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Phantom Smells in Perimenopause: What the Evidence Says

A phantom smell is a fact about your nose, not about your body. Everything useful follows from that one sentence, including why washing more does nothing.

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Somewhere in the middle of an ordinary week, you start smelling cigarette smoke in a house where nobody smokes. Or burning, faintly, from no appliance you can find. Or cat urine, in a flat with no cat. You check the sockets, open the windows, sniff your own clothes, and ask whoever is nearest whether they can smell it. They cannot.

That experience has a name, a measured prevalence and a reasonable first step. It also has one sentence underneath it that makes everything else fall into place: a phantom smell is a fact about your nose, not about your body. Once that is clear, most of what people do about it — washing more, changing deodorant, buying a different soap — stops making sense, and a much shorter list takes its place.

Phantom and distorted are two different things

The NIH’s National Institute on Deafness and Other Communication Disorders names four smell disorders. Two are about quantity: hyposmia, “a reduced ability to detect odors”, and anosmia, “the complete inability to detect odors”. Two are about quality: parosmia, “a change in the normal perception of odors”, such as when something familiar is distorted; and phantosmia, “the sensation of an odor that isn’t there.”

The difference matters more than it sounds. Parosmia needs a real odour to distort; phantosmia does not need anything at all. A 2023 review of both puts it plainly: parosmia “should not be confused with phantosmia, in which the distortion of smells occurs in the absence of olfactory stimuli” (Altundag, 2023). The distinction is practical rather than academic: modified olfactory training has evidence behind it for post-infectious smell loss and for COVID-related parosmia, while for phantosmia “the treatment of phantosmia is less straightforward, with an emphasis on determining the etiology and providing symptomatic relief.”

That question, asked half as a joke in a thread of fifty-three replies, is the whole diagnostic problem in nine words. From the inside, there is no way to tell which kind of smell it is.

How common it is depends entirely on who was asked

Four numbers circulate, and they disagree by a factor of seven — because they were collected from four different groups of people.

The figure to trust for a general question is the first. In the Swedish National Study on Aging and Care, 2,569 adults aged 60 to 90 were interviewed, and phantosmia was defined carefully as “an odor percept in the absence of any stimuli in the surrounding environment that could emit the odor.” The prevalence was 4.9% (Sjölund et al., 2017). About one person in twenty.

The other three are narrower groups: 363 patients at a smell clinic, who had already sought help (Nordin et al., 1996); 2,340 adults on an online research panel, whose authors say voluntary participation “is likely to favour selection bias, probably overrepresenting individuals with more persistent or severe symptoms” (Rehman et al., 2026); and 4,691 people who already had COVID-related smell loss (Bousquet et al., 2023).

One finding from the Swedish study contradicts the obvious assumption. Phantom smells were associated with female gender, with vascular risk burden and with also reporting parosmia — but measured olfactory dysfunction was not related to phantosmia at all. A phantom smell is not a sign that your nose is failing. It is something else happening in a nose that may be working perfectly well.

The smell nearly everybody names is the same smell

Three independent sources, asked in three completely different ways, return the same answer.

The Swedish population study reports that “the most frequently reported phantom smell was smoky/burnt.” The NHS, listing changes to the sense of smell, gives its example as “smelling things that are not there (phantosmia), like smoke or burnt toast.” And Google’s own suggestions, queried across seven stems today, run heavily to smoke, burning and burnt toast.

The threads match. In the fifty-three-reply thread read for this article, cigarette smoke and burning dominate, and several people say they have never smoked and have spent months suspecting a neighbour. There is a published counterpart to that detail: in the analysis of 1,723 phantosmia descriptions from people with COVID-related smell loss, “reference to ‘tobacco’ was more frequent in non-smokers.”

Which is worth knowing mainly because it removes a particular worry. Smelling cigarettes in a non-smoking house is not something strange happening specifically to you; it is the single most reported phantom smell there is.

Nobody has measured it in the menopause transition

Here is the gap, stated precisely. A title-and-abstract search for phantosmia returns 169 records: a real literature, not an empty field. Pairing that same term with menopause, perimenopause, estrogen or oestrogen returns nothing at all. Not a small study, not a weak study. Zero.

That is a specific absence rather than a general one, and it sits oddly beside the NIDCD’s own list of causes of smell disorders, which includes both “aging” and “hormonal disturbances.” The category is acknowledged; the particular question has not been asked.

What has been asked is the same question in a different hormonal state. A longitudinal study followed women through pregnancy and after it, asking about sensitivity, distortions and phantom sensations. Abnormal smell or taste perception was reported by 76% of the pregnant women. Increased smell sensitivity was very common early on — 67% — and was “occasionally accompanied by qualitative smell distortions (17%) and phantom smells (14%).” The abnormalities were less common late in pregnancy and “almost absent post partum” (Nordin et al., 2004).

Pregnancy is not menopause. But it establishes that phantom smells can rise and fall with a hormonal state in a way that has actually been measured in people, which is more than can be said for most of what is asserted on this subject. It makes the experience plausible. It does not make it proven, and nobody should tell you otherwise.

The only test that separates a phantom smell from a real one

There is exactly one, and it is not clever: somebody else’s nose.

This is what people in the threads do without being told to. They ask a partner. They ask three people. They take a black light to the carpet looking for the cat urine. One commenter describes blaming new neighbours for cooking smells — until the neighbours went on holiday and the smell carried on.

The threads also contain the control case. A reader describes smelling burning and assuming it was phantom, like the cigarette smoke she also gets. Three days later other people could smell it too, and a failing fan had to be replaced. That smell was real; it had simply been faint, and she had detected it first.

So one failed confirmation settles nothing. A repeated pattern — the same smell, many times, in different rooms and different company, and nobody has ever once smelled it with you — points at your nose. A smell other people eventually find points at a source. Establish which you have before you spend anything, because the two lead to completely different next steps.

Why it is not imaginary

People with phantosmia are routinely told, gently or otherwise, that it is in their heads. There is a small, old and striking piece of evidence against the dismissive version of that.

Between 1988 and 1999, one surgeon saw a series of patients with unremitting phantosmia lasting longer than four years. Eight had olfactory mucosa surgically removed; seven had “complete and permanent resolution” of the phantom smell on follow-up averaging 5.4 years. The removed tissue showed “a decreased number of neurons, a greater ratio of immature to mature neurons, and disordered growth of axons with some intraepithelial neuromas” (Leopold et al., 2002).

The caveats are large and the authors state them themselves: eight patients, one centre, retrospective, and surgery that is “extremely difficult with significant risks, and therefore should be limited to specialized centers.” This is not a treatment to ask for. It is cited here for one narrow reason — in the people examined, there was something physically abnormal to find. The phantom smell had a place.

The headache question, from the other side

A reader in one thread reports that her phantom smells arrived as her migraine aura changed from visual to olfactory. It is worth raising with a doctor, but the published numbers point the opposite way from the assumption.

In 113 patients meeting formal criteria for migraine, given a sixty-five-item questionnaire about smell, phantosmia was reported by 4.4% and olfactory hallucinations by 6.2% — while migraine triggered by an odour occurred in 90.2%, with perfume, cleaning products, cigarette smoke and vehicle exhaust the four commonest triggers in that order (Fornazieri et al., 2016). In migraine, the usual relationship between smells and headaches runs from the smell to the headache, not the other way round. The sensitivity side of that is covered separately in our piece on a heightened sense of smell in menopause.

What a bar of soap can do here, which is nothing

This site is about persimmon soap, so it should say where its own subject stops.

A persimmon tannin bar is a rinse-off wash. The case for it rests on 2-nonenal, an aldehyde described as greasy and grassy that is generated when skin-surface lipids oxidise and that was “detected only in older subjects (40 y or older)” (Haze et al., 2001). Everything a wash can do, it does to something sitting on skin.

A phantom smell is not sitting on your skin. Pairing phantosmia with body odour or hygiene in the published literature returns no records at all — not a thin evidence base, an absent one. And the threads make the stakes concrete: people describe washing repeatedly, changing products and interrogating their own clothes for months before anyone tells them the smell has no source to wash off. That is money and self-esteem spent in the wrong direction.

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What to do instead

A short list, in order.

1. Rule out a real source once, properly. Gas, appliances, the fridge, the drains, the bins, the car. Then stop re-checking, because the re-checking becomes its own problem.
2. Get one other person to be your instrument. Not three people every time — one person you trust to answer honestly, as a standing arrangement.
3. Keep a short note for a fortnight. The smell, the time, how long it lasted, where you were, who else was there and whether they smelled it. That page is far more useful to a GP than a description from memory.
4. See a GP if it is not settling. The NHS advises a non-urgent appointment if your sense of smell has not gone back to normal in a few weeks; the GP will look for obvious causes such as sinusitis or nasal polyps and may refer on.
5. Do not buy anything for it. There is no product for phantosmia, and the absence of one is not a gap in the market.

The bottom line

A phantom smell is a fact about your nose. It is common enough to have a population prevalence of about one in twenty in older adults, it is most often smoke or burning, it is not evidence that your sense of smell is failing, and in the few people whose olfactory tissue has been examined there was something physically abnormal there to find.

What it has not got is a menopause literature, so anyone who tells you confidently that perimenopause causes phantom smells is going beyond what has been measured — the nearest evidence is from pregnancy, and it is suggestive rather than settled. What it also has not got is a product. If you are smelling something nobody else can, the useful next steps are one other person’s nose, a two-week note and a GP appointment. The things sold on this website will not help you, and we would rather say so than sell you one.

If other people can smell it, that is a different article: start with what changes about body odour in perimenopause, or with why you may not be able to smell yourself.

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