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Perimenopause: Why Doctors Often Miss the Diagnosis

by: Dr. Mary Claire Haver

Some medical conditions are easy to recognize. If you have a fever, sore throat, and cough, you and your doctor immediately recognize that something is wrong. It might be viral, or it might be something that can be treated by antibiotics, but the symptoms are apparent, and physicians have protocols to get to the diagnosis and provide treatment. This scenario is far from the reality when it comes to diagnosing perimenopause

For those in midlife, the symptoms of perimenopause can be more vague and are often the same as symptoms of other conditions. If one is experiencing mood swings and anxiety, is it perimenopause, or depression, or both? People can face many challenges when it comes to getting the diagnosis and treatment they need to navigate and control perimenopause symptoms. 

Here’s my advice on understanding the challenges within our current healthcare system and what you can do to face the problem head on.

Table of Contents

Challenge #1: No Standard Criteria for Diagnosis

The problem starts at the beginning: there is no official method of diagnosing perimenopause. This means that different physicians may diagnose and treat perimenopause differently, based on their training and experience. 

People born female, on average, reach menopause at age 51, but perimenopause can begin much earlier. Sometimes the declining hormone levels begin in the 40s or even in the 30s. Everyone is unique, and there is a wide range of symptoms and severity.

Without a standardized way to diagnose perimenopause,
symptoms are like pieces of a puzzle that must be put together using a detective-style approach.

– Dr. Mary Claire Haver

Challenge #2: Lack of Awareness

Unfortunately, perimenopause just isn’t on the radar for many physicians. Some may be quick to look at symptoms like fatigue and mood changes, and attribute them to other issues, missing the root cause of the problem. Historically, there has been insufficient research and healthcare-industry emphasis on women’s health, and this is exemplified in the lack of awareness of perimenopause symptoms, diagnosis, and treatment. 

Insufficient Screening

Many physicians do not routinely screen for perimenopause symptoms. Often, the possibility is only discussed when symptoms are severe, or when patients have learned about the symptoms on their own and tell their doctor. The lack of a proactive screening can lead to delays in diagnosis and leave people suffering from symptoms without hope for improvement. 

Are you in Perimenopause?

Take our perimenopause quiz to find out

Challenge #3: Lack of Training

It may come as a surprise to learn that many physicians receive very limited training in menopausal medicine. In one survey, 80% of medical residents reported feeling “barely comfortable” discussing or treating menopause symptoms, and only 20% of OB/GYN residency programs offer menopause training. 

Without a comfort level in identifying perimenopause symptoms, physicians may rely on treating joint pain with anti-inflammatory medications, or prescribing antidepressants to treat the surface-level symptoms. A more experienced health provider will dive deeper into the issues of hormonal imbalance to determine the best way to address symptoms. 

Medical Implications of a Missed Perimenopause Diagnosis

Hot flashes, night sweats, mood changes, weight gain, hair loss, and the many other symptoms can certainly have a negative impact on quality of life. But, it is important to understand that other medical conditions can arise from declining hormone levels.

During the menopause transition, people born female are at a greater risk of developing cardiovascular disease, osteoporosis, and some cancers. By identifying perimenopause symptoms sooner, patients can take proactive steps to stay healthier and hopefully prevent some of these menopause-related conditions.

Take Charge of Your Health

Until the healthcare system evolves and takes greater ownership of perimenopause diagnosis and treatment, it may be left up to you to initiate the discussion. When you are struggling with symptoms, it is important to speak with your physician and advocate for yourself.  If you feel like your needs are not being met or your symptoms are dismissed as “a normal part of aging,” then it’s time to find a new provider. Here is some advice on how to find good menopause care. The Galveston Diet also has a list of Recommended Physicians who are in tune with the needs of those in midlife. This can be a valuable resource for taking control of your health and wellbeing. You can also visit the North American Menopause Society (NAMS) for a list of certified practitioners.

  1. Contributor: In the Misdiagnosis of Menopause, What Needs to Change? (
  2. Depression or Menopause? Presentation and Management of Major Depressive Disorder in Perimenopausal and Postmenopausal Women – PMC (
  3. Menopause preparedness: perspectives for patient, provider,… : Menopause (

Related Posts:

The Galveston Diet can help women in menopause feel more confident in their skin.

This blog provides general information and discussion about medicine, health and related subjects. The words and other content provided in this blog, and in any linked materials, are not intended and should not be construed as medical advice. If the reader or any other person has a medical concern, he or she should consult with an appropriately-licensed physician or other health care worker.

Never disregard professional medical advice or delay in seeking it because of something you have read on this blog or in any linked materials. If you think you may have a medical emergency, call your doctor or emergency room immediately.

The views expressed on this blog and website have no relation to those of any academic, hospital, practice or other institution with which the authors are affiliated.

While the information on the site was prepared to provide accurate information regarding topics related to general and specific health issues, the information contained in the site is made available with the express understanding that neither Dr. Mary Claire Haver,, nor the other experts on the site, nor the site itself, nor members of the Site are dispensing medical advice and do not intend any of this information to be used for self-diagnosis or treatment.


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