Phantom smells. Itchy ears. Ringing in your ears. Skin that suddenly feels like it’s crawling.

If you’ve ever thought (or Googled!) “Is this a perimenopause symptom, or am I losing my mind?” you are not alone, and you are not losing it. There is a reason for every one of these.

Why does perimenopause cause such weird symptoms?

Perimenopause is known for the big symptoms: hot flushes, mood swings, weight gain. What no one tells you is that oestrogen receptors sit in cells right through your body. Your nose, your ears, your eyes, your skin, your mouth, your gut, your heart, your brain. So as oestrogen fluctuates wildly on its way down to menopause, tissues everywhere respond. That is why the symptom list looks random when it really isn’t.

Progesterone adds the other layer. It is your calming hormone and it declines first, so your nervous system becomes more reactive. Everything gets turned up: sensations, sound, sleep disruption, anxiety. Put the two together and you get a body that suddenly feels like it is behaving strangely for no reason. There is a reason.

1. Phantom smells (smelling smoke, burning, or scents that aren’t there)

One day, I swore I could smell sawdust, as if someone had just planed a piece of wood right next to me. There was no sawdust. Phantom smells, particularly burnt, smoky, metallic, mouldy or musty ones, are remarkably common in perimenopause. So is the opposite: suddenly not tolerating perfume, coffee or certain foods.

What phantom smells actually are

The medical name is phantosmia: perceiving a smell when there is no source. It is different from parosmia, where a real smell is distorted, like coffee smelling of petrol, though you can have either. Phantom smells are usually brief, they come and go, and they often affect one nostril more than the other. The most commonly reported are smoke or burning, cigarettes, something chemical or metallic, and occasionally something sweet or rotten.

Why perimenopause triggers it

Oestrogen receptors are present in the olfactory bulb and in the brain regions that process smell. Your sense of smell is genuinely hormone sensitive: it shifts across your menstrual cycle and heightens in pregnancy, so it makes sense that it becomes erratic when oestrogen fluctuates unpredictably. Falling oestrogen also dries the mucous membranes, including the lining of your nose, which changes how those olfactory nerve endings behave. And a more reactive nervous system amplifies the signal.

Worth knowing about the aggravators too: migraine (phantosmia can be an aura), sinus congestion or infection, dental problems, reflux, poor sleep, a high stress load, and low zinc or B12. Both of those nutrients matter for smell and taste.

“Almost every woman who mentions phantom smells to me says the same thing first: ‘you’re going to think I’m mad’. She isn’t mad. Her sense of smell is hormone sensitive, and her hormones are all over the place. Naming it is half the relief.” ~ Sarah McLachlan, The Perimenopause Naturopath (BHSc Naturopathy), Australia

What helps

• Rule out the simple things first: sinus congestion, a dental problem, or a medication side effect
• A saline rinse for the nasal lining, especially if you are dry or congested
• Check zinc, B12 and iron, because deficiency affects smell and taste and all three are common in perimenopause
• Steady your blood sugar and your stress load, because episodes cluster in stressful, under-slept, under-eaten weeks
• Track it for a fortnight, noting timing against your cycle, sleep, stress and food. Patterns show up fast, and it makes a GP visit far more useful

For what it is worth: I am now two years post-menopause and the phantom sawdust smell has completely disappeared. My body has adapted to its lower oestrogen levels, and that particular glitch is gone.

2. Itchy ears, ringing ears, and odd ear sensations

Ever find yourself scratching inside your ears like a dog with fleas? Or dealing with random ringing, buzzing or popping? Some women describe a strange vibration inside their head, like their ears are full of static.

Why: there are oestrogen receptors on the cells and nerves in your ear canal and inner ear, so hormone shifts can change how your ears produce wax, drain fluid and process sound. Some researchers believe perimenopause can trigger temporary tinnitus through changes in circulation and nerve function.

3. Dry eyes, or eyes that won’t stop watering

I struggled when I tried contact lenses for playing lacrosse. I would spend ages getting them in and out, and most of the time I gave up and played without them.

Why: oestrogen influences tear production and the quality of the tear film. As levels drop, eyes can become dry, gritty and irritated, and confusingly they can also water more, because irritated eyes overproduce tears. Screens, air conditioning and antihistamines all make it worse.

4. Crawling skin, electric shocks, and tingling

This one frightens a lot of women because it feels neurological, but it is usually a hormonal shift at play.

Why: oestrogen supports nerve function and skin hydration. When levels drop, nerves become more reactive, which leads to itching, tingling, buzzing or random jolts. Some women report sudden sensitivity to fabrics that never used to bother them.

Important: vitamin B12 or iron deficiency, diabetic neuropathy, fibromyalgia and anxiety can also cause formication (crawling, itchy skin), tingling hands and feet, or electric shock sensations. Please talk to your health professional and get some blood tests done rather than assuming it is hormonal.

5. Sudden gut issues and new food intolerances

Can’t tolerate wine, coffee, dairy or your usual go-to meals anymore? Bloated after everything you eat?

Why: perimenopause changes your gut microbiome, slows digestion and reduces digestive secretions, so you can react to foods that were fine before. Red meat is the classic one, because it needs the most stomach acid to break down. I have written about that in detail here: why you can’t eat meat anymore. And if bloating is your main issue, start here: how to reduce bloating in perimenopause.

6. Burning mouth, or a metallic taste

Oestrogen supports the mucous membranes and saliva production in your mouth, along with the nerves that carry taste. As levels drop, some women get a persistent burning sensation on the tongue or lips, or a metallic or bitter taste that will not shift. A dry mouth makes both worse.

What helps: hydration, addressing reflux if it is in the picture, checking iron, B12 and zinc, since all three affect taste and tongue health, and seeing your dentist to rule out other causes.

7. Heart palpitations and skipped beats

That thump or flutter, often at night or alongside a hot flush. Oestrogen influences your heart rate and your blood vessels, and falling levels combined with more adrenaline output make palpitations common in perimenopause. Caffeine, alcohol, poor sleep, low iron and an overactive thyroid all amplify them.

Please note: palpitations that come with chest pain, breathlessness, dizziness or fainting, or that simply do not settle, need medical assessment. See your GP rather than assuming hormones.

When a weird symptom deserves a GP visit

Hormones explain a great deal in midlife, but not everything, and good practice is to rule out the rest first. Please book in rather than waiting it out if you have:

• Palpitations with chest pain, breathlessness, dizziness or fainting
• Phantom smells that are constant rather than coming and going, only in one nostril, or arriving with headaches, vision changes, numbness, weakness or confusion
• Sudden hearing loss, or tinnitus in one ear only
• Crawling or tingling skin alongside numbness or weakness
• Any new lump, unexplained bleeding, or unexplained weight loss

So what actually helps?

Just because something is common does not mean it has to be your new normal. The right food, lifestyle and daily habits help your body adapt to changing hormones, smooth the fluctuations, and settle these odd symptoms.

• Build stress resilience. Stress makes every one of these symptoms louder. Rather than trying to remove stress, which is not always possible, work on your body’s capacity to handle it.
• Support gut and liver function. These organs process and clear excess hormones, so keeping them happy smooths the rollercoaster, making it more like the kiddy version at the theme park than the Tower of Terror.
• Check your nutrients. Iron, B12 and zinc turn up again and again in this list. Test rather than guess, and have results read against optimal ranges rather than just “normal”.
• Steady your blood sugar. Protein at every meal does more for symptom load than almost anything else.

If you’re tired of Googling your symptoms, wondering whether you’re going crazy, and you just want a simple, effective way to feel better, I’ve got you. Book a free Clarity Call and we’ll work out what’s driving your symptoms and what to eat, drink and do about it.

Frequently asked questions