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When Phantom Smells Signal Something Serious While phantom smells during perimenopause and menopause are usually harmless and temporary, certain warning signs should prompt immediate medical attention: Red Flags That Require Evaluation Phantom smells that suddenly appear after age 60 Symptoms that progressively worsen over time Phantom smells accompanied by other neurological symptoms: Severe headaches or migraines with new characteristics Vision changes or loss Weakness on one side of the body Difficulty speaking or understanding speech Memory problems or confusion Seizures or loss of consciousness Changes in coordination or balance Phantom smells in only one nostril (unilateral phantosmia may indicate localized issues) Symptoms that persist for more than a few months without improvement According to Cleveland Clinic, you should call a healthcare provider if phantom smells last more than three weeks, especially if they're not clearly linked to an infection or cold