Misdiagnosed as Menopause: When Symptoms Deserve a Second Look
A woman in her mid-40s noticed worsening fatigue, disrupted sleep, night sweats, palpitations, and rising anxiety. Brain fog interfered with her ability to focus. Exercise that once felt manageable now left her breathless.
She was told it was menopause.
That explanation made sense—but it did not explain everything she was experiencing. For months, she adjusted her expectations, managed her sleep, and assumed her body was simply changing. It was only later, after symptoms continued to escalate, that another possibility was considered.
Being misdiagnosed as menopause is more common than many women realize. Hormonal transition—whether perimenopause or menopause—can cause real and distressing symptoms. But not every midlife symptom is hormonal, and assuming so can delay appropriate evaluation.
Why This Misattribution Happens
Menopause and perimenopause are familiar and expected diagnoses for women in their 40s and 50s. Hot flashes, sleep disruption, mood changes, and cognitive complaints are well described. Clinicians see it constantly. Patients expect it.
Because of this overlap, new or worsening symptoms are often attributed to hormonal change without further investigation. The framing feels reassuring to both patient and clinician: this is normal, this will pass, your body is doing what it’s supposed to do.
But hormonal transition should be a diagnosis of consideration—not a reason to stop looking. When it becomes shorthand for “nothing else to evaluate,” treatable conditions can be missed.
Signs That Something Else May Be Contributing
Certain features should prompt a closer look.
Fatigue from hormonal transition tends to fluctuate. Illness-related fatigue is often crushing and unrelenting—present from waking and unrelieved by rest. Night sweats may be drenching rather than brief hot flashes. Shortness of breath or air hunger is not typical of menopause. Cognitive symptoms may come and go unpredictably rather than improve with sleep or stress reduction.
When symptoms escalate quickly, feel disproportionate to what others describe, or fail to respond to hormonal support or lifestyle changes, another cause should be considered—even if menopause is also playing a role.
Babesia and the Overlap With Menopausal Symptoms
One condition frequently misdiagnosed as menopause is Babesia, a tick-borne parasitic infection of red blood cells.
Babesia can cause night sweats, temperature dysregulation, anxiety, palpitations, fatigue, and reduced exercise tolerance—a symptom profile that closely mirrors hormonal transition. In women whose menstrual cycles are already irregular or have stopped, the overlap can be nearly seamless.
Babesia is a parasitic infection, and standard Lyme antibiotics are not effective treatments for it. When unrecognized, symptoms may persist or worsen despite reassurance that “this is just your hormones.”
Testing for Babesia has important limitations. Blood smears frequently miss low-level infection, and antibody testing may reflect past exposure rather than active disease. When laboratory results are inconclusive, symptoms often default back to a hormonal explanation—and once that frame is in place, reassessment may stop.For more on Babesia, see Babesia and Lyme: It’s Worse Than You Think.
Why This Pattern Persists
Once a patient has been told her symptoms are menopausal, both she and her clinicians may stop questioning that explanation—even when the clinical picture does not fully fit.
This is not always a failure of attention. It reflects how medicine is structured: familiar diagnoses are easier to reach, and unfamiliar ones require extra effort to pursue. For many clinicians, menopause is familiar. Babesia is not.
The result is that some women spend months or years managing symptoms that were never fully hormonal in the first place.
For Women Who Feel Dismissed
If you have been told your symptoms are “just menopause” but something still feels off, that concern deserves evaluation—not reassurance.
Hormonal transition and medical illness can coexist. One does not exclude the other. The goal is not to deny menopause, but to ensure that overlapping or contributing conditions are not overlooked. Hormonal transition may amplify symptoms from another condition rather than fully explain them.
Being misdiagnosed as menopause does not mean your experience was imagined. It means the explanation was incomplete.For more on misdiagnosis patterns, see Misdiagnosing Lyme Disease: The Great Imitator.
Frequently Asked Questions
Can menopause cause fatigue and night sweats? Yes. Hormonal transition can cause both. But the severity, pattern, and associated symptoms matter—especially when they are out of proportion to what is typically expected.
Can infections be mistaken for menopause? Yes. Conditions such as Babesia can cause night sweats, anxiety, palpitations, and fatigue that closely resemble hormonal change.
How do I know if I’ve been misdiagnosed as menopause? Consider seeking further evaluation if symptoms are severe, progressive, unresponsive to treatment, or include features not typical of hormonal transition—such as air hunger, marked exercise intolerance, or drenching night sweats.
What should I do if my doctor dismisses my concerns? You can ask for additional testing, request a referral, or seek a second opinion from a clinician experienced with complex or multisystem illness.
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.
