Nerve Pain During Perimenopause: What Is Causing It and How to Manage It
Burning, tingling, and shooting nerve pain are under-recognised symptoms of perimenopause. Learn why estrogen affects nerves and what can help.
The Link Between Estrogen and Nerve Health
Estrogen is neuroprotective. It supports myelin, the protective sheath around nerve fibres, helps regulate the sensitivity of pain receptors, and promotes nerve repair after injury. When estrogen falls during perimenopause, nerves can become more excitable and less well insulated. This lowers the threshold at which they fire, producing burning, tingling, crawling, or electric shock sensations without any obvious injury. These neuropathic symptoms are real physiological events, not anxiety or imagination, and they deserve to be taken seriously and investigated.
What Perimenopausal Nerve Pain Can Feel Like
The most common nerve-related sensations in perimenopause include tingling or numbness in the hands or feet, burning sensations on the skin (sometimes called formication if it feels like insects crawling), shooting or electric pains in the limbs, and a feeling of tightness or a band around the trunk. Some women experience burning or rawness of the vulval skin (vulvodynia) which has a neuropathic component. Restless legs syndrome, characterised by an irresistible urge to move the legs at night accompanied by uncomfortable sensations, is also more common during perimenopause and involves nerve dysfunction.
When to Seek Medical Assessment
Tingling and burning that is persistent, worsening, or affecting a specific limb needs evaluation to exclude treatable causes. Carpal tunnel syndrome (nerve compression at the wrist) is more common in perimenopause due to fluid retention and inflammation, and is eminently treatable. B12 deficiency, thyroid dysfunction, and diabetes can all cause peripheral neuropathy and should be checked with blood tests. A neurologist can arrange nerve conduction studies if there is concern about structural nerve damage. Do not assume all nerve symptoms are simply hormonal without ruling out these other causes.
Movement and Physical Strategies
Regular aerobic exercise improves peripheral circulation and nerve health. It also reduces the central nervous system sensitisation that amplifies pain signals. Swimming and cycling are gentle on the joints while still providing cardiovascular and neurological benefits. Stretching tight muscles that run alongside nerves (such as piriformis stretches for sciatic nerve symptoms, or wrist stretches for carpal tunnel) reduces mechanical nerve compression. Yoga and tai chi combine movement, balance, and nervous system regulation, all of which benefit perimenopausal neuropathic symptoms.
Nutrients and Supplements for Nerve Health
B vitamins are critical for nerve function. B12 deficiency is particularly common in women over 40, especially those on long-term metformin or proton pump inhibitors. B1, B6, and B12 together support myelin maintenance and nerve repair. Alpha-lipoic acid (600 mg daily) has evidence for reducing neuropathic symptoms in peripheral neuropathy and is safe for most people. Magnesium glycinate helps with nerve excitability and muscle cramps that often accompany neuropathic pain. Omega-3 fatty acids support the structural health of nerve cell membranes.
Medical Treatments
HRT that stabilises estrogen levels often reduces neuropathic symptoms significantly, supporting the view that hormone fluctuation is a primary driver in many cases. For persistent neuropathic pain, low-dose amitriptyline or duloxetine are first-line medications that modulate pain signalling in the nervous system. Gabapentin and pregabalin are also used for neuropathic pain but require careful prescribing due to side effects and dependency risk. Carpal tunnel syndrome responds well to splints worn at night, physiotherapy, or a corticosteroid injection, and can be resolved surgically if conservative treatment fails.
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