Menopause Symptoms That May Surprise You

For almost every woman, menopause comes with symptoms. On average, menopause (defined as the biological process that occurs when menstruation stops permanently) happens between ages 45 and 55, but symptoms can begin up to 10 years before that, the period called perimenopause.

Hot flashes are the most common complaint — as many as 3 out of 4 women in the United States have them — and weight gain and mood swings are also well-known issues. But there are many other lesser-known symptoms that can also be caused by the loss of estrogen that happens when monthly periods become irregular and eventually stop.

These issues can affect everything from your joints to your nails — even your nervous system — and can have a major impact on quality of life. Keep reading to learn more about surprising menopause symptoms, why they happen, and what you can do about it.

During perimenopause and menopause, some women report that their muscles and joints hurt, but they don’t know why, says Vonda Wright, MD, an orthopedic surgeon and researcher in Orlando, Florida.

“They say, ‘I don't know what happened, but I think I’m falling apart.’ And many times they’ve been told by other clinicians or read somewhere that it’s just part of aging,” says Dr. Wright.

In fact, it could be a symptom of menopause. When estrogen “walks out the door,” it impacts musculoskeletal tissue, including muscle, bone, fat, and muscle-derived stem cells, because those all have estrogen receptors, she says.

In her recent research on the symptom, Wright dubbed this phenomenon the “musculoskeletal syndrome of menopause,” which includes a group of conditions and symptoms that become more common in perimenopause and beyond, including joint pain, frozen shoulder (stiffness and pain in the shoulder joint), a loss of muscle mass, and worsening osteoarthritis.

Research suggests that more than half of menopausal women have muscle and joint pain, which can be debilitating.

“I had this, and it was devastating. I’m an athlete, and I could barely get out of bed,” says Wright.

But there are a few things women can do to combat muscle and joint pain in addition to taking medication.

After clearing it with your provider, Wright suggests lifting heavy weights and adopting a jumping practice to help stimulate bone density and build muscle. Activities like jumping rope or hopping on one leg have been shown to be safe and maintain or improve bone density in post-menopausal women — but appropriate instruction and supervision is important to reduce the risk of injury.

Replacing sugary carbs with fibrous carbs (think broccoli) as part of an anti-inflammatory diet may also help reduce muscle and joint pain, she says.

Dry, itchy skin is a common but uncomfortable symptom of menopause. As estrogen levels decline, so does your skin's ability to retain moisture.

“The reduction in estrogen decreases natural oil production and collagen, making the skin thinner and more vulnerable to dryness and itchiness,” says Karen Carlson, MD, an ob-gyn at the UNMC Medical Center in Omaha, Nebraska.

To combat dry skin, use a gentle, unscented soap when showering and moisturize afterwards. Apply lotion to areas of your skin that feel dry throughout the day.

Many women may notice a change in the fullness of their breasts when they go through menopause, says Dr. Carlson.

“The drop in estrogen levels leads to the shrinking of glandular tissue in the breasts, resulting in less dense and more fatty breast tissue,” says Carlson.

Breast tissue becomes softer, which can make breasts look and feel different than in your premenopause days.

A metallic taste in your mouth is an uncommon but recognized symptom for some women going through menopause. “Fluctuating estrogen levels can affect the taste buds and the pathways in the brain that control taste,” Carlson says.

So-called burning mouth, which is also linked to menopause, can cause a bitter or metallic taste in the mouth. “Other symptoms [of burning mouth] include pain, discomfort, tingling, scalding, numbness, or a burning sensation in the mouth, lips, and tongue,” says Carlson.

It's estimated that 1 in 4 women may experience a decrease in saliva flow when estrogen levels go down.

“Dry mouth, also known as xerostomia, is primarily due to the decrease in estrogen levels, which can significantly reduce saliva production, leading to a dry feeling in the mouth and throat,” says Carlson.

There is a direct link between hormonal changes and oral health during menopause, leaving women more susceptible to gum disease. If left untreated, this can lead to symptoms like bleeding gums, inflammation, and even tooth loss.

Carlson recommends talking with your dentist about issues relating to dry mouth, burning mouth, or any type of gum disease.

Although menopause itself does not directly cause body odor, hormonal changes during this time can influence factors that might contribute to it, says Carlson.

For example, when your estrogen levels drop, your hypothalamus gland is fooled into thinking you're overheated and causes you to sweat excessively, as during a hot flash, which can result in a not-so-pleasant body odor.

Research suggests that the majority of women feel like their nails are dry and brittle after going through menopause.

“The decrease in estrogen levels during menopause leads to reduced collagen production and diminished moisture retention, which can weaken the nails and make them more prone to breaking or splitting,” says Carlson.

Additionally, hormonal changes may affect nail growth, she adds.

Though not as common, some women experience dizziness or lightheadedness during menopause. Hormonal fluctuations, particularly the drop in estrogen, can impact the nervous system and blood circulation, leading to occasional dizziness or lightheadedness, says Carlson.

Menopause has also been linked to different types of vertigo, including benign paroxysmal positional vertigo, which is triggered by changes in head position.

“Other menopause-related factors, such as sleep disturbances, anxiety, or changes in blood pressure, can also contribute to dizziness,” says Carlson.

Tinnitus, or the perception of ringing in the ears, is not a common menopause symptom, but menopause can contribute to tinnitus in some women, says Carlson.

“The decline in estrogen levels during menopause can affect blood flow and nerve function in the auditory system, potentially leading to tinnitus. Hormonal fluctuations may also exacerbate stress or anxiety, which are known to intensify tinnitus symptoms,” she says.

Hormone fluctuations may also play a role in Meniere’s disease, a chronic and disabling inner ear condition. People with Meniere’s disease have recurrent and spontaneous episodes of vertigo that often come with hearing loss, vision changes, and pulsatile tinnitus, which is a type of tinnitus that causes a thumping or whooshing sound in one or both ears.

Unusual neurological feelings like tingling, numbness, itching, or a “creepy crawly” feeling on the skin can be caused by menopause, but it's not very common, says Carlson.

“These symptoms, often referred to as paresthesia, again are linked to hormonal changes during menopause, particularly the decline in estrogen,” she says.

“Estrogen plays a role in maintaining healthy nerve function, and its reduction can lead to nerve sensitivity or disruptions. Additionally, stress, anxiety, or sleep disturbances during menopause may intensify these sensations,” says Carlson.

Even though this change can be related to menopause, it can also be a sign of other more serious health conditions. If it keeps happening, talk to your healthcare provider.

You may have heard women talk about “brain zaps” or electric shock-like sensations during menopause, and they are a real thing (though not a common complaint), says Carlson.

“These can feel like mild to severe jolts of pain that radiate from the head or extremities and are typically related to hormonal fluctuations, particularly the decline in estrogen levels,” she says.

There isn’t much research about this phenomenon, but the sensations are thought to be linked to changes in the nervous system and neurotransmitter activity during menopause.

“Although they can be uncomfortable, these sensations are generally temporary,” says Carlson.

Bladder weakness can cause you to leak urine when you sneeze, laugh, jump, or lift something heavy.

Also known as urinary incontinence, bladder weakness is a very common problem during and after the menopause transition, says Carlson.

“Lower estrogen levels during menopause affect the muscles and tissues of the pelvic floor and the urinary tract, leading to weakened support for the bladder. This can cause symptoms like urgency, frequency, or even accidental leakage of urine,” she says.

Estrogen also helps with the elasticity and health of the urethra and bladder. A reduction of estrogen means those factors aren’t as strong, which can also make bladder control challenging.

“Additionally, other menopausal factors such as weight gain and changes in the pelvic floor muscles can further contribute to bladder weakness,” says Carlson.

Depending on the severity of symptoms, your provider may recommend dietary changes, pelvic floor muscle exercises (Kegel exercises), medications, or surgery.

If women are bothered by these or other more common menopause symptoms, Carlson recommends that they talk with their provider — ideally a menopause expert.

“Then, with joint decision-making regarding the individual risks and benefits, they can decide if a trial of hormone therapy (HT) is right for them. While HT could help, it is hard to know how an individual will respond until it is tried,” says Carlson.

Systemic hormone therapy is recommended for the treatment of hot flashes and night sweats, and local estrogen therapy (with a cream, ring, or suppository) is recommended for vaginal dryness.

However, hormone therapy can be considered to see if it helps with other symptoms, including less common ones, if the benefits outweigh the risks, she says.

The menopause-related decline in estrogen can impact muscles and joints, skin, nails, the mouth, and bladder, which can negatively impact quality of life.
Menopause-related hormonal shifts can also affect the nervous system, causing issues like tinnitus, dizziness, and “electric shock” sensations.
Hormone therapy may alleviate some menopause symptoms, but a person should discuss their individual needs and risks with a healthcare provider for optimal treatment.

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