Surprising Symptoms of Perimenopause No One Tells You About

Hot flashes, night sweats, and irregular cycles are only part of the story. Changing estrogen and progesterone act on the brain, nerves, skin, mucosa, and pelvic tissues, so the symptom list can look strange and random at first glance. What feels “weird” is often fully explainable by biology. Many of these symptoms are common, some are rare, and several are under-recognized in clinics and unfortunately in research.

What are unusual perimenopause symptoms?
Fluctuating estrogen and progesterone can trigger odd nerve zaps, internal vibrations, tinnitus, metallic taste, itchy skin, burning mouth, vivid dreams, and bladder changes. Most are benign once serious causes are excluded. Better sleep, hydration, CBT, resistance training, skincare, and targeted medical care can help.

Neurological Symptoms: Strange Nerve Sensations 

Your nervous system is rich in estrogen receptors, which is why fluctuating levels can change how nerves fire and how your body responds. The most common neurological symptoms in perimenopause are headaches, migraines, dizziness, and sleep-related restlessness. 

These affect a large proportion of women – about one in three report frequent dizziness, and around 40% experience more headaches or migraines1. On top of these, some women develop odd jolts, buzzing, or sudden chills, which are the nervous system reacting to unstable hormonal inputs rather than disease. Uncommon symptoms still deserve attention, but most are benign once serious causes are excluded2, 3.

• Electric shock sensations: brief zaps or jolts that sometimes come just before a hot flash and resolve within seconds. They are uncommon and thought to happen when nerves fire irregularly during hormone swings.
• Internal vibrations: a buzzing or humming inside the body with no visible shaking, often worse at rest or at night. Rare overall, but many women describe it, and it is usually harmless once other conditions are ruled out.
• Cold flashes: sudden chills with goosebumps when the body’s thermostat overshoots in the cooling direction. Not well studied, but many women feel a cold wave after a hot flash.
• Restless legs: an urge to move the legs in the evening or at night that can disrupt sleep. Estimated to affect about 10-20% of midlife women, more often in women than men4.

Dizziness and vertigo: a spinning or unsteady feeling that often comes with anxiety and poor sleep. About one in three women report frequent episodes, and most improve with better sleep and anxiety treatment.

Sensory Changes: Smell, Taste, Hearing, and Skin

The most common sensory changes in perimenopause are subtle – food tastes different, perfume smells overpowering, or skin feels drier and more sensitive than before. These shifts happen because estrogen helps regulate taste buds, olfactory neurons, the inner ear, and skin nerves. 

As hormone levels drop, everyday sensations can feel “off.” For some women, the changes are mild; for others, they are dramatic. These unusual sensory symptoms are unsettling but grounded in biology, and most improve once hormones stabilize or the underlying reason is treated5, 6.

• Altered smell: some women lose sensitivity to odors, while others find smells overwhelming or even notice scents that are not there. These changes are linked to hormone effects on the smell pathways.
• Metallic taste: s bitter or “pennies/cents in the mouth” taste, often tied to dry mouth and changes in saliva. It usually improves once dryness is treated.
• Tinnitus: ringing, buzzing, or humming in the ears that can begin or worsen in perimenopause. Studies show it affects a noticeable minority of women and is linked to hormone fluctuations.
• Itchy skin and formication: General itchiness or the feeling of insects crawling on the skin. This happens when skin becomes drier and nerves more sensitive.

Physical Symptoms: From Changing Skin and Hair to Mouth and Body Odor

The usual physical changes of perimenopause are well known: skin becomes drier and thinner, hair sheds more easily, and nails lose strength. Estrogen supports collagen, elastin, and keratin, so when levels fall, these structures weaken. But perimenopause can also bring less obvious physical shifts which are not widely discussed, yet they are common enough to show up repeatedly in both research and women’s stories7, 8.

• Facial asymmetry: one side of the face may sag or wrinkle more, as skin elasticity declines unevenly after estrogen drops. Research confirms that skin loses collagen faster in the years around menopause.
• Hair changes: thinning on the scalp while coarse hairs appear on the chin or upper lip. Up to two thirds of women notice changes in hair pattern by menopause.
• Brittle nails: nails split, peel, or form ridges as keratin weakens. Many women see nail changes at the same time as skin dryness.
• Burning mouth: a hot or tingling feeling on the tongue or inside the mouth without visible changes. It affects up to a third of women and is linked to reduced saliva and nerve sensitivity.
• Dry mouth and gums: saliva production drops and gums can feel sore or recede. This raises the risk of cavities and gum disease.
• Body odor changes: some women notice a stronger or different natural scent, often tied to sweating, microbiome shifts, and even changes in how the nose senses odors.

Emotional and Mental Health: Mood Swings, Anxiety, Anger, and Disturbing Dreams

The emotional side of perimenopause often catches women off guard. Mood swings and low motivation feel like PMS that never quite ends, and sleep disruption only makes emotions harder to manage. 

Anxiety is one of the most common symptoms, affecting nearly half of women during the transition, and the risk of depression doubles or even triples compared with premenopause. Beyond most common symptoms, some women notice emotional or behavioral changes that feel unfamiliar and sometimes unsettling. These changes are driven by hormone effects on brain chemistry, and often improve once sleep and hormones stabilize9, 10.

• Anxiety and panic: worry, tension, or sudden panic attacks are common, often linked with poor sleep and palpitations.
• Rage and impulsivity: outbursts of anger or acting without thinking can appear, even in women who never had these traits before.
• Vivid dreams: dreams become more intense or unsettling, with about one in ten women reporting weekly nightmares. Sleep fragmentation makes them easier to recall.

Sexual and Bladder Changes in Perimenopause

The most common genital and bladder symptoms of perimenopause are dryness, painful sex, decreased libido, and a sudden urge to urinate or leakage with coughing or exercise. These changes come from falling estrogen, which reduces moisture, thins tissues, and changes the vaginal microbiome. Alongside these familiar concerns, women sometimes develop less expected symptoms that are just as real but rarely discussed11, 12.

• Genital paresthesia: a rare but unsettling sensation, often described as a vibration or “phone buzzing” feeling in the vulva or vagina. It is linked to nerve sensitivity in thinning tissues and usually improves with local treatment.
• Pelvic organ prolapse sensations: a feeling of heaviness, pressure, or a bulge in the vagina that happens when the pelvic floor muscles and tissues become weaker. It is not common in early perimenopause but becomes more frequent as women get older or after childbirth.