Is It Menopause or Something Else?

A woman in her late 40s may feel many things when she wakes up soaked in sweat: annoyed, anxious, maybe a little sad. One thing she probably won’t feel? Surprised, because she’ll assume her night sweats have to do with menopause. Not fun, but nothing to worry about.

But what if it’s not menopause? While night sweats, hot flashes and brain fog are classic signs that a woman is going through “the change,” they can also be signs of other health problems — some of them serious.

Knowing which conditions can be mistaken for menopause may help you recognize when symptoms could be something else.

Menopause 101

A woman is in menopause when she has gone 12 straight months without a period. Perimenopause starts when a woman first has symptoms related to hormonal changes and ends one year after she stops getting her period.

Perimenopause can last from four to eight years. Common symptoms during this time include:

• Hot flashes
• Night sweats
• Sleep problems
• Mood/mental health changes
• Vaginal dryness
• Decreased interest in sex
• Joint and muscle pain
• Brain fog and other issues with concentration
• Memory problems

Although not everyone will have all these symptoms, few of us can expect to sail through menopause without issues; more than 8 in 10 women report having some symptoms in the transition to and during menopause.

Same symptoms, different problem

Because menopause can come with many symptoms, women in their 40s and 50s might be tempted to chalk up any health changes to menopause — especially if their healthcare providers (HCPs) don’t tell them otherwise.

But some of the most common menopause symptoms could be red flags if they’re not caused by hormone changes, according to Dr. Mary Jane Minkin, a clinical professor of obstetrics, gynecology and reproductive sciences at Yale University School of Medicine and a member of HealthyWomen’s Women’s Health Advisory Council. She explained that some conditions may be mistaken for menopause because of shared symptoms. These include:

Pregnancy

Perimenopausal women can still get pregnant until they go a full year without getting their period. So, when patients have missed periods and hot flashes, Minkin always rules out pregnancy first.

Hyperthyroidism (overactive thyroid)

Hyperthyroidism is when the body makes too much of a hormone called thyroxine. It can cause irritability, sweating and other symptoms that are common during menopause. “Hyperthyroidism certainly can masquerade as menopause — skipping periods, making you hot and making you sleep lousy,” Minkin said.

Collagen vascular diseases

Collagen vascular diseases occur when the body’s immune system attacks its own tissues and organs. Some of these diseases, including lupus and rheumatoid arthritis, can look like menopause. “If somebody is hot and achy, it could be menopause, but it also could be collagen vascular disease,” Minkin said.

Cancer

Some cancers can cause missed periods, night sweats and other symptoms also experienced during menopause. “Hodgkin’s disease and non-Hodgkin lymphoma are the classics, but several other cancers can do it,” Minkin said.

Sleep apnea

Since poor sleep is so common during perimenopause, women may think nighttime waking is the result of menopause when they really have sleep apnea. Sleep apnea is a common but underdiagnosed sleep disorder that is linked to heart disease and other health problems.

More than just menopausal mood swings

Although they affect nearly one in four peri- and menopausal women, mood changes shouldn’t be dismissed as menopause either, said Dr. Lisa Larkin, an internal medicine physician and a member of HealthyWomen’s Women’s Health Advisory Council.

“We know that the perimenopause transition is a time of vulnerability to mood disturbance,” Larkin said. She explained that some women have anxiety or depression for the first time during this transition, although they are more common in those with a history of these conditions.

“But not all depression at age 50 is related to menopause, and appropriate management often includes typical antidepressant/anti-anxiety medications,” Larkin said.

Having trouble concentrating and remembering things could be menopausal brain fog — but could also be signs of dementia. About 200,000 people under the age of 65 have early onset Alzheimer's disease.

How to know if your symptoms are menopause

So how do you know if your symptoms are menopause or something else? Start by talking to your HCP. They may suggest you try hormone therapy, which should work to ease your symptoms if they are related to menopause. If hormone therapy doesn’t work, it’s a sign that something else may be going on — and you and your provider can act accordingly.

“If I give a patient estrogen and she says, ‘Nope, hasn’t made a difference at all, and I’m still sweating like crazy,’ then I’m going to look for other causes,” Minkin said.

And if your HCP dismisses every symptom and concern with “It’s just menopause” no matter what you say? Time to find a new HCP.

“Women need to advocate for themselves at midlife,” Larkin said. “They need to proactively discuss bothersome/new symptoms with their HCP. If their HCP does not take an adequate medical history, or does not adequately investigate or address their concerns, they should get another opinion from another provider.”

For more information and to find a menopause expert, try “Find a Menopause Practitioner” through the North American Menopause Society.

This resource was created with support from Pfizer and developed in partnership with American Association of Nurse Practitioners.