A woman in her mid 40’s might be experiencing poor sleep, leading to her feeling exhausted. Her joints ache. She can’t concentrate as well as she used to. She’s more anxious than usual and occasionally feels her heart racing.
She does what a lot of women do, she begins a search for her symptoms, perhaps she discusses them with friends or relatives, maybe even consults social media. The conclusion she might arrive at - Perimenopause.
Awareness vs Assumption
We now have much greater public awareness of the menopause transition (though I would argue not nearly enough), but that public awareness doesn’t always translate into either clinical or familial support. In a 2026 survey of 1,000 U.S. women aged 35–59 in the perimenopause stage, 72% reported experiencing pushback from doctors, friends, or family when they raised the possibility that their symptoms were related to perimenopause (ThisIsMenopause, 2026).
Using the resources she has available she has come to her own conclusion that perimenopause is the most likely reason for how she is feeling. The problem is that awareness shouldn’t become assumption.
Let’s look back at her symptoms - poor sleep, aching joints, can’t concentrate as well as she used to. She’s more anxious than usual and occasionally feels her heart racing.
All of these can occur during the menopause transition. But they are also non-specific. They can occur across numerous conditions and as part of other processes.
What we can say is that knowing that a symptom can occur during perimenopause doesn’t necessarily tell us that perimenopause is causing it.
When Symptoms Overlap
Long COVID - common symptoms include fatigue, brain fog, sleep disturbance, headaches, dizziness, palpitations, muscle and joint pain. In fact Newson et al (2021) found that seventy percent of women surveyed with Long COVID believed that some of their symptoms could be related to perimenopause or menopause.
Thyroid disease - common symptoms include fatigue, cognitive difficulties, mood changes, temperature sensitivity, palpitations and menstrual changes. Sowers et al. (2003) found that because of the overlapping of symptoms clinicians differentiate between Thyroid disease and menopausal symptoms.
Sleep disorders - A review (Hall et al - 2015) specifically examining insomnia and sleep apnea in midlife women found that approximately 50% experience insomnia and reported that around 20% develop sleep-disordered breathing during the menopause transition. The consequences of sleep disturbance include impaired mental and physical functioning all of which can also be attributed to the menopause transition.
Aging - Given that aging and the menopause transition happens at the same time, how do we clearly define which is responsible for a particular symptom. This does not excuse women being told their symptoms are simply due to them aging. Harlow et al. (2017) found that symptom patterns in midlife women were present before menopause and often remained stable throughout the menopause transition.
OR vs AND
The question becomes not is the menopause OR something else but is this menopause AND something else.
A woman can be perimenopausal and iron deficient.
Perimenopausal and have Long COVID.
Perimenopausal and develop thyroid disease.
Perimenopausal and have sleep apnea.
And all of the above will have symptoms that can also be identified as part of the menopause transition. What becomes important is the symptoms that can be more readily assigned to the menopause transition, for example changing periods and suddenly experiencing hot flashes tells a clinician a lot more about the likelihood of perimenopause than fatigue and brain fog on their own.
What we are moving toward is that “common in menopause” and “specific to menopause” are very different things. The risk is that as awareness improves, menopause shouldn’t become a diagnostic endpoint that prevents investigation of other possible contributors.
We are making progress in informing women, men and clinicians about menopausal symptoms, we still have a long way to go. Taking menopausal symptoms seriously is an important step and at the same time it requires us to also look beyond that as the only cause.
What this really means is treating the whole woman. Not a group of symptoms, but her complete experience. That doesn’t mean the menopause transition isn’t the cause, it means it could be that and something else.
This article is not meant as medical advice and is for information purposes only.
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This is a great thought provoking post. I love the AND/OR because it highlights the lack of knowledge/understanding there is about our own body, its physiology beyond diagnosis and corresponding pill.