An ear, nose, and throat surgeon says "everything" gets drier—not only the areas classically associated with the reproductive system.
Every year, around two million women in the U.S. enter perimenopause, according to 2025 research. Perimenopause—defined by the Cleveland Clinic as the transitional period before menopause—is far more than just irregular periods and hot flashes. It’s a complete hormonal recalibration, and with that comes a wide array of unexpected symptoms that can leave many women feeling uncomfortable and frustrated.
Because hormones influence nearly every system in the body, the effects can be surprisingly widespread. Tonia Farmer, MD, a board-certified ear, nose, and throat doctor (ENT) and head and neck surgeon says issues affecting body parts—that seem to be totally separate from the reproductive system—can sometimes be traced back to these hormonal shifts. With the ultimate goal of quicker diagnosis and more effective interventions, she’s now helping women identify the surprising ears, nose, and throat symptoms that could signal hormonal changes during perimenopause and menopause, including:
Ears
- New/worsening tinnitus (ringing)
- Hearing changes (muffled sounds, sensitivity)
- Ear fullness or pressure (sometimes presenting as what doctors call Eustachian tube dysfunction)
- Vertigo or dizziness
- Itchy ears from drier skin
Nose and sinuses
- Nasal dryness
- Crusting
- Post-nasal drip
- Nonallergic (hormonal) rhinitis
- Nosebleeds
Throat, mouth, and voice
- Hoarseness
- Vocal fatigue or instability
- A lower speaking pitch
- Obstructive sleep apnea
- Burning mouth
The mechanisms connecting hormones to these potential symptoms can be just as surprising as the symptoms themselves. Some are direct—for instance, lowered estrogen levels can reduce blood flow or affect fluid balance in the inner ear, leading to hearing changes or tinnitus. But others are less so, such as in the case of obstructive sleep apnea, a condition that causes pauses in breathing during sleep. This can be a side effect of hormonal weight gain, which affects menopausal women in their fifties at an average rate of 1.5 pounds per year, the Mayo Clinic says.
As for symptoms such as nasal dryness, crusting, nosebleeds, burning mouth, and vocal hoarseness, Dr. Farmer notes it can seem that “everything is dry” during perimenopause and menopause. Just as “the skin and the mucosa of the vaginal area gets dry—well, same thing: the mucosal membranes inside the nose and throat can also dry out because of those hormonal changes.”
In other cases, these hormonal changes can even impact the immune system, leading to new onset allergies, worsening of existing symptoms, or more challenges in allergy treatment. She notes that when female patients in their thirties, forties, or fifties present with a runny nose or allergies, a hormonal imbalance is not necessarily her first assumption—but she always considers it a possible contributing factor. “We just don’t think about menopause and perimenopause and hormonal changes and how they can affect these ENT symptoms,” says Dr. Farmer, who is also the chief medical ambassador for the nosebleed product company Nampons.
Though menopause awareness is improving and more women are exploring menopause treatments such as hormone replacement therapy, Dr. Farmer says that many women are still experiencing certain symptoms without support. She adds that if your symptoms have persisted for two weeks or more, this is your cue to seek medical attention to rule out other possible causes that could require intervention, and ideally reach a diagnosis.
“Go see your family doctor or an ENT like myself, because it could be something else, like a physical blockage, a polyp, or a deviated septum,” Dr. Farmer says. “And don’t be afraid to ask about hormones. If your doctor is dismissive or doesn’t really know a whole lot about the matter, seek out a second opinion,” she urges.
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