Most women are aware of perimenopause symptoms such as hot flushes, brain fog, anxiety and joint pain. But the years before menopause come with a host of other symptoms, including lesser-known ones such as frozen shoulder, tinnitus and voice changes.
Associate Professor Rukshini Puvanendran, co-director at KK Menopause Centre, explained that during perimenopause the ovaries gradually produce less oestrogen, which can cause a wide range of symptoms.
“Certain organs are more sensitive to oestrogen changes,” she said. “For example, the hypothalamus, which controls body temperature, is highly sensitive, hence causing vasomotor symptoms such as hot flushes and night sweats.”
Dr June Tan Sheren, consultant family physician at Tucker Medical, described oestrogen as “one of the female body’s great multi-taskers”.
“It acts on bone and muscle, blood vessels, the brain, metabolism, skin, mood, the urogenital system and much more, which is why its decline at menopause has such wide-reaching effects,” she told CNA Women.
Here are some symptoms that women may not have attributed to perimenopause:
FROZEN SHOULDER
Oestrogen has an anti-inflammatory effect and helps maintain connective tissue and joint health, so its decline can contribute to inflammation and stiffness in the shoulder.
Assoc Prof Rukshini, who is also head and senior consultant of Family Medicine Service at KK Women’s and Children’s Hospital (KKH), said that women develop frozen shoulder three times as often as men, around age 50, earning it the traditional Chinese name wu shi jian, or “50-year shoulder”.
Treatment includes physiotherapy or anti-inflammatory medication; early treatment improves outcomes.
HEART PALPITATIONS
Oestrogen influences the cardiovascular system and the autonomic nervous system, which controls your heart rate, among other things. Fluctuating levels can trigger palpitations – you could have a heightened awareness or sensation of a racing, fluttering or irregular heartbeat.
Assoc Prof Rukshini said it’s a common perimenopausal symptom, though often alarming to those who experience it.
She stressed it’s important to consult a doctor to rule out heart causes. Once this is done, managing stress, and reducing caffeine and alcohol may help.
ELECTRIC SHOCK SENSATIONS, SKIN CRAWLING, TINGLING IN HANDS AND FEET
You might feel electric shock sensations (sudden, short jolts or zaps), your skin crawling (formication) or tingling in your hands and feet.
This is because changes in oestrogen levels disrupt the body’s systems for regulating temperature, processing pain and sending sensory signals through nerves, Dr Sheren explained.
She cited a large meta-analysis that found 20 per cent of women reported formication.
Severe or widespread sensations may be treated with medication, while menopausal hormone therapy may be considered when they occur alongside other menopause symptoms, said Dr Sheren.
“If the unusual sensation is experienced in just one specific area of the body, we need to think about whether it's actually a symptom of a nerve problem rather than due to menopause,” she added.
HOW LONG DO MENOPAUSE SYMPTOMS LAST?
Just because you’ve reached menopause after 12 months of no periods doesn’t mean the symptoms go away.
Dr Ho Ping Ling, an obstetrician and gynaecologist at Ascensus Health (MAH), said how long symptoms last and how severe they are vary enormously from woman to woman, shaped by the degree of hormonal decline, and environmental, social or personal factors.
Vasomotor symptoms: Hot flushes and night sweats will gradually ease over a multi-year window, Dr Ho said.
She said one American study – the Study of Women’s Health Across the Nation – found that hot flushes and night sweats persisted for a median of 4.5 years after a woman’s final period.
Genitourinary symptoms: Vaginal dryness, which is driven by ongoing oestrogen deficiency, often persists or even worsens over time, said Dr Ho. It can present as recurrent urinary tract infections, discharge or infection.
Sleep and mood disturbances: “These follow a more variable course, generally improving within a few years after menopause, though they’re often compounded by other life factors,” she added.
Dr Sueziani Zainudin, senior consultant endocrinologist at Ascensus Health Specialist Centre (RSMC), said the duration is not fixed for every symptom – “there isn’t one menopausal clock”. However, if persistent or unusual, she advised consulting a doctor.
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FEELING DIZZY, LIGHT-HEADED OR EXPERIENCING VERTIGO
Dr Sueziani Zainudin, senior consultant endocrinologist at Ascensus Health Specialist Centre (RSMC), said sex hormone receptors are present in the vestibular system, which includes structures in the inner ear that help us maintain a sense of balance.
Fluctuating hormones may therefore influence balance and it’s not unusual to feel dizzy, light-headed, “less steady” or experience vertigo. However, an association with menopause doesn't necessarily mean hormones are the cause.
Dr Sueziani recommended adequate hydration, regular meals, sufficient sleep, gradual changes in posture, and physical activity that maintains strength and balance. See a doctor if you have persistent or severe dizziness, or sudden dizziness accompanied by weakness, severe headaches or chest pain.
HOW YOUR BODY HANDLES CAFFEINE
Hormonal changes can affect how the liver metabolises caffeine, causing stronger or longer-lasting effects such as jitteriness, anxiety or disrupted sleep.
Caffeine can also aggravate menopausal symptoms like hot flushes, especially in women who are sensitive to caffeine, said KKH’s Assoc Prof Rukshini. She suggested cutting down, switching to decaf and avoiding caffeine later in the day.
DRY OR TIRED EYES, BLURRED VISION
Dr Sueziani said sex hormones, including oestrogen, influence the eye’s tear- and oil-producing glands. As hormone levels fluctuate, the tear film can become less stable, causing dryness, grittiness, burning, eye fatigue and sometimes, intermittent blurring that improves after blinking.
“Dry-eye disease is more common in women and becomes increasingly prevalent around and after menopause,” said Dr Sueziani. “Recent evidence supports menopause as a risk factor, although ageing, screen use, contact lenses and certain medical conditions can also contribute.”
Regular screen breaks, blinking, avoiding direct air-conditioning or fans, staying hydrated and using preservative-free lubricating eye drops can help. See a doctor for persistent blurred vision, eye pain or sudden visual changes.
ITCHY EARS, HEARING LOSS, TINNITUS
Oestrogen helps protect and maintain the hair cells and nerve pathways in the cochlea, the inner-ear structure involved in hearing.
So, when oestrogen drops, hearing can decline and the ear’s electrical signalling can become “noisy”, which is one theory for why tinnitus develops or worsens, said Dr Sheren.
A study found natural menopause nearly doubled the risk of hearing loss compared with that of pre-menopausal women.
Itchy ears likely relate to the same skin-thinning, dryness and barrier changes affecting skin all over the body during oestrogen decline, since the ear canal is lined with skin, Dr Sheren added.
See a doctor if you have any new or progressive hearing loss or persistent tinnitus. Dr Sheren warned that anxiety, depression and insomnia can trigger or worsen tinnitus so these should be addressed too.
A WEAKER OR RASPIER VOICE
The voice box or larynx contains hormone receptors that are highly sensitive to hormonal changes. The most profound voice changes in women happen during the menopause transition, Dr Sheren explained.
Women may notice their voices becoming weaker or hoarser, cracking, being harder to project, or unable to hit high or low notes when singing.
Almost 50 per cent of menopausal women report noticeable voice changes, which can affect quality of life, work and social functioning, said Dr Sheren.
Work with a voice therapist on vocal hygiene (care of the voice) and technique, stay well hydrated, and improve posture and breathing.
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Source: CNA/pc