Dark Patches Under the Eyes Are Not a Recognized Postmenopausal Symptom
Periorbital hyperpigmentation (dark under-eye patches) is not an established symptom of menopause based on current clinical guidelines and evidence.
Recognized Menopausal Symptoms
The symptoms consistently linked to menopause based on available evidence are limited and well-defined:
- Vasomotor symptoms (hot flashes and night sweats) are the hallmark menopausal symptoms, affecting 50-75% of women during the menopausal transition 1, 2
- Genitourinary syndrome of menopause includes vaginal dryness, dyspareunia, urinary urgency, and pruritis 3, 2
- Sleep disturbances are consistently associated with the menopause transition 3, 1
- Depression and mood fluctuations have established links to menopause 3, 1
- Sexual dysfunction and reduced libido are recognized menopausal symptoms 3, 4
3 explicitly state that "only vasomotor symptoms, atrophic vaginitis, dyspareunia, sleep disturbances and depression are consistently linked to the menopause transition, on the basis of currently available evidence."
Symptoms NOT Consistently Linked to Menopause
Other symptoms commonly attributed to menopause but lacking consistent evidence include:
Periorbital hyperpigmentation is notably absent from all clinical guidelines and research evidence on menopausal symptoms 3, 6, 7, 8, 1, 4, 2.
Clinical Implications
When a postmenopausal woman presents with dark under-eye patches:
- Do not attribute this finding to menopause as it lacks evidence-based support
- Consider alternative dermatologic causes such as allergic contact dermatitis, atopic dermatitis, post-inflammatory hyperpigmentation, or hereditary factors
- Evaluate for systemic conditions that may cause periorbital changes (thyroid disease, anemia, sleep disorders)
- Assess for lifestyle factors including sleep quality, stress, and sun exposure
Common Pitfall to Avoid
3 warns against "assuming all symptoms are menopause-related, as some may be due to aging, psychological disorders, or other medical conditions." This is particularly relevant for dermatologic findings like periorbital hyperpigmentation, which have no established pathophysiologic connection to estrogen deficiency or the menopausal transition.