By Carita Rizzo
It was the strangest thing. Six months ago, Kate, 52, walked into her house and was absolutely repulsed by the smell of her dog and two cats. “To me, the house reeked of pet,” says the author of Strong As a Girl. “I’m generally very, very clean. I don’t think we have a house that smells like animals.” To make the matter worse, no one else could confirm what she was feeling. “Everybody around me was like, ‘Kate, there’s nothing there,” she recalls. “A friend who is very honest was dropping something off. I knew she would tell me the truth. She smelled nothing.” To Kate, the sensation resembled a return to pregnancy, where she had been highly sensitive to all smells. Though she knew she was in perimenopause, and had other indicators like unusual rage and brain fog, Kate was unprepared for this particular symptom. “I was like, oh my God, is this a thing?”
While Kate embarked on a possibly unnecessary cleaning kick, Lauren, 41, was experiencing something even more disturbing — smelling cigarette smoke where there was none. “I thought my husband was smoking in our house,” she says. “He doesn’t smoke. I remember being very confused. There’s only one other person on the other side of us, and I thought he might be a secret cigarette smoker. He’s not. Last week I was coming down my stairs and all of a sudden I was hit with cigarette smoke. I said to my husband, ‘Do you smell that?’ And he said, ‘Smell what?’” Lauren started researching her olfactory hallucinations online. “TikTok served me something about how this could be a sign of perimenopause,” she says. “I also have lupus, so for me, now, it’s like, ‘Is it lupus? Is it perimenopause? Am I dying?’”
Kate and Lauren are not alone. Online, women are reporting a sensitivity to smells, questioning whether their own body odor has changed in their 40s, or if they are simply experiencing it differently. “Has anyone noticed their body producing all sorts of extra smells once they’re in perimenopause? I double cleanse in the shower with soap and an anti-bacterial wash and I’m still funky,” writes one Facebook user. “I can’t tell if I smell more or if I am smelling more,” says another woman in response. “I can be grossed out by every single odor that wafts within 30 feet of me.”
Olfactory hallucination is a real phenomenon (it’s called phantosmia), but a change in your sense of smell in perimenopause is not imagined. “If you ask a Harvard researcher, they’re going to say, ‘We don’t have enough data to support that.’ If you ask someone that talks to women every single day, they’re going to say, ‘Absolutely,’” says Daniela Ezratty, an Atlanta-based nurse practitioner who specializes in hormone replacement therapy, nutrition, and aesthetics at Ezratty Integrative Aesthetics. “I hear some women saying, ‘I can’t smell my perfume anymore,’ and I hear women going, ‘Oh my God, when my husband cooks, I want to throw up.’”
While olfactory changes are not the most reported symptom of perimenopause, they are not out of the realm of possibilities. There are estrogen receptors everywhere in our body, including our olfactory system, which controls our sense of smell. “We know that estrogen and progesterone have modulatory effects on your olfactory system,” says Dr. Kim Einhorn, board certified OBGYN and founder of MP Collective, the Philadelphia area’s first comprehensive, membership-based GYN practice for women in menopause and perimenopause. “Sometimes in perimenopause, when your hormone levels are fluctuating, they can be very high followed by very low, and you could absolutely have a heightened sense of smell. It is similar to when you’re pregnant, when your estrogen levels are running super high and you are sensitive to different smells.”
If you thought perimenopause just meant a steady decline in estrogen, think again. “What really happens during perimenopause is that, as our ovaries age, they become less able to pump out estrogen, but it doesn’t cease all together,” says Dr. Einhorn. “You have months where you’re not really making any estrogen and you feel the night sweats and low energy, and then you have other months where your pituitary gland is working so hard to stimulate your ovaries to make estrogen that it can cause a double ovulation. That triggers breast tenderness and bloating and can include potential olfactory changes, cognitive changes, and mood changes. It runs the gamut.”
Meanwhile, the dip in estrogen can affect the blood vessels in the nasal passage, resulting in a permanent decrease of smell in menopause. “When we lose estrogen, the vessels are hardening in the nose,” explains Ezratty. “Because of this, getting to the olfactory bulb through the nasal passage is going to be harder. You also get drier mucus membranes, just like in the vagina, with lack of estrogen.” While data is scarce for menopause symptoms in general, here there is no doubt of cause and effect.
The good news is, if your olfactory symptoms are related to hormone fluctuations, HRT can offer relief within the week. “It gets even better over the following weeks to a month,” says Dr. Einhorn. “Sometimes it needs optimization. I try to not start women at the dose that I think they’re going to need because I want to mitigate side effects that are scary to women, like breast tenderness. Sometimes it takes a few months to get them to the point where they feel great.” But almost every symptom related to perimenopause tends to go away when the fluctuations calm down. “Whether it’s abdominal weight gain, insomnia, weird dreams, lack of sense of smell, itchy nipples, or ‘I want to divorce my husband,’ they all get better,” says Ezratty. “Our hormones are as unique as we are, and our receptors are as well, but usually regulating them makes that individual’s symptoms better.”
While phantosmia, i.e. smelling things that aren’t there, is a possible symptom of perimenopause, it can also be a sign of more serious health conditions. “I would always have my patient check with a neurologist or an ENT if it was accompanied by other symptoms,” says Dr. Einhorn. “If there’s a brain tumor, patients might have visual changes or headaches. Common cognitive challenges during perimenopause are: I forgot why I walked in the room. I forget where my keys are. That’s different than: What are my keys? How do I get home? When my patients come to me worried about getting early onset dementia, I run them through a battery of questions and if it seems like there’s something on the abnormal side, they get a further workup.”
What you are probably not hallucinating are the sudden changes to your body odor in perimenopause. “Oh, 100%,” laughs Dr. Einhorn. “I’m not going to lie. I’ve noticed it myself. For a period, I couldn’t stop smelling. I switched my deodorant several times. I knew why, because I hear it all the time. Women are like, why do I smell so bad? The eccrine glands are actually secreting a different, more concentrated, more sebaceous substance that has an odor. But then, I’ll go through a phase where I don’t have to wear deodorant for months. It’s such a weird thing, but that is absolutely hormonal.”