Did you know that menopause is more than just experiencing hot flashes and night sweats? Many women experience other Menopause symptoms, such as dizziness, allergies, and heart palpitations. In this very interesting episode, Dr. Hirsch will break down six of the more commonly heard of uncommon symptoms of menopause. This is a must-listen for any woman in midlife and at menopause!

So, two weeks or a week ago or so I posted about rare symptoms of perimenopause and menopause. And I can’t believe the amount of responses I got from this one post, which shows me that there are so many other symptoms that go missed, and they’re misunderstood, and it just leads to the confusion or the feeling of not ever being able to treat what it is, or that dismissive response that you might get from your clinician. So we’re gonna be talking about six of the more uncommon perimenopause, menopause symptoms in today’s episode.

All right, so let’s get into today’s episode, which is, explaining six of the more uncommon symptoms of, again, both perimenopause and menopause. And I always want to remind women that symptoms of menopause, those classic symptoms or unclassified symptoms as we’re gonna talk about today can certainly start in a perimenopause where you’re still having periods whether they’re more frequent or they’re more spaced out. And so these are going to be the more uncommon symptoms of either a perimenopause or menopause.

Now, right off the bat, I also wanna let you know that I’m not exactly sure I know the physiology behind each of these, but I’m gonna do my best to stay true to you and tell you when I don’t know something. But it doesn’t mean that we don’t know that, it might just mean that Heather Hirsch doesn’t know absolutely everything. I know, I have to say it out loud, but it is true! And so, if there are other folks out there who know a little bit more about this, these topics could each have experts in their individual fields. So I’m really excited to dive into this today. And the other final point is that, this list is not exhaustive. There are probably many more uncommon symptoms of perimenopause and menopause that we still haven’t yet recognized. And again, this list is just not a fully comprehensive list.

So let’s jump into the first one on the list which is really actually much more common than I think other clinicians realize, and that is vertigo. Vertigo, if you don’t know, is the medical term for dizziness. Most vertigo is classified as benign positional vertigo. That means what it sounds like. When you move your head from side to side, that’s when you feel the dizziest.

So a really good example of this is someone who is waking up and their alarm goes off and they immediately shoot out of bed without really opening their eyes and letting their brain know what direction they’re looking in and sitting up slowly. When you jump and shoot out of bed and you’re experiencing benign positional vertigo, you can feel a lot of dizziness, that’s one example of it. And this gets very commonly diagnosed in midlife perimenopause and menopause.

Now, we do know that there are estrogen receptors from head to toe. I say this all the time. And there are estrogen receptors in our ears. Literally, there’s an estrogen receptor in every organ system of your body. So don’t be surprised. So, estrogen receptors are in our ears. And as that estrogen starts to decline in perimenopause or as you make no more estrogen once you’re menopausal, for some women, it must just trigger either an imbalance or a firing of neurons that are not supposed to be firing any longer, which kind of is what happens with hot flashes, and that can trigger this feeling of vertigo.

Now, vertigo or dizziness is pretty much or mostly subjective, meaning that you feel it but it’s not like it is great, great tests to determine what is causing it. Now, a neurologist would debate me on this absolutely, but I’m not a bonafide neurologist. And there are ways to tell if someone has benign positional vertigo. It could also be commonly from an infection, and again, it could also perhaps be commonly from the changing hormone levels.

Now, interestingly, when I prescribe hormone therapy to my patients who know this, often, not always, often that vertigo gets better. So that to me says, Aha! There’s an imbalance or there’s a decline in estrogen receptors which are really important in our inner ear. And when we replace estrogen, that symptom goes away. So vertigo, which is the medical term for dizziness, is really common in midlife and in menopause. It’s not very commonly linked to menopause or perimenopause. In my opinion, I think this is a commonly uncommon symptom and it often gets misdiagnosed as either benign positional vertigo or vestibulitis, which is an infection causing these symptoms. And women can undergo all sorts of horrific treatment; trying one drug and then another, or a vestibular rehab.

Another way to say vestibular rehab is where you go and you kinda have your head positions moved around a lot so that you can stop that dizzy sensation only to find that when we use hormone therapy, that symptom goes away. So I think this is really fascinating. And certainly, if it’s something that you’re experiencing and you’ve tried a lot of things, you might wanna see a menopause expert and think about a trial of hormone therapy. Now, hormone therapy is not FDA-approved to treat. This hormone therapy is, by the textbook, FDA-approved to treat hot flashes, night sweats, and severe genitourinary syndrome of menopause. But certainly, if you cannot treat your vestibulitis or vertigo any other way, you should definitely consider a trial of hormone therapy, and/or you may have one of those other symptoms anyways.

Onto the next, actually two, I’m gonna lump these together because I think there are related. And the next two more uncommon symptoms were new skin rashes and allergies. Now, I think that what these have in common is an anti-histamine pathology. So as you probably know, ’cause we all know about seasonal allergies, right? And seasonal allergies are typically in the fall or in the spring. For me, it’s in the spring. And I go take a walk outside, and I feel great, and I’m smelling all the fresh flowers, and all the new cut grass, and then I come home and my eyes are just watering and itching, and then I just can’t wear mascara for like another month ’cause it’s just gonna get rubbed off immediately.

And I’m supposed to take an anti-histamine because my histamines in my body are rising, they’re starting to attack those pollens in the air ’cause they think that they’re dangerous to me. And when I take an anti-histamine, that can help to diminish those symptoms because I’m kinda telling my body, “Hey, calm down, you don’t really need to attack those.” So, a skin rash or a new allergy at menopause may be related to a flare of histamine release from the drop in estrogen level. And you’re thinking, “Well, there’s certainly, come on! Estrogen cannot really regulate all of these things.” Yeah, yes it can. It really can. Estrogen is so powerful and we have not yet, I don’t think we… Gotten into the depth of how powerful estrogen is.

But if you listened to my podcast before you certainly have learned so much about the way estrogen affects so many symptoms or organ systems in our bodies such as our cardiovascular system, our bones, our brain, et cetera. It’s really fascinating. So I really think what’s happening here is there some histamine release from the loss or decline in estrogen, which can either cause new allergies to develop or it can cause skin rashes or new skin changes which can… Again, both of these processes may be, in my opinion, related to a new level of histamine released in your body. So, can you treat these things with estrogen? Well, I certainly think I see these less often.

Specifically allergies, a lot of patients are gonna tell their doctor and their doctor’s gonna try to treat them with an anti-histamine. And for all I know, that could probably work. Or if it’s a skin change, or a new skin rash, or lesion, they’re gonna work that up. They might prescribe a patient a topical steroid cream which works again to decrease that histamine release, or they’re gonna send them to see a dermatologist. And so, I wouldn’t say that it’s the most common thing that I hear my patients say in the uncommon category, but definitely, I hear skin changes quite frequently. Now, there are of course the pretty obvious ones that are more like dry skin. My hair is really dry and brittle, my nails are really dry and they break really easily.

But there’s also the, I have a new rash. I am breaking out to this new food, or this new cream, or this new lotion, and this has never happened to me before. Those cases do definitely stump me. And to what degree estrogen replacement can help? I am not totally sure because these still may be multifactorial. It is really hard to say if it’s directly related to the drop in estrogen and a change in histamine or new release in histamines, or is it just that all of a sudden the company put a new product in that lotion or put a new product in your shampoo and it’s causing you to have a certain symptom.

And again, the same thing with allergies, it’s so hard to say. And so many of the times we’re treated with anti-histamines and that might work just perfectly, and we don’t really know how well they are related or directly respond to estrogen if we gave them estrogen. So I think these symptoms are so fascinating because so many of you were quick to reply to the comments and say yes you experienced something similar. So to me, that means that there is definitely probably likely something there. All right, we have three more to get into.

Okay, moving on to the fourth of the commonly uncommonly reported menopause symptoms is joint aches and pains, or what we more commonly refer to in the medical lingo as arthralgias. Arthralgia is the medical term for just joint aches and pains. Now, this actually has been known about for a really long time among menopause experts. But it’s been more slowly adapted or inputted into the minds of clinicians in internal medicine, family medicine, OB-GYN. So we know that this is a really quite uncommon side effect of the perimenopause and menopause transition.

Because if you guessed, well, you’re gonna say there are estrogen receptors in your joints, yup. There are estrogen receptors in your joints. And for many people, when those estrogen levels start to decline, they can feel those arthralgias. Now, this is something that I will say I see in my clinic very commonly. And this is because I ask this question. It is actually something that is in a standardized questionnaire called the menopause rating scale or the MRS. So it’s almost so well known that it’s in pre-validated surveys that many of my mentors have used and other researchers and clinicians in the menopause field certainly use when they’re doing research on menopause symptoms. So I do ask my patients routinely about arthralgias. I will even have some patients say that that is their primary symptom, that is the main thing that is bothering them.

Again, not that hormone therapy is FDA-approved for arthralgias, but usually either they have some other symptom a hot flash here and sweat here or there, or vaginal dryness, so that we can do a trial of hormone therapy. Sometimes it’s not their primary thing, it may be those terrible hot flashes, but they also say, “And I have these terrible arthralgias and I wish that I could get rid of them.” And we then see if by starting a hormone replacement therapy that they resolve.

And many, many times, they do. I have a patient who is an endodontist, an absolutely lovely woman, and someone who has had to go crawling to an endodontist for all sorts of tooth pain. I highly, highly respect anyone in the dental field. But she came to see me because she was having arthralgias in her hands, and of course, that was affecting her job. She had some other symptoms as well, but this was so primary to her and she had tried a lot of things.

Now, we did certainly talk about the fact that this could be overuse because an endodontist, or a dental hygienist, or a secretary, or anyone who is doing repetitive motions with their hands, with their wrists, could have overuse, right? There are multiple reasons why, and could also be compounded by perimenopause menopause. And for this particular patient, she had such a distinct improvement in those arthralgias. She just was flying high.

And I love seeing this because, for so many people, this really helps tremendously improve their quality of life. I did a podcast a few back that you might wanna listen to with my former colleague at Ohio State, Dr. Alexa Meara on arthritis. And we talked a lot about the two main kinds of arthritis, osteoarthritis, which is wear and tear, overuse injuries, typically think about your knees. If you’ve been a runner for 20, 30 years, you start to gain a little bit of weight in midlife, or after children, or during pregnancy, et cetera, and you have a lot of wear and tear. That is osteoarthritis.

And we compare this to rheumatoid arthritis, which is an autoimmune condition. And that podcast is great to really differentiate between osteoarthritis and rheumatoid arthritis. And in that podcast, we did talk a little bit about arthralgias, which is a third and sort of a separate category. It’s more like these diffuse aches. They don’t always seem to start in the morning or later in the day. And these do seem to get better with estrogen. So such a fascinating topic and something that so many of you, again, were quick to chime in to say that you experienced as well and nobody connected the two dots.

Moving on, the next symptom we’re gonna talk about is heart palpitations. I also did a fantastic podcast with Dr. Dara Lee Lewis, who works at the Brigham and Women’s Hospital with me in Boston Massachusetts as a women’s specialty cardiologist. And we talked about heart palpitations in great, great depth. This is one of the most popular podcasts I did. It’s a couple back, maybe it’s in the 50s, you’re gonna have to scroll back a little bit. Or it’s also a video on YouTube, and my YouTube channel is Health by Heather Hirsch. And it’s the exact same thing, you just can see us talking.

So if you have experienced heart palpitations, you are not going to wanna miss that podcast and that YouTube video because Dr. Lewis really explains the physiology behind heart palpitations, benign heart palpitations, the kinds that are more annoying than they are actually dangerous. And the physiology behind that she explained to me and to the listeners is that, when estrogen levels change, the node that controls the firing of your heart or the synchronization of the heartbeat, it can get thrown off. And that’s why heart palpitations, especially or particularly these benign palpitations can start in midlife at perimenopause in the menopause transition, and then sometimes or often seem to get better postmenopausally, meaning after it’s been a year of no period you don’t make any estrogen anymore, your levels are not fluctuating because you’re not making any estrogen.

And therefore those heart palpitations really start to cease. But what a really interesting explanation and really interesting role of the physiology that estrogen plays in our heart and there are many other topics about estrogen and the heart, but specifically I’m talking about how the fluctuating levels, which happens a lot, levels fluctuate in perimenopause and through the menopause transition when you’re waiting for it to be 12 months for no period, how those fluctuations can cause heart palpitations. S

o this is also something that is really common, it’s a big reason that patients in midlife go off to see cardiologists, they wear the Holter monitor, the one that you have to strap on and wear for either a day or wear for several days, and it can be really anxiety-provoking. So we’re gonna talk about panic attacks last and next. And it’s just certainly something where all of a sudden you haven’t utilized the healthcare system, now you’re telling your doctor you’ve got heart palpitations, now you’re getting all these blood works, and seeing a specialist, and wearing a heart monitor, and worrying that you have heart disease when really, this is a side effect of the fluctuation levels in perimenopause and into menopause.

If only doctors, internists, family medicine doctors, everyone who’s a clinician, even my cardiologists who are not so familiar with fluctuating hormones, if they all knew how prominent this is that the fluctuating levels of estrogen can cause these heart palpitations, so many women would be so much more at ease because we could really explain to them what is happening. And for most women, because these are benign, which means, again, just annoying, knowing what is happening under the hood or why that is happening and then giving women some tips and tricks on how to reduce those heart palpitations which Dr. Dara Lee Lewis does in that podcast and/or YouTube is really, really helpful. And that’s just so significant. Now, going off of heart palpitations, heart palpitations itself can cause panic attacks. So let’s get into panic attacks, mood changes, and anxiety.

Now, a panic attack can have many different etiologies. One of the leading reasons or thought process behind panic attacks is when all your catecholamines just all your neurotransmitters that kind of stimulate that fight or flight response, just, they get released. And this is really, a panic attack is when it happens incorrectly. So an example of a correct response is if a big bear is coming at you all your catecholamines are released, and all of a sudden you run like the wind and you fly away at 8.0 miles per hour and you get the heck out of there. When this incorrectly happens, if you’re standing at the grocery store and you’re deciding between pinto beans, or red beans, or black beans, and all your catecholamines are released and there was no stimulus.

And that panic attack can then be evoked because you have all of these catecholamines released, and hormones are released, and you’re revved up for nothing. And it can be very, very scary. Then we can get this cyclical kind of attacks to when we go back to the grocery store and we go look at the bean aisle we remember, we can feel what happened to us and that can even trigger it to happen again. So they can kinda come cyclically. Now, because panic attacks and mood changes are also very common in perimenopause and menopause when you’ve never had one before, there is also a thought process that this can be a result of the drop in hormone levels. So the drop in hormone level could either be considered the stimulus and again, probably the wrong stimulus because it’s not dangerous or maybe it is, and we could certainly argue that too.