinnitus)
The inner ear contains estrogen receptors. When hormone levels fluctuate, symptoms can appear such as persistent itching in the ear canal, a blocked-ear sensation, intermittent buzzing or ringing (tinnitus), or the perception of sounds as wavelike or pulsating.
Research has identified a link between the phase of the menstrual cycle and hearing function: when progesterone levels are high, hearing can be temporarily altered. In perimenopause, these fluctuations become irregular and more pronounced. Tinnitus, in particular, has a significantly higher prevalence in menopausal women than in the general female population.
As with many of the symptoms in this list, the difficulty is that itchy ears and tinnitus are almost never mentioned in connection with hormonal transition, leading to long and often inconclusive diagnostic paths.
5. Dizziness and feeling unsteady
Suddenly feeling unsteady, having episodes of mild dizziness or the sensation that your feet are not firmly planted on the ground: these are symptoms many women in perimenopause describe, and they are rarely linked to hormones.
Estrogen, progesterone and testosterone influence the way blood vessels dilate and contract. When levels fluctuate, this can trigger sensations of lightheadedness, pressure or dizziness. Sex hormones also act on the brain areas that regulate balance and on the inner ear, which is a key structure for spatial orientation.
Dizziness in perimenopause often appears episodically and unpredictably, and tends to be more frequent during moments of acute estrogen decline.
6. Joint pain and morning stiffness
Waking up with stiff hands, having knee pain without any traumatic cause, feeling that your joints are less fluid than usual: these are very common symptoms in perimenopause, but they are almost never recognized as such.
Estrogen has a documented anti-inflammatory effect on connective tissues and cartilage. It regulates pain perception, connective tissue hydration and the local inflammatory response. When it declines, joints become more prone to inflammation and pain, especially in the morning.
This mechanism is also behind the frozen shoulder described in point 1, and it explains why many women in this stage receive diagnoses of rheumatoid arthritis or fibromyalgia that later turn out to be incomplete or wrong. Learn more in this article.
7. Electric shock sensations
A sudden and brief sensation like a small electric shock, often felt in the head, neck or on the surface of the skin. It can come before a hot flash, or appear completely on its own.
This symptom is among the least known. The CanesMeno survey cited in the introduction found that more than 90% of the women surveyed did not know that electric shock sensations could be a possible symptom of perimenopause. The mechanism is neurobiological: the decline in estrogen alters the conduction of nerve impulses, producing these brief and often surprising shocks.
The temporary nature of the sensation (it lasts a few seconds) makes it difficult to describe to a doctor, and often leads women not to report it. Yet knowing what it is reduces the anxiety that accompanies each episode.
8. Dry mouth and dry eyes
Estrogen regulates mucus production and the lubrication of mucous membranes throughout the body. When it declines, dryness does not only affect the vaginal area, which is the most discussed symptom: it also involves the mouth and eyes.
Dry eyes in perimenopause can appear as itchy eyes, eyes that tire easily, feel sandy or become very sensitive to screens. Dry mouth can lead to difficulty swallowing, changes in taste and greater susceptibility to cavities and gum problems.
A study cited on PMC found a significant association between oral dryness and climacteric symptoms and their treatment (PMC: 12113011). Here too, the oral and conjunctival mucosa contain estrogen receptors, and their activation has a direct role in maintaining lubrication.
9. Brain fog
Forgetting where you put your keys, struggling to find words during a conversation, feeling less focused than usual, having the sensation that your thinking is slower or less clear. This group of cognitive symptoms is commonly called brain fog.
Estrogen supports synaptic plasticity, which is the brain’s ability to form and modify neural connections. It also regulates circadian rhythm and sleep. When it declines, both functions are impaired: the brain runs with less hormonal support, and sleep quality, already reduced by night wakings, further worsens daytime cognitive function.
Brain fog in perimenopause is real, measurable, and tends to improve when hormone levels stabilize. Recognizing it as a hormonal symptom, and not as a sign of early aging or cognitive disease, matters for both health and mental wellbeing. Read more details in this article.
10. Itchy skin and the sensation of insects on the skin (formication)
Skin that itches without an obvious dermatological cause. In some cases, the sensation is more specific: a tingling feeling as if insects were crawling under the skin, a phenomenon known in medicine as formication.
Both symptoms have a precise hormonal basis. Estrogen regulates epidermal thickness, collagen content, barrier function and sebum production. When it declines, the skin becomes thinner, drier and more reactive. Formication, on the other hand, is a neurological symptom: estrogen decline alters the conduction of peripheral nerve impulses, producing abnormal sensations on the skin surface.
These symptoms overlap with other conditions such as iron deficiency and thyroid disorders, both more common in women at this stage. This is why a complete clinical evaluation is always the right starting point, rather than automatically attributing everything to perimenopause.
What to do with this information
Reading this list could trigger two opposite reactions: relief (finally, an explanation for something I was experiencing without knowing how to name it) or concern (I did not know there were so many symptoms).
Both reactions are legitimate. But the most useful response is a third one: bringing this awareness into a conversation with a health professional specialized in menopause.
Perimenopause is a complex biological transition, and its symptoms are best understood within a clinical evaluation that integrates gynecological or endocrinological perspective, nutritional perspective and wellbeing medicine. Recognizing your symptoms is the first step. Finding someone who knows how to listen to them in the right context is the second.
To understand where you are in your transition and build a personalized path, you can start with the PauseTest: our digital assessment tool that analyzes your profile across four areas and guides you toward the answers most suitable for you.
FAQ
How many symptoms does perimenopause have in total?
Medical literature documents more than 40. The best-known ones, such as hot flashes, night sweats and cycle irregularity, represent only part of the picture. Many lesser-known symptoms, including those described in this article, involve the nervous system, joints, sensory system and cardiovascular system.
At what age does perimenopause begin?
On average between 40 and 47, but it can begin earlier. Early perimenopause, before age 40, is less common but documented. Diagnosis is based on symptoms and menstrual history more than on a blood test, because hormone levels fluctuate a lot during this stage and a single blood draw can appear “normal” even when the transition is already underway. IMS and EMAS guidelines indicate that in women over 45 with typical symptoms and an irregular cycle, hormonal confirmation is not necessary to begin a care pathway.
Do perimenopause symptoms resolve on their own?
Some symptoms ease when hormone levels stabilize in postmenopause. Others, such as joint pain or cognitive symptoms, can persist or worsen without intervention. Timing and intensity vary greatly from woman to woman. This is why personalized monitoring with a professional is more effective than passive waiting.
When should I talk to a doctor about my symptoms?
Always, when symptoms interfere with daily quality of life. In particular, frequent or intense palpitations, recurring dizziness or persistent shoulder pain deserve medical evaluation to rule out non-hormonal causes, even if a connection with perimenopause is suspected. Book an appointment with a doctor specialized in perimenopause and menopause here.
Is there a test that confirms perimenopause?
Perimenopause diagnosis is clinical: it is based on symptoms and changes in the menstrual cycle. Blood hormone levels (FSH, estradiol) can support the evaluation, but they do not define it on their own. At this stage, hormone values fluctuate and a single blood draw can be misleading. The overall picture, evaluated by an experienced professional, is more reliable than any single test. To start a care pathway, go here.
Sources
- Frozen shoulder as an endocrine manifestation: PMC narrative review 2025 - PMC12564958
- HRT and adhesive capsulitis study (PubMed 2025): 41614260
- Palpitations in perimenopause, Carpenter et al., Indiana University: cited in Online Menopause Centre
- Burning mouth syndrome in menopause: PMC 4195183 · PMC 4520363
- Neural mechanisms of burning mouth syndrome and estrogen: PMC 12030133
- Oral dryness and climacteric symptoms: PMC 12113011
- CanesMeno survey on unrecognized symptoms: gathered.how
- IMS 2023 Practitioner’s Toolkit (perimenopause diagnostic guidelines)
