Personalizing Menopause Treatment for Uncommon Symptoms

While hot flashes and night sweats dominate most conversations about menopause, many patients experience a range of lesser-known symptoms that can be difficult to explain and treat.

Makeba Williams, MD, FACOG, MSCP, professor of obstetrics and gynecology at University of Illinois College of Medicine and clinical director of the Center for Health, Awareness, and Research on Menopause, described these “esoteric symptoms of menopause” at The Menopause Society 2025 Annual Meeting.1 These include symptoms like burning mouth pain, skin crawling, changes in body odor, food intolerance, ear ringing or tinnitus, and patients generally not feeling like themselves.

“You might know them as the ones your patient read about in the deep recesses of the web or on social media,” Williams said. “They attribute them to perimenopause, and they believe that hormone therapy will relieve them. So, what do you do with those patients?”

With that question in mind, Williams focused on how clinicians can respond when faced with symptoms that lack clear data, using evidence-informed reasoning and a shared decision-making model to individualize care for women going through menopause.

Tinnitus: Can Hormone Therapy Help?

Tinnitus affects roughly 13% of adults aged 45 to 64 years, with similar rates between women and men.2 Although tinnitus can be caused by a number of factors, menopause-related hormonal changes may influence auditory processing and sensitivity in women.1

“The curiosity about whether hormone therapy can be beneficial to tinnitus is quite reasonable,” Williams explained. “We do see that there is a presence of estrogen receptors throughout the auditory canal, and these receptors play a role in protecting hearing, modulating copular function, sound localization, as well as auditory signal processing. And we see that estrogen can be neuroprotective and perhaps has a role in synaptic plasticity and auditory sensitivity.”

However, she emphasized that current data remain limited and inconclusive. While there have been reports of decreased tinnitus handicap scores in women using hormone therapy, Williams said there still isn’t definitive proof of a causal relationship.3,1

Williams urged clinicians to balance expertise with empathy. | Image credit: insta_photos – stock.adobe.com

Because tinnitus can stem from multiple causes—neurologic, vascular, or stress-related—she said its management should be multidisciplinary. While there are currently no FDA-approved drugs for treating tinnitus, other options include cognitive behavioral therapy, sound therapy, hearing aids, cochlear implants, brain stimulation, local anesthetics, antidepressants, and counseling to learn coping methods.

Burning Mouth Syndrome

Another symptom Williams discussed was burning mouth syndrome, a chronic pain condition that produces a burning or scalding sensation in the mouth despite it appearing normal. Its prevalence ranges from 10% to 40% among perimenopausal and postmenopausal women—up to 7 times higher than in men, with peak incidence between ages 50 and 70.

Burning mouth syndrome is “a diagnosis of exclusion,” Williams said, as its cause is not well understood and often overlaps with anxiety, mood disorders, or sleep disruption. Treatment options include topical agents such as clonazepam, capsaicin, aloe vera, or short-term topical anesthetics, as well as systemic options like SSRIs, tricyclic antidepressants, antipsychotics, and vitamin supplementation. Cognitive behavioral therapy has also shown benefit in helping patients cope with chronic discomfort.

The oral mucosa, Williams added, shares biologic similarities with the vaginal mucosa, both containing high levels of estrogen receptor beta. “It stands to reason that perhaps estrogen could be helpful here,” she said, noting, “There is limited evidence that estrogen can reduce these symptoms in perimenopausal and menopausal women.”

Importance of Shared Decision-Making

When evidence is unclear, Williams urged clinicians to balance expertise with empathy. “The key component here is conveying clinical evidence and expertise—there’s no forsaking that,” she said. “We also take into account what are our patient’s goals, her values, what are her preferences?”

She described effective shared decision-making as requiring vulnerability from both the provider and patient. Clinicians must share what is known and unknown about treatment options, she said, while patients articulate their goals, values, and tolerance for uncertainty.

To guide these conversations, Williams outlined the “COD” framework: choice, options, decision.

In “choice talk,” clinicians invite the patient to participate, acknowledge the patient’s symptoms and how they impact their life, and emphasize that they have options for managing them. “Options talk” is the next step, where providers review available treatments, explain risks and benefits and how much evidence is available, and make sure the patient understands the conversation being had. Finally, in “decision talk,” the clinician elicits patient preferences and arranges next steps.

According to Williams, this method encourages patient participation and is centered on understanding patient values.

“It reduces bias, it supports the diverse communication needs not only of our patients, but [also] our providers, and it allows for uncertainty and flexibility,” she added. “It helps us to individualize care by aligning treatment decisions with what matters most to patients.”

References

1. Williams M. Personalized treatment options for uncommon symptoms. Presented at: The Menopause Society 2025 Annual Meeting; October 22, 2025; Orlando, FL.
2. Jarach CM, Lugo A, Scala M, et al. Global prevalence and incidence of tinnitus: a systematic review and meta-analysis. JAMA Neurol. 2022;79(9):888-900. doi:10.1001/jamaneurol.2022.2189
3. Lai JT, Liu CL, Liu TC. Hormone replacement therapy for chronic tinnitus in menopausal women: Our experience with 13 cases. Clin Otolaryngol. 2017;42(6):1366-1369. doi:10.1111/coa.12879