Ringing, Tingling, Cramps: Perimenopause or Something Else?
Yes, ringing in the ears, tingling and cramps can be part of perimenopause, but the three do not sit on the same footing. Some odd symptoms have a plausible hormone link. Others need a different check first. You can sort them into two piles in one evening with a calendar and a pen. The whole thing turns on two counts: how many of eight symptoms you have had in the last three months, and how many of those sit in the "check something else first" pile.
Count your eight symptoms against your cycle tonight
Open your phone calendar or cycle app and find the start dates of your last three periods. Then take a sheet of paper and list these eight: ringing in the ears, tingling or numbness in hands or feet, crawling on the skin, an electric-shock jolt, muscle cramps, aching joints, burning in the mouth, dry eyes.
Next to each, write the date of the latest episode in the past three months, or a zero. Then count how many days after a period started each date fell.
The exact steps, the scoring and the cases where the count misleads are in the test block below. It takes fifteen minutes. You walk into the appointment with dates and cycle days instead of adjectives.
Count your odd symptoms against your cycle tonight
Phone calendar or cycle app, a sheet of paper, a pen (15 min) · 15 min
- Write the start dates of your last three periods, newest first.
- Down the page, list: ringing in the ears; tingling or numbness in hands or feet; crawling on the skin; electric-shock jolt; muscle cramps; aching joints; burning in the mouth; dry eyes.
- Next to each, write the date of the latest episode in the past three months, or 0 if there was none.
- For each date, count the days since your most recent period started. Write that day number beside it.
- Count A: how many of the eight have a date and not a zero. Count B: how many have episodes bunched within a few days of the same cycle day.
- Count C: how many of your A are ringing, tingling in hands or feet, or cramps. Those three are the check-first pile.
What you end up withA, B and C: symptoms in three months, bunched by cycle day, check-first
- A is 0clearNone of these eight in three months. Nothing to sort from this list.Look for other causes separately, and bring whatever does bother you to the appointment with its dates.
- A is 1 to 2mildOne or two symptoms. This fits a question to one clinic rather than a pattern.Ask the matching clinic. If C is 1 or more, start with the check in the table.
- A is 3 to 5moderateEnough symptoms for a pattern worth taking to an appointment.Bring the page. If B is 2 or more, say which cycle days they cluster on.
- A is 6 to 8markedMost of the list is present, and all of it now sits on one sheet.Bring everything with its labels, and ask for the check-first items to be ordered first.
When this test liesPeriods irregular or missing, so cycle day cannot be counted. Dates filled in from memory instead of records. Hormonal contraception or a coil. A new medicine, an illness, or a change in caffeine or alcohol during the three months. For a cleaner result, keep the record one more month.
Find your case
| Your number | What it means | What to ask for | First step |
|---|---|---|---|
| Electric-shock jolt, often just before a flush; crawling on the skin | Hormone link plausible. A sudden zap, or the feel of ants moving over the skin with no rash. | Name both as symptoms, not only the flushes, and ask whether they follow your cycle. | Write the cycle day of each episode and whether a flush came after. |
| Aching joints | Hormone link plausible. Ache or stiffness in several joints, often noticed on waking. | Ask whether any joint is swollen or hot, and whether the ache shifts with your cycle. | Write which joints and on which cycle days. |
| Dry eyes; burning in the mouth | Hormone link plausible. Gritty eyes by evening; a scalded feeling on tongue or gums. | An eye check for tear dryness, and a dentist's look at the mouth and saliva. | Write the time of day and the cycle day; list any medicines you take. |
| Tingling or numbness in hands or feet | Check something else first. Pins and needles inside the limb, which is different from crawling on the skin surface. | Blood tests for B12, the vitamin that keeps nerves working, and for thyroid; a review of your medicines. | Write which fingers or toes, and whether it comes at night or on waking. |
| Ringing in the ears | Check something else first. A sound only you hear. | A hearing test and a look inside the ear. Say whether the sound beats in time with your pulse. | Write which ear, and the cycle days when it is loudest. |
| Muscle cramps | Check something else first. A muscle locking suddenly, often at night. | Blood tests for the salts muscles depend on, and for thyroid; whether any medicine of yours can cause cramps. | Write which muscle, the time, and your cycle day. |
Why these symptoms are missing from the lists
A hot flush can be seen across a desk. The doctor watches you go red and sweat, and writes it down. Ringing in the ears is heard by one person. Pins and needles are felt by one person. A list built from what a clinician can see stops at flushes.
The rest is split by where it lands. Ringing goes to the ear, nose and throat clinic. Tingling goes to a neurologist, the doctor for nerves. Aching joints go to a rheumatologist, the doctor for joint disease. A burning mouth goes to a dentist. Dry eyes go to an eye doctor. Each one checks their own organ, finds little, and sends you home. None of them is asked to put five findings in one column and look at the cycle.
Eight symptoms, five clinics, and nobody is in charge of the sum. No single doctor failed here. Medicine is split by organ, and a visit lasts about ten minutes. The sum is left to you, and the test above is how you do it.
Check these three before blaming hormones
Tingling or numbness in hands or feet has ordinary, checkable causes. A clinician looks first at B12, the vitamin that keeps nerves working, at the thyroid, at blood sugar, at a pinched nerve in the wrist or neck, and at your medicines.
Ringing in the ears starts with a hearing test, a chart of what you hear at each pitch, and a look for wax. Clenched jaw and neck tension are also examined, and so are medicines.
Muscle cramps start with the salts in your blood that muscles depend on, the thyroid, and again your medicines. If a tablet is on the suspect list, ask about it. Do not stop it on your own.
Each of these has a cause that can be found and fixed whatever your hormones are doing. Put a hormone label on them first and a fixable cause can sit unchecked for years.
Which five symptoms have a plausible hormone link
Each of these five has a mechanism that makes the link reasonable.
The shock before a flush: the brain area that sets body temperature seems to fire both the flush and the jolt.
Crawling on the skin: skin and its nerve endings respond to sex hormones, so swings can change how it feels.
Dry eyes: the glands that make tears, and the oily layer that stops them evaporating, respond to sex hormones.
Aching joints: joint tissue carries hormone receptors, the docking points hormones act on.
Burning in the mouth: the lining of the mouth and the saliva glands respond to sex hormones too.
Ringing is the weak link. I have no study that shows hormones cause ringing in the ears, and none that rules it out. It is plausible and unproven. That is why it sits in the check-first pile: the hearing test gets done either way.
For the whole pile, a label tells you what to check first. It does not decide the cause.
Why one hormone blood test cannot sort this
In perimenopause, hormone levels jump from day to day, sometimes within a week. A single blood draw shows one morning. A result in range does not rule perimenopause out, and a result out of range does not confirm it.
What a clinician can use is the pattern: which days after a period started, and near what. Before the period, at night, after a bad night of sleep. Your count gives that pattern. One number cannot.
If your periods still arrive on schedule, read [Can You Be in Perimenopause With Regular Periods?](/perimenopause-regular-periods/). If you do go for blood tests, How to Prepare for an Iron and Hormone Blood Test covers timing. Sleep and anxiety have their own pages: waking at 3am and anxiety in perimenopause.
Say this at the appointment, then hand over the page
Say this, word for word: "I have kept a record for three months. Here are eight symptoms with dates and the day of my cycle. I would like the ones marked check-first looked at first, and I would like the pattern considered for the rest."
Then hand over the page. For each check-first symptom, ask for the test in the table: a hearing test for ringing, blood tests for B12 and thyroid for tingling, blood salts and thyroid for cramps.
Whether hormone therapy would help any of these is a question for your doctor.
You were not inventing eight symptoms. Five clinics each saw one, and your page is the only place where all eight sit side by side.
If it does not go to plan
- You cannot remember the dates of episodes.Write your best guess and mark it with a question mark. Start recording from today and repeat the count in a month.
- Every episode falls on a different cycle day.That is a result too. B is low, so the check-first pile matters more. Bring the list as it is.
- Your periods are irregular.Count days since the last period anyway, but treat B as unreliable. Bring the raw dates.
- The doctor has ten minutes and glances at the page.Ask for the check-first items to be written in your notes, and ask which one will be done first.
Honestly: what is settled and what is not
The sorting here is an order of checking, built from the ordinary causes each symptom is known to have. Nobody has given me figures for how many women get each of the eight, so I give none. Whether hormone therapy helps these symptoms is a question for your doctor. Your own record, with dates, is the strongest evidence you can bring.
What to do with this
- Count your eight symptoms against cycle days before the appointment.
- Send ringing, tingling in hands or feet, and cramps to the check-first pile.
- Ask by name for a hearing test, and for blood tests for B12 and thyroid.
- Bring dates and cycle days, not adjectives.
- Keep the record one more month if your periods are irregular.
Questions people also ask
Can perimenopause cause ringing in the ears?
Ringing sits in the check-first pile on this page, so the first step is a hearing test and a look inside the ear. What your cycle pattern adds comes after those are done. If the sound beats in time with your pulse, or hearing drops suddenly in one ear, get urgent care.
Can I have these symptoms if my periods are still regular?
The count works with regular periods, and it works better with them, because cycle days can be counted. Regular periods do not rule hormone changes out. See the article on perimenopause with regular periods for the detail.
Which doctor should I see first?
Start with your family doctor or general practitioner and bring the page. One person looks at all eight together and decides which clinic, if any, needs to see you for a single symptom.
This article is information, not medical advice, diagnosis or treatment. Reference ranges, doses and protocols differ between people and between laboratories. Talk to a qualified clinician before changing anything about your care.