What are unusual symptoms of perimenopause and their causes?

Unusual Perimenopause Symptoms and Their Causes

Beyond the classic hot flashes and night sweats, perimenopause causes several unexpected symptoms that women often cannot explain, including joint pain, vertigo, brain fog, palpitations, and panic attacks—symptoms that may appear years before menopause even when estrogen levels remain adequate. 1

Five Unusual Perimenopausal Symptoms

1. Joint Pain and Myalgias

• Arthralgias and myalgias are consistently linked to the menopausal transition and represent a common but often overlooked symptom 2
• These musculoskeletal symptoms occur due to fluctuating estrogen levels affecting inflammatory pathways and joint tissues 2
• Women may undergo extensive rheumatologic workups if perimenopause is not considered as the underlying cause 1

2. Brain Fog and Cognitive Dysfunction

• Cognitive changes including difficulty concentrating, memory problems, and mental cloudiness are directly associated with the menopausal transition 2
• These symptoms result from estrogen fluctuations affecting neurotransmitter systems and cerebral blood flow 1
• Women often describe this as "not feeling like myself anymore" and may fear serious neurological illness 1

3. Palpitations and Panic Attacks

• Cardiovascular symptoms including heart palpitations and panic attacks occur during perimenopause even with adequate estrogen levels 1
• These arise from hormonal fluctuations affecting the autonomic nervous system and cardiovascular regulation 1
• In an online study, 20% of women in menopausal transition reported unexplained symptoms that caused fears of serious illness 1

4. Vertigo and Dizziness

• Vestibular symptoms including vertigo and dizziness are reported during the perimenopausal transition 1
• These symptoms likely result from estrogen's effects on inner ear function and balance mechanisms 1
• Women may undergo extensive ENT evaluations without considering hormonal causes 1

5. Mood Swings and Anxiety (Beyond Depression)

• While depression is recognized, severe mood swings and anxiety show an abrupt rise in prevalence as women approach later stages of the menopausal transition with longer bouts of amenorrhea 3
• Depressed mood and increased anxiety increase during the transition, with symptoms often interacting—depressed women experience worse hot flashes and worse sleep 3
• These psychiatric symptoms result from fluctuating estrogen and progesterone levels affecting serotonin, GABA, and other neurotransmitter systems 4

Common Pitfalls in Recognition

• These unusual symptoms may present years before menopause and can occur even when estrogen levels are still adequate 1
• Women experiencing these symptoms often undergo extensive medical workups for other conditions if perimenopause is disregarded as the cause 1
• Unlike hot flashes which eventually resolve, some symptoms like vaginal dryness will not go away without treatment 3
• Symptomatic perimenopause can last much longer than previously thought—the SWAN study reported median duration of 11.8 years for women affected in early perimenopause 1

Underlying Mechanisms

• The profound reproductive and hormonal changes during perimenopause involve fluctuations in estrogen and progesterone that affect multiple organ systems beyond the reproductive tract 3
• Circadian changes, decreased melatonin production, and physiological changes associated with aging compound the hormonal effects 4
• These symptoms are sufficiently bothersome to drive almost 90% of women to seek healthcare provider advice 3