I'm a hormone expert - here are 5 perimenopause symptoms you've never heard of (and they're not hot flushes!)

When we talk about perimenopause symptoms, the conversation usually turns straight to night sweats, mood swings and the dreaded hot flushes. But for millions of women, the reality of hormonal decline can be far more bizarre – and frustrating.If you’ve recently noticed a maddening buzzing in your ears at midnight, suddenly developed hay fever out of nowhere, or find yourself mysteriously dropping your morning cup of tea, you aren’t losing your mind. You might just be experiencing the hidden side of changing hormone levels.Dr Louise Newson is a hormone health expert and founder of the Balance app. She says she sees patients every day who have spent months – sometimes years – shuttling between GPs, audiologists and specialists, totally unaware that their bizarre physical quirks could share a single root cause.She says, ‘From the inner ear to the tip of your tongue, progesterone, oestradiol and testosterone interact with receptors in almost every cell of your body. When those hormone levels plummet, the body reacts in ways your doctor might never have warned you about.’ Hormone expert Dr Louise Newson shares some of the lesser-known perimenopausal symptoms.Here are five surprising perimenopause symptoms you may never have heard of, and Dr Newson’s advice on how they can be treated.1. TinnitusHearing a sound, such as ringing or buzzing, when there is no outside noise has many causes, but many women find their tinnitus starts or worsens when their hormone levels change or drop. The cells in our inner ears and brains have hormone receptors for progesterone, oestradiol and testosterone, so their function can change without the right levels of these hormones. Many women find their tinnitus starts or worsens when their hormone levels change or drop This symptom can be particularly bad at night, when hormone levels are often at their lowest.In my clinic, many women find that their tinnitus reduces or resolves completely when they are prescribed the right dose and type of progesterone, oestradiol and testosterone.2. New allergiesSome women can develop new allergies during perimenopause, even if they’ve never been prone to them before.We know fluctuating and falling levels of testosterone, oestradiol and progesterone can affect the function of mast cells and other immune cells. Both play important roles in releasing histamine during allergic reactions and inflammation. Some women can develop new allergies during perimenopause Progesterone and testosterone help stabilise mast cells and dampen histamine, while low levels of these hormones can contribute to allergies, mast cell activation and histamine intolerance. Many women improve when they are prescribed testosterone and progesterone.Sometimes these symptoms can worsen with oestradiol, so the type of hormone prescribed is really important.3. Burning mouthBurning mouth syndrome is a term used to describe discomfort, pain or burning in your mouth, and it can affect around 40% of menopausal women. This occurs when nerves in your mouth change the way they send messages about warmth, cold and taste to your brain.Hormonal changes – including fluctuating and low levels of progesterone, oestradiol and testosterone – can cause burning mouth syndrome. These hormones all help support the way your nerves work, so when levels fluctuate and fall, this can trigger symptoms.Women who are prescribed the right dose and type of hormones often find their burning mouth symptoms really improve.4. Becoming more clumsyMany women find they become clumsier as they become perimenopausal or menopausal. Spatial ability and cognitive function are also influenced by hormones, as are areas of your brain that co-ordinate movement. The hormones progesterone, oestradiol and testosterone all work on every cell in the body. Many women find they become clumsier as they become perimenopausal Progesterone also influences fine motor skills and performance on spatial tasks. What all this means is that slower co-ordination might affect your balance – and explain those trips – while poorer co-ordination can lead you to drop things when your hormone levels are low.5. Restless legsRestless legs syndrome is a condition that causes a very strong urge to move your legs, usually when sitting or lying down, especially when you are trying to sleep. Restless legs syndrome can improve with hormone treatments such as progesteroneThis can really improve with hormone treatments – progesterone, oestradiol and testosterone. Frustratingly, many women with restless legs symptoms are not prescribed hormone treatments and are instead prescribed other medications, such as gabapentin, pregabalin, ropinirole and pramipexole, which all have far more side effects and risks than hormone treatments.