When Symptoms Are Attributed to Perimenopause
Perimenopause symptoms mistaken for illness are a common reason women are reassured when something else may be contributing to their symptoms. A woman noticed worsening fatigue, disrupted sleep, night sweats, palpitations, and rising anxiety. Brain fog interfered with focus, and exercise tolerance declined.
She was told it was perimenopause.
That explanation made sense—but it did not explain everything she was experiencing.
Hormonal transition can cause real and distressing symptoms. But not every midlife symptom is hormonal, and assuming so can delay appropriate evaluation.
Why Perimenopause Symptoms Are Often Mistaken for Illness
Perimenopause is a familiar and expected diagnosis for women in their 40s and early 50s. Hot flashes, sleep disruption, mood changes, and cognitive complaints are well described.
Because of this overlap, new or worsening symptoms are often attributed to hormonal change without further investigation. This framing can feel reassuring to both patients and clinicians. However, perimenopause should be a diagnosis of consideration—not exclusion.
When Perimenopause Symptoms Are Mistaken for Illness
Certain features should prompt a closer look. Illness-related fatigue is often crushing rather than fluctuating. Night sweats may be drenching rather than brief hot flashes. Shortness of breath or air hunger is not typical of hormonal transition. Cognitive symptoms may fluctuate unpredictably rather than improve with rest or stress reduction.
In some patients, perimenopause symptoms overlap with Lyme disease or associated coinfections, complicating attribution. When symptoms escalate quickly, feel disproportionate, or fail to respond to hormonal or lifestyle interventions, another cause should be considered.
Babesia and the Overlap With Perimenopausal Symptoms
Babesia infection can closely resemble perimenopause. Night sweats, temperature dysregulation, anxiety, palpitations, fatigue, and reduced exercise tolerance are common. In women, these symptoms are frequently attributed to hormonal change—particularly when menstrual cycles are already irregular.
Because Babesia is a parasitic infection of red blood cells, standard Lyme antibiotics do not treat it. When unrecognized, symptoms may persist or worsen despite reassurance that “this is just perimenopause.”
Why This Pattern Is Often Missed
Testing for Babesia has important limitations. Blood smears frequently miss low-level infection, and antibody testing may not confirm active disease.
When laboratory results are inconclusive, symptoms often default back to a hormonal explanation. Once symptoms are framed as perimenopause, reassessment may stop—even when the clinical picture does not fully fit.
Looking Beyond Hormones When Perimenopause Symptoms Don’t Fully Explain Illness
Hormonal transition can contribute to symptoms, but it should not explain everything. When symptoms are severe, progressive, or out of proportion to typical perimenopause, clinicians should broaden the differential rather than intensifying reassurance.
Hormonal transition and medical illness can coexist, and one does not exclude the other.
This is why perimenopause symptoms mistaken for illness should prompt careful reevaluation rather than automatic reassurance.
When symptoms are dismissed as hormonal without careful evaluation, treatable conditions may be missed.
For Women Who Feel Dismissed
If you’ve been told your symptoms are “just perimenopause” but feel something isn’t right, that concern deserves careful evaluation. Hormones matter—but they are not the only explanation.
The goal is not to deny perimenopause, but to ensure that overlapping or contributing conditions are not overlooked.
Frequently Asked Questions
Can perimenopause cause fatigue and night sweats?
Yes. Hormonal transition can cause both, but the severity, pattern, and associated symptoms matter.
Can infections be mistaken for perimenopausal symptoms?
Yes. Conditions such as Babesia can cause night sweats, anxiety, palpitations, and fatigue that resemble hormonal change.
When should perimenopause symptoms be reevaluated?
When symptoms are severe, progressive, fail to respond to treatment, or include features such as air hunger or marked exercise intolerance.
References
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New England Journal of Medicine. Vannier E, Krause PJ. Human babesiosis. 2012;366(25):2397–2407.
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International Journal for Parasitology. Krause PJ. Human babesiosis. 2019;49(2):165–174.
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Endocrine Reviews.Santoro N, Randolph JF. Reproductive aging and the menopause transition. 2011;32(3):371–401.
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JAMA Internal Medicine. Avis NE, et al. Duration of menopausal vasomotor symptoms. 2015;175(4):531–539.
