Unexpected perimenopause symptoms

By Shweta Arora, MD, board-certified physician · Medically reviewed by Robin Arora, MD · Updated October 2026

Hormones act on far more than the ovaries. Skin, joints, the inner ear and the brain all have hormone receptors, so the transition can show up in places nobody warned you about.

Why perimenopause can show up in surprising places

In perimenopause, progesterone often falls first while estrogen swings up and down. Those swings can affect tissues throughout the body, which is why symptoms can come and go. Each symptom below can also have other causes, so it deserves a proper look rather than a shrug.

Frozen shoulder

Frozen shoulder (adhesive capsulitis) causes shoulder pain followed by stiffness that makes it hard to lift your arm. According to the American Academy of Orthopaedic Surgeons, it’s most common in people in their 40s to 60s, affects women more often, and is much more common in people with diabetes or thyroid disease. It often starts without any injury.

It moves through stages: a painful “freezing” phase over weeks to months, a stiff “frozen” phase, then a “thawing” phase that can take months to two years. Most people improve without surgery, and physical therapy is the usual first step. Researchers are still studying how much falling estrogen contributes.

Itchy, dry or more sensitive skin

The American Academy of Dermatology notes that skin loses about 30% of its collagen in the first five years of menopause, and holds less water, so it can become drier, thinner and more sensitive.

• Use a mild cleanser and a fragrance-free moisturizer right after bathing.
• Keep showers warm, not hot.
• Wear sunscreen daily.

Itching all over without a rash is different. It can come from thyroid, kidney, liver or blood conditions, so it needs an exam and labs.

Ringing ears and changes in smell

Some women report new ringing in the ears (tinnitus) or smelling things that aren’t there (phantom smells) during perimenopause. The inner ear and smell pathways have hormone receptors, but research on these symptoms is still early. Because hearing and smell changes have many possible causes, we check for those first.

Is it perimenopause or something else?

Thyroid problems, diabetes, low iron, medicine side effects and other conditions can mimic or add to these symptoms. See perimenopause or thyroid? and which labs help.

How we evaluate and treat

1. Keep a 4 to 8 week symptom diary: what, when, where you are in your cycle and how you slept.
2. We take a full history, examine you and order targeted labs when they help.
3. We treat the specific problem, such as physical therapy for frozen shoulder or skin care for dryness, and discuss whether hormone therapy fits your overall picture. See our perimenopause guide.

Every plan is individualized, and treatment is recommended only when it’s right for you after your consultation.

Related reading: Perimenopause: symptoms, diagnosis and treatment · Is it perimenopause or your thyroid? · Mood, sleep & brain fog in midlife. Browse the full Women’s Health Library.

See us in person or by video

Visit our physician-led team at our Hudson, Ohio or Barboursville, West Virginia office, or meet Dr. Robin Arora by telehealth from anywhere in Ohio, West Virginia, Kentucky or Florida.

Get same-day care for sudden hearing loss or ringing in one ear, ringing that pulses with your heartbeat, phantom smells with confusion, seizures or a severe headache, shoulder or arm pain with chest pressure or shortness of breath (call 911), or all-over itching with yellow skin or eyes.

Sources: American Academy of Orthopaedic Surgeons, OrthoInfo: Frozen Shoulder; American Academy of Dermatology, skin care during menopause; The Menopause Society 2022 Hormone Therapy Position Statement. This page is general education, not medical advice.