The 10 Most Unusual Symptoms of Perimenopause (and What They Really Mean)

0:28So good, so good, so good. That's why Oli's science back support is made with a blend of melatonin and L-theanine for both kiddos and grownups. So when your mind won't switch off, you've got something that can help. Erasing thoughts and restless nights won't stand a chance. Find Oli's sleep solutions for the whole family at Oli.com. That's O-L-L-Y dot com. Perimenopause doesn't just show up as hot flashes and missing periods. And I know that you know this if you're in perimenopause because your symptoms started way before your period even started to become unpredictable. And maybe your period is still regular, but you're having these symptoms that your doctor never even warned you about.

1:11So things like, you know, that deep itch inside your ear that drives you nuts and you can't ever seem to reach it? Or that feeling like your tongue has been burnt on coffee that lasts all day long? or how the random zaps, like you touched a live wire or the thing I feel like we don't talk about enough in medicine, which is how the brain feels like it just left, like it just literally stopped working. And then we go to our doctor and they say, hmm, it's just stress and your labs are normal. This is not a hormone thing, except that it absolutely is. And here's what's really important for every woman to understand.

1:49These symptoms can start in your 30s and your early 40s. And if you wait until menopause to address them, well, you're already behind. So today, I'm going to walk you through the 10 most unhinged symptoms of perimenopause and what's actually driving them and what you can do to start stabilizing and supporting your body now. And I want you to stay with me until the end because at the end, I'm going to tell you the biggest mistake women make that makes all of this so much worse and how you can avoid it. Now, if you're feeling like, oh shoot, am I behind? No worries. I've got you in this episode.

2:26I'm Dr. Jolene Brighton. I'm board certified in naturopathic endocrinology. I'm a nutrition scientist, certified menopause practitioner and sex counselor, and the host of The Dr. Brighton Show, which you're listening to right now. And if you can take a quick minute to hit subscribe, drop me a comment, or leave me a review so more women can find this information, I'd be super grateful. Okay, but let's not hold this up any longer and let's get into the 10 most unhinged symptoms of perimenopause. Our first unhinged symptom sounds completely ridiculous until it actually happens to you and that is itchy ears.

3:03Not like, oh, I have allergy itching, but like deep, persistent, like just, you know, aggravating to no end and distracting level of itching that's happening in your ear canal. and your first instinct may be to grab a Q-tip and go digging. Please don't. We're going to come back to that. But first, I want to tell you what is actually happening and why do we get such maddening, itching ears in perimenopause? Estrogen. It's like always estrogen, I swear. But estrogen, okay, if I didn't get the memo yet, it's not just about reproduction. It's also about hydration and tissue integrity. It helps maintain your collagen.

3:43It helps maintain your elasticity and your natural oil production. And when estrogen starts to drop, as it does eventually in all of our lives, your mucous membranes start to dry out. Now, we talk about this with the vagina, right? This is one that we talk about commonly with perimenopause. And sometimes we talk about it with the eyes. I do have an episode coming up on that. But we almost never talk about the ears. And so the ear canal can become dry. It can become irritated. It can feel hypersensitive. And all of that gets interpreted by your brain as itching. Now, you're probably like, just tell me what to do.

4:25And here's a few things that can actually help. So one is you can actually use some oil, like a small amount of olive oil or coconut oil, and apply that to the outer ear and just barely, barely on the inside, not all the way on the inside. Sleeping with a humidifier at night to support your hydration. This can also help the sinuses, the throat as well. We want to stay hydrated. Yes, that matters here too. And in some cases, using topical estriol internally in the ear canal can help restore tissue integrity. But we never want to go deep in the ear canal, okay? So if your ears are itching and no one has an answer, it might not be allergies, friend.

5:06It might be your hormones. And if you're a candidate for estrogen therapy, then it's worth considering because this is a sign your estrogen is low. I'm going to link in the show notes at drbrighton.com other episodes on what you should know about hormone therapy in perimenopause and menopause. drbrighton.com, D-R-B-R-I-G-H-T-E-N.com. You will have that in this episode's show notes. For our second unhinged symptom, we are staying with the ears. We're going to talk about something that can feel unsettling. It can be very, very distracting, and it is ringing in your ears. So if you've ever had that constant background ringing, tinnitus is what it's called in medicine, you understand when I say this is disruptive.

5:55You know how disruptive it can be. And most people are told things like we just don't know why it's happening, but we actually do have some clues. We know, dun, dun, dun, estrogen again. Estrogen plays a role in this. So estrogen plays a role with blood flow to the auditory system, so in your ears, and the neurotransmitters that are signaling in your brain. So when we get that estrogen fluctuation and eventually decline, the auditory, the ear pathways, the way we're getting sound, those can become dysregulated. The brain can start amplifying internal noises. And then you layer on that stress, which increases nervous system sensitivity.

6:35And that tinnitus can become louder, more persistent, and much harder to ignore. So what can help here? This is where we got to support the nervous system, the brain, not just the ear. So this is where we start looking at bringing in things like magnesium. We know that can be helpful. I'm usually doing magnesium glycinate like 300 milligrams a day. We need to check B12 levels. We need to talk about stress regulation and how to actually calm the nervous system. We might want to think about white noise at night because it can be distracting when you have this ringing in your ears. You can't fall asleep.

7:10And for some women, this is part of the conversation around early hormone support, not waiting until every symptom is so severe. So you may need to start talking to your doctor about hormone therapy. I also think meeting with an audiologist can be super helpful as well because they can check, see if other things are going on, and certain ways that they can support you. Number three on our countdown to the top 10 most unhinged symptoms of perimenopause. Okay, this one's going to sound bizarre. And it is bizarre. It feels really bizarre, because it's burning tongue. And it feels like you burnt your mouth on a cup of hot tea or hot coffee, like a hot beverage, except you didn't, that didn't actually happen.

7:52And it doesn't go away. So this again, is where estrogen coming into play. Estrogen is going to be affecting saliva production. It affects our oral tissue health. So does progesterone in this. It's also involved in balancing your oral microbiome. Same as your gut microbiome. Estrogen is involved here. And so when estrogen drops, saliva goes down, tissues start to become more sensitive, nerves in the mouth become more reactive. And then your mouth starts to feel dry, irritated. Now, as I say dry, know that you could have overlapping Sjogren's syndrome. I have a whole episode on that autoimmune disease if you want to check it out.

8:33But your mouth is also neurologically hypersensitive. And so women will notice things like, you know, brushing their teeth feels different. You know, eating food feels different. There can be changes in their taste happening. But these changes in estrogen are what are helping contribute to the burning sensation in your mouth. This is why we want to be proactive with estrogen therapy instead of waiting until we have all these symptoms. So what can help here is definitely staying hydrated. Things like chewing gum that supports saliva production. You want to avoid alcohol, acidic foods. You want to check your B vitamin status and think about taking B vitamins, alpha lipoic acid.

9:14And then of course, there is looking at things like hormone therapy. you may need to take a trip to your dentist and even consider cognitive behavioral therapy. And I want to assure you that while this feels random, and your doctor might convince you that it is, that this is something we absolutely see in perimenopause and menopause. All right, moving on to number four. This is something I mentioned in the intro, and it is something that genuinely scares people, and it can be debilitating. And that is electric shock sensations, which women will describe as zaps, as jolts, sometimes feeling like you're getting stabbed, like a sudden electrical feeling in the body.

9:56And that can be a sign, like if it's happening on the face, it can be a sign of trigeminal neuralgia. And it can be a sign that something is seriously wrong with your nervous system. However, while your nervous system is involved, it may not be in the way you think if this is just a hormone-related change of perimenopause. So estrogen, again, it's regulating how neurons fire. It's regulating how signals are transmitted in the brain. And so we already talked about estrogen is also involved in neurotransmitters. But what we see is that nerve signaling becomes less stable. You start getting misfiring.

10:36You start getting these pain sensations that happen. And then you add on top of that things like cortisol dysregulation, blood sugar swings, which I've done a whole episode on, the poor sleep that comes from low progesterone and the eventual decline of estrogen. And this all has created the perfect environment for a hyperactive nervous system. So what are some things that can help? You definitely want to meet with your doctor and get this worked up. And I'd also say magnesium is critical here. Non-negotiable is stabilizing blood sugar. We've got to alleviate some of the stress and bring in nervous system regulation practices like vagus nerve stimulation and deep breathing.

11:16This is another situation where we want to rule out things like a B12 deficiency. And while this can still be hormonal, and that may be all it is, we need to be thorough in working this up and making sure nothing else is going on. That same statement is true and applies to number five on our list, which is closely related, but slightly different. And that is tingling in your hands and your feet. So this can feel like your limbs are falling asleep for absolutely no reason. So that can be confusing. And this is again where estrogen is involved, but this could also be diabetes. This could be elevated levels of B6 intake.

11:54So while, you know, we look at estrogen for how it supports circulation, nerve sensitivity, and how when it drops, it can change blood flow and nerves can become more reactive. We want to make sure we're not missing other things as well. So while I'm talking about perimenopause and things that can be part of perimenopause, know that we always rule out other things before assuming it's perimenopause because we want to consider insulin resistance. If we have nutrient deficiencies or like I said, excess vitamin B6 coming in. If you have nerve compression, so you might actually have carpal tunnel or something else going on structurally, and that needs to be investigated.

12:33Now, other things that can help, moving your body daily, getting good circulation is a non-negotiable. Again, blood sugar regulation, because if it's not diabetes now, we still want to be thinking about preventing that. And then looking at the targeted micronutrient support you may need. But I really want to underline, make sure that it's nothing else because hormones can be a trigger, but they're not always the only player and it could be something else going along with your hormones. Now, number six, if you know, you know, we need to talk about this one like a whole lot more because it's such a disruptive symptom and that is when your brain stops working the way it used to.

13:16And if you have ADHD or autism, this can feel like everything literally fell apart over And why is that? Estrogen directly influences dopamine. Dopamine is a neurotransmitter that's responsible for our focus, motivation, and executive functions, like being able to put together a grocery list, actually buy the things on the list, go home, follow a recipe, and then manage to clean it all up. Like things we take for granted. But when estrogen starts fluctuating, dopamine drops, executive function tanks, mental fatigue definitely skyrockets, because estrogen is also involved in supporting immune health and energy metabolism in the brain.

13:57So if you feel like, oh, I get like halfway through a project and I run out of steam, that can definitely be because we don't have enough estrogen taking place. Now, I talked about dopamine here, but I want you to understand that estrogen is involved in so many other neurotransmitters. So I have episodes specific on perimenopause when you've been living with ADHD or you are late diagnosed ADHD. I also have episodes about why does it feel like I have ADHD, but I don't actually. I'm just in perimenopause because these are two different phenomenons. And for the non-ADHD brain, take a big breath and just sigh with me now because that all gets better for you.

14:42It will get better. but you need support in the meantime. That doesn't mean you just like raw dog your way through perimenopause here as the kids these days say. I feel so old saying that, but I have a teenager if you can't tell. And so I'm laughing because if you're my age, you know raw dog meant something else back in the day. But raw dogging now just means like getting no support as you move through something. At least that's my interpretation of how the kids are using it. Anyhow, I digress. One thing I hear from women all the time is that they're struggling with symptoms like hot flashes, sleep disruptions, and brain fog, but aren't sure where to turn to for help.

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17:19If you are an ADHD woman, And I need you to understand you need support and you need it sooner than a non-ADHD woman. I will put lots of support in the show notes of this episode. And I also want to say that your brain may not come back by doing nothing the way we would expect a non-ADHD brain to come back. And so it's really important that you understand that. But I want to explain a little bit more about why this gets so much worse in perimenopause and what to do about it. So I mentioned that estrogen is involved in other transmitters than just dopamine. Then we've got progesterone that's involved in GABA stimulation via its neurometaboli, which is allopregnenolone.

18:00Then we've got inflammation, sleep disruption, cortisol dysregulation that can all be from fluctuating estrogen, progesterone, and testosterone. And your brain is also operating in an energy deficit, a low signal state. So this is why it's normal, but I don't just stand for it, okay? It's normal to feel brain fog, forgetfulness, inability to finish tasks, dropping words mid-sentence, okay? Like that is a normal change of the brain to some degree in perimenopause. However, it can also be a sign of Alzheimer's risk. So while it can be a remodeling of the brain, changing in how we're using energy, and you're going through this normal period, it also may not be.

18:46So this is why you want to work with a provider and you want to put the things we're going to talk about into play to support your brain, because we don't want to wish that we had prevented things down the road. And if you've read Dr. Lisa Moscone's books, you know I've endorsed them. I'm a big fan of her work. I will put that in the show notes because I also think that's a really valuable resource for understanding why women are such high risk for Alzheimer's and dementia. Why we're making up over 60 % of that population. And I want to give a nod before I go into what helps just to all the caregivers who are out there, because all of this caregiving while going through perimenopause, like 10x is the experience.

19:24Now, what does help? Okay, firstly, if you want a guide on understanding your brain and your hormones, head to drbrighton.com slash synch. D-R-B-R-I-G-H-T-E-N.com slash S-Y-N-C. That is going to be a five-day guide helping you get to know your brain and how it interacts with your hormones. Now, because you are struggling with energy metabolism in the brain, blood sugar stability is key. And there's a reason why this keeps showing up in things, and that's because it's really easy for us to have unstable blood sugar, spikes in insulin, drops in our blood sugar because of estrogen changing. So this looks like getting adequate protein in the morning and fiber at every single meal.

20:08I'd also consider targeted supplements, so cognitive support supplements, something like my Radiant Mind formula that has saffron, bacopa, citicholine. We want to support memory, focus, mood, and attention. Exercising regularly is a non-negotiable, not just for helping your blood sugar, but because it increases neuroplasticity chemicals, it helps amplify your ability to focus, have sustained attention, it helps with both mood, and it has blood flow benefits. So with estrogen declining, exercise becomes your bestie, and sleep as well. And yes, you may need progesterone therapy, but sleep is vital to your brain running its detox pathways, repairing DNA, and boosting function the following day.

20:52So if you get bad sleep the next day, we expect your brain's gonna struggle. Another thing worth trying is creatine, five grams daily, because this can help with brain energy in this phase of life. It's also helpful if you're working out so that you have more energy your next workout. And then of course, check your vitamin D and check your iron status, because if you're low in those, you're gonna have brain fog, you're gonna have hormonal issues. And it's gotta be said. for many women, early intervention with hormone support, not waiting for things to be super severe, like you're losing your mind, can help here.

21:27It can help with brain function. All right, let's move on to number seven, which is really, it's offensive. It's weirdly offensive. Okay? It's a metallic taste in your mouth. So this is like you've been sucking on a coin. That's what women describe it as. It's actually pretty straightforward in this as well. We because it again comes back to estrogen, oral hydration, and saliva production. So your mouth is getting dry, your taste receptors are changing, and now you've been thinking you've been sucking on a penny all day. Your brain is perceiving a metallic taste. It's disgusting. It is offensive.

22:03So what can we do to help with this outside of doing hormone replacement therapy? Number one is hydration. Number two, chewing on gum, bitters, so bitter tinctures, having lemon water, things that help stimulate saliva. Support your oral health. It is time for a trip to the dentist. And while the mechanism is really simple, it is a really weird and disturbing symptom. All right, number eight, which is maybe the most disturbing symptom, is when your hair feels thinner, flatter. You're seeing more of your scalp. It's not just about aging here. We know that changing hormones are changing the hair growth cycles, the follicle health, the health of your scalp overall.

22:50And as your hormones decline, your hair follicles can shrink and become unhealthy. If DHT, a form of testosterone, is too high, that can cause miniaturization of the follicles. Your growth gets slowed. Androgens can have more of an influence if we don't have enough estrogen and progesterone. But we also need to look at other things like iron. If your ferritin is below 50, that could be a cause. If you're hypothyroid, if you have a low protein intake, all of those can be big drivers of hair loss. Now, what can help? Firstly, we don't want to guess here. We need to figure out what is going on. And I have a whole episode on hair loss.

23:29And I'll put an article too in the show notes on hair loss at drbrighton.com. So you'll have those two resources for hair loss. We also need to support nutrient status. We need to be gentle with our hair, and then we need to address what hormone shifts are happening. These are key if you want to regrow your hair. Again, you'll have resources at drbrighton.com in the show notes. Now, number nine, I think is to be expected, but it does catch a lot of women off guard, and that is the loss of fullness in our breasts when they start to become droopy. Some women will call it rocks in socks. I've heard more than one patient describe it this way.

24:10Estrogen's going, so is glandular tissue, collagen, elasticity. So we're going to see tissue changes. We're going to see volume decrease. We're going to see the skin structure shifts. This is not something you should be ashamed of. We all go through this and you cannot completely override biology. It is super rude for your breast to do this to you. And, you know, while it is a normal change, here's some things that we can support. We can support skin health, collagen production, muscle tone underneath. So this is where, you know, this becomes part of a broader hormone conversation. I'm not going to be able to just give you estrogen and then your breasts just come back to the full state.

24:56But you can certainly strength train. You can eat collagen. You can take vitamin C, zinc, vitamin A, and help support your collagen. All right, number 10. Finally, one of the most common, honestly, the most common, rude and unhinged changes of perimenopause is bloating and digestive changes. So if your digestion is feeling suddenly unpredictable, thank you, estrogen, for affecting our gut motility, our microbiome, the diversity of our microbiome, inflammation signaling, our intestinal hyperpermeability, so become more reactive to food. So with estrogen shifting, we'll see digestion slows down, gas increases, more food sensitivities, microbiome composition starting to change.

25:40We might feel more inflamed. And a lot of women are told just eat more fiber. The truth is it's not enough. It's not enough. I'm sorry. Let's talk about what actually helps. It's not just increasing fiber. Okay. It's actually diversity. Diversity of fiber that helps here. 25 to 35 grams is great, but if it's the same thing day after day, that's not going to build microbial diversity. We want to also support the microbiome with fermented foods or probiotics. So you might need to start taking an oral probiotic, but you definitely want to bring in kimchi, sauerkraut, miso. Asian culinary is winning when it comes to fermented foods, but eating more fermented foods and just every day dosing your microbiome with a little bit of that.

26:23And then we also have to look at your nervous system because digestion needs to be parasympathetic activity, rest and digest. If you're eating, standing up, you're stressed out, you are always feeling stressed while you're even in the kitchen. Like friends, we got to do some things to nourish your nervous system back into rest and digest. And I have in the show notes ways to do that that I will give you more resources on. But let's go back to what I said at the beginning. The biggest mistake I see is when women wait until things are so unbearable to take action. And by that point, inflammation has taken hold.

27:03This is why they start estrogen. They're like, why isn't my brain better? Like everyone said it would be. We got to work on that inflammation. Or maybe nervous system is so dysregulated. The hormones are not enough. We've got to do more. The brain is already struggling. It becomes harder to recover. Like your joints are achy. I'm telling you to exercise. You're like, how? So, you know, the women who are doing things best, I would say, that we can look towards. They start to support their body early in perimenopause. They don't wait for a crisis. But something has to be said in this conversation.