Menopause is a biological process which marks the end of a woman’s menstrual cycles. A woman is officially diagnosed with menopause after she has gone 12 months without a menstrual period. The average age for menopause in the United States in 51. Many physical symptoms accompany this change, including hot flashes and sleep disruption. Some medications may be used to mitigate these symptoms, such as hormone therapy.
Perimenopause is a term for the period of time leading up to menopause, during which a woman may experience a variety of symptoms related to the impending change. During this time, estrogen levels in the body rise and fall unevenly. This may affect the regularity of menstrual cycles, and woman may experience other symptoms, such as hot flashes, sleep issues, urinary incontinence, mood swings, and more. Many women begin to experience perimenopause in their 40s, though some can start to have symptoms in their 30s.
While menopause and perimenopause are both natural, biological processes, they can pose a unique risk for women: misdiagnosis. Dr. JoAnn Pinkerton, professor of obstetrics and gynecology at the University of Virginia Health System and executive director of the North American Menopause Society warns, “Many doctors aren’t adequately taught about what symptoms might be perimenopause and what symptoms are not.” A recent article highlights a series of troubling cases in which a variety of doctors made a variety of misdiagnoses, all of whom assumed perimenopause when the actual underlying condition was much more severe.
These examples include a 42-year-old woman who complained of heart palpitations and anxiousness to her physician. She was told these were consistent with perimenopause and put on antidepressants. A second opinion, complete with an EKG and a stress echocardiogram revealed pattern suggestive of artery blockage. Another woman at age 48 began to experience heavy bleeding with her menstrual cycle, including odd clumps of tissue, as well as bleeding following intercourse. Her doctor assured her that these symptoms were consistent with perimenopause and were no cause for concern. After another year of symptoms, she consulted gynecologist, who performed an ultrasound and found a mass. She was diagnosed with Stage IV uterine cancer and died in less than two years.
Misdiagnosis attributable to perimenopause is deeply troubling, and it is an especially problematic time in life for misdiagnosis to occur due to the risk factors for serious medical issues. For example, in the United States, about 5.2% of newly diagnosed cancers occur in individuals aged 35-44 years old, while that figure increases nearly threefold to 14.1% among individuals aged 45-54 years old. Heart disease risk will also increase during this period of a woman’s life. These represent two of the leading causes of death in the U.S., meaning that it is especially important for doctors to receive adequate training around what is and is not perimenopause and not rush to a diagnosis.