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.

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.

“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.

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.

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.

“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.

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.

“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.

“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.

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.

“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.

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.

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.

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.