When "menopausal symptoms" are something else

When “menopausal symptoms” are something else

One of the problems with making an accurate diagnosis of menopause is that typical symptoms, including hot flashes, night sweats, heavy irregular bleeding, and mood disorders, can sometimes be caused by other health conditions.

And it is important to exclude them.

“Of course, if a woman is over 45 and has distinct symptoms of declining estrogen levels, such as these characteristic symptoms, it is probably perimenopause or menopause, but it is not always so clear,” says Dr. Karen Morton, consultant gynecologist, who runs a menopause clinic in Guildford, Surrey and online.

Many women going through perimenopause and menopause experience bad mood (stock photo used)

Many women going through perimenopause and menopause experience bad mood (stock photo used)

Tests are not usually needed to diagnose menopause, but your doctor may recommend checking levels of follicle-stimulating hormone (FSH) and estrogen (specifically estradiol, the most common type of estrogen); FSH levels increase and estradiol levels decrease as menopause progresses.

While you can get FSH tested at home (these tests check urine levels, doctors check blood levels), it’s unwise to self-diagnose, says Sid Dajani, a pharmacist from Bishopstock in Hampshire.

He says there is a risk of suggesting that menopause is to blame for all the ills that afflict middle-aged women.

“For example, heavy bleeding during your period could be a sign of uterine fibroids,” he says.

Dr. Morton explains that the irregular bleeding that women so often think of as a normal part of menopause can be a sign of cancer.

“We always look for red flags that suggest malignancy.”

In some cases, the cessation of menstruation may actually be pregnancy. “You should always be asking the question, ‘Can I be pregnant?’ Sid Dajani says

Menopausal symptoms can have many other causes.


Kelly Swingler, 41, business coach and psychologist, lives in Peterborough with her partner and twin sons, 21, and adopted sons, 18 and 11.

Within two months of starting HRT, the anxiety and “burnout” that I had been suffering from on and off for eight years disappeared.

My periods stopped after a minor uterine operation in 2013. It didn’t bother me too much: I was 32 years old, had heavy periods since my teenage years, and already had children.

Kelly Swingler from Coates, Cambridgeshire.  She says, “Now my energy is 100% better and my brain fog is clearing up.  My night sweats and anxiety are also gone.”

Kelly Swingler from Coates, Cambridgeshire. She says, “Now my energy is 100% better and my brain fog is clearing up. My night sweats and anxiety are also gone.”

But in 2015, I started having trouble sleeping and night sweats, put on weight, and started to feel anxious and emotional.

Older female colleagues said it could be menopause, but my therapist said I was too young and put me on antidepressants.

I took them in the hope that they would make me feel “normal”. But my mood continued to decline, and on that Christmas Eve I wanted to kill myself.

I decided that I should start helping myself. I stopped taking antidepressants and improved my diet. I started doing yoga more and gradually began to feel better.

But in 2017, the same symptoms began to plague me, which I again attributed to “burnout” at work. I felt like I really needed to fix this in my head.

The therapy helped, but by 2019 the cycle was repeating itself, and by 2020, when the pandemic hit, I felt like I didn’t know what planet I was on.

But after watching Davina McCall’s documentary on menopause last May, I recognized the symptoms and realized that I wasn’t going crazy: it was menopause.

The two friends then mentioned a private doctor who put them both on HRT. I visited their doctor in October 2021 and was prescribed estrogen patches and a daily progesterone pill; within a few weeks I felt completely different.

Now my energy is 100% better and the fog in my head is dissipating. My night sweats and anxiety are also gone.

I was afraid of HRT and possible side effects. But I feel that any risk outweighs the risk of not taking HRT. I can’t believe it changed my life.

Interview Jill Foster

HIGH BLOOD PRESSURE: A recent study published in the European Heart Journal found that many middle-aged women can live with undiagnosed hypertension because symptoms, including chest pain, exhaustion, headaches and heart palpitations, are instead attributed to menopause.

This is because the aging process of the coronary arteries “is different in women and men, and it starts at menopause,” says Angela Maas, lead author of the study and professor of women’s heart health at the Radboud University Medical Center in Nijmegen, the Netherlands.

IRREGULAR HEART: A rapid heartbeat (combined with hot flashes and other symptoms) can be a sign of menopause – there are estrogen receptors in the heart, explains gynecologist Dr. Heather Curry, former chairman of the British Menopause Society.

But it’s important not to overlook heart rhythm problems due to electrical failures in the heart, which are more common with age.

Dr. Morton adds: “People think it’s just menopause, when in fact it could be the heart developing a strange rhythm that has nothing to do with hormones.”

THYROID PROBLEMS: These are also relatively common and can cause menopause-like symptoms such as hot flashes and heart palpitations. Thyroid problems can be detected with a simple blood test.

DEMENTIA. A recent study published in Scientific Reports found that menopause affects a woman’s brain structure and how brain cells connect to each other.

“Some women may mistakenly fear that they have early-stage dementia,” says Dr. Morton.

But unlike the “brain fog” associated with menopause, Alzheimer’s is a progressive disease that gets worse over time.

Brain fog affects about two-thirds of women going through perimenopause and menopause, possibly because the brain also has estrogen receptors.

ARTHRITIS: Pain is another health problem that gets worse during menopause, but constant discomfort that doesn’t change can be caused by other conditions like arthritis.

“Don’t think it’s menopause. If something is bothering you, you should see a doctor,” says Sid Dajani.

DEPRESSION: Perhaps one of the most common areas of confusion is whether it is menopause or depression.

Many women going through perimenopause and menopause experience bad moods.

“The causes of mood swings in menopausal women are complex, but estrogen plays a role in many brain functions, so a drop in estrogen levels during perimenopause may affect the psychological well-being of some women,” says Dr. Morton.

Yet, unfortunately, some people are misdiagnosed as depressed and put on antidepressants when they really need hormone therapy, says Dr. Curry.

“Fortunately, there is a growing awareness among physicians that low mood and anxiety can be caused by hormones.”

How to sit on the couch… without back pain

Prolonged sitting is bad for posture and health. Now yoga teacher Susie Reading’s new book shows how to sit properly even when you’re lounging…

When you’re lounging on the couch in front of the TV, it’s important to think about how you sit.

I am wary of sagging sofas that cause the spine to form a C-shape, putting pressure on the joints.

When you're lounging on the couch in front of the TV, it's important to think about how you sit.

When you’re lounging on the couch in front of the TV, it’s important to think about how you sit.

Support the natural curve of your spine and joints by placing a pillow under your lower back or tucking a rolled-up blanket under your knees, which will help relieve stress on your back if your legs are extended.

  • Consider stuffing pillows with foam inserts (foam provides better support than feathers).
  • Use commercial breaks as a reminder to get up and move.
  • If you get stuck at your desk, get up regularly.
  • Invite congregations to walk rather than sit, stand when you drink water, and use a small glass or bottle that you need to get up and refill.
  • Setting an alarm every 30 minutes can also help.
  • If extended periods of sitting are unavoidable, check regularly to see if you are slipping into bad habits.

Sit To Get Fit by Suzy Reading (Aster, £12.99). To order for £11.69 go to mailshop.co.uk/books or call 020 3176 2937. Offer valid until 22 February.

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