What Is Neuropathy?

What Does Neuropathy Feel Like?

Descriptions are remarkably consistent from person to person, and they are often more useful than any single test in pointing toward nerve involvement. Common ones include:

• Pins and needles. A prickling or crawling sensation, often in the toes or fingertips, sometimes worse at rest or at night.
• Burning. Hot, raw or scalded-feeling skin, classically in the soles of the feet.
• Numbness. Reduced or absent sensation, so that cuts, blisters or temperature changes go unnoticed.
• Electrical or shooting sensations. Brief jolts, zaps or stabbing pains that come without warning.
• Socks or gloves that are not there. A thick, padded or wrapped feeling over the feet or hands.
• Hypersensitivity. Light touch, bedsheets or sock seams feeling painful — a sign that nerves are misfiring rather than simply quiet.
• Not knowing where the feet are. Loss of position sense, which shows up as unsteadiness in the dark, on uneven ground or in the shower.

What Causes Neuropathy?

There are many potential causes, and identifying which one applies changes what can be done about it. Among the most frequently considered:

• Diabetes and impaired glucose tolerance. One of the most common causes worldwide, and a reason glucose or HbA1c testing appears early in most evaluations. See metabolic change in midlife.
• Vitamin deficiencies. Vitamin B12 deficiency is an important and treatable cause; excess vitamin B6 can also injure nerves. Related reading: iron, vitamin D and fatigue.
• Alcohol. Heavy or sustained use, often combined with nutritional deficiency.
• Medications and chemotherapy. Several chemotherapy agents and some antibiotics and other drugs can be neurotoxic.
• Autoimmune disorders. Including inflammatory neuropathies and neuropathy associated with systemic autoimmune disease.
• Kidney disease and thyroid disease. Both can affect peripheral nerves; thyroid disease is also easy to overlook in midlife — see why thyroid problems can be missed during menopause.
• Hereditary neuropathies. Inherited conditions, often with a long history of high arches, foot deformity or affected relatives.
• Nerve compression. Carpal tunnel syndrome, ulnar compression at the elbow, or nerve-root irritation from the neck or low back.
• Other neurologic conditions. Some central nervous system conditions mimic neuropathy and need to be distinguished from it.

Sometimes no cause is identified despite an appropriate workup. That is a recognized outcome rather than a failure, and it does not prevent symptom-directed treatment.

Is Tingling During Menopause Always Neuropathy?

No. Women do report tingling, burning or altered skin sensations during the menopause transition, and when those sensations are brief, move around the body and come with a normal examination, they are frequently benign.

The problem is the assumption. Symptoms should not automatically be attributed to menopause, because the age at which the menopause transition happens is also the age at which glucose intolerance, B12 deficiency, thyroid disease, carpal tunnel syndrome and spine-related nerve irritation become more common. Persistent, progressive, asymmetric, painful or weakness-associated symptoms may warrant evaluation for neuropathy or another neurologic cause.

Our fuller written treatment of this is on tingling and sensory symptoms, with the video explanation at can menopause cause tingling and numbness? and the broader context in the menopause symptom guide and neurologic symptoms in menopause.

How neuropathy is evaluated

Evaluation is built around the pattern. A clinician asks where the symptoms started, whether they are symmetric, how quickly they have progressed and whether there is weakness — then examines sensation, strength, reflexes, gait and coordination.

From there, testing is chosen to fit the clinical picture rather than ordered as a fixed panel. Blood testing commonly includes glucose or HbA1c, vitamin B12, thyroid function, kidney function and a complete blood count. Nerve-conduction studies and electromyography (EMG) can confirm whether nerves are affected, whether the problem is axonal or demyelinating, and how widespread it is. Imaging of the neck or back, autoimmune testing, genetic testing or a skin biopsy are added when the pattern calls for them.

Cognitive symptoms sometimes travel alongside sensory ones, particularly when sleep is disrupted by painful feet. Our brain fog guide and when brain fog deserves evaluation cover how to think about that combination.

Questions to bring to your clinician

• “Does my examination suggest a peripheral nerve problem?”
• “Which blood tests are worth doing to look for a cause?”
• “Would nerve-conduction studies or EMG add useful information for me?”
• “Could any of my medications be contributing?”
• “Is my glucose, B12 or thyroid function in a range that could affect nerves?”
• “What should make me come back sooner rather than waiting?”