What are the challenges of diagnosing perimenopause?

Written by: Mr Mahantesh Karoshi
Edited by: Conor Dunworth

Diagnosing perimenopause can be challenging due to the highly individualised nature of the transition to menopause and the overlap of symptoms with other medical conditions. In his latest article, leading consultant gynaecologist Mr Mahantesh Karoshi explains some of the difficulties in diagnosing perimenopause.


What are some of the challenges that contribute to the difficulty in diagnosing perimenopause?

There are various different reasons why perimenopause can be difficult to diagnose. Some of the challenges include:

  • Variability in symptoms: Perimenopause symptoms can vary greatly from woman to woman, making it difficult to identify a common set of diagnostic criteria. Symptoms may include irregular menstrual cycles, hot flashes, night sweats, sleep disturbances, mood changes, vaginal dryness, and decreased libido.


  • Age range: Perimenopause typically occurs between the ages of 45 and 55, but it can begin as early as the mid-30s or as late as the early 60s. This wide age range can complicate the diagnostic process.


  • Overlap with other conditions: Many perimenopause symptoms can also be indicative of other medical conditions, such as thyroid disorders, hormonal imbalances, or chronic fatigue syndrome. This can lead to misdiagnosis or delays in treatment.


  • Hormone level fluctuations: Hormone levels can fluctuate greatly during perimenopause, making it challenging to rely on blood tests for diagnosis. Oestrogen and follicle-stimulating hormone (FSH) levels can vary from day to day or even within the same day.


  • Lack of standardized diagnostic criteria: There is no universally accepted set of diagnostic criteria for perimenopause, which can lead to inconsistent diagnoses among healthcare professionals.


  • Reliance on self-reporting: Many symptoms of perimenopause are subjective, such as mood changes and sleep disturbances. This can make it difficult for healthcare providers to accurately assess the presence and severity of perimenopausal symptoms.


  • Cultural and social factors: Women from different cultural backgrounds may have different expectations and experiences of perimenopause, which can affect the reporting and interpretation of symptoms.


  • Underdiagnosis or misdiagnosis: Because perimenopause is a natural life stage rather than a disease, some healthcare professionals may overlook or minimize its impact on a woman's quality of life, leading to underdiagnosis or misdiagnosis.


To overcome these challenges, healthcare providers often rely on a combination of clinical history, physical examination, and laboratory tests to diagnose perimenopause. Patient education and open communication are also essential in helping women understand and manage this complex life transition.


Mr Mahantesh Karoshi is a leading consultant gynaecologist based in London. If you would like to book a consultation with Mr Karoshi, you can do so today via his Top Doctors profile.

By Mr Mahantesh Karoshi
Obstetrics & gynaecology

Mr Mahantesh Karoshi is a London-based women’s health expert and consultant gynaecologist, with a special interest in ovarian cysts, heavy menstrual bleeding, infertility, fibroids, and adenomyosis. He is currently one of the most highly-rated gynaecologists in London with a very good reputation amongst his patients and peers.

Mr Karoshi's work is recognised internationally, having volunteered in Ethiopia’s Gimbie Hospital, and later receiving the Bernhard Baron Travelling Fellowship from the Royal College of Obstetricians and Gynaecologists which led to his work in the University of Buenos Aires. Here he worked on the techniques needed to surgically manage morbidly adherent placental disorders - a serious condition that can occur in women with multiple caesarean sections.

He believes in an open doctor-patient relationship, being sure to include the patient and educating them so that they understand their condition better and they can be directly involved in their care and management at every stage. Aside from his clinical work, he is actively involved in research, which together with his experience, has given him the opportunity to publish the first stand-alone textbook on postpartum haemorrhage which was launched by HRH Princess Anne.

At the core of Mr Karoshi's practice is a high standard of professionalism where patients are involved in their treatment and where the latest techniques and advancements are used to provide an extremely high level of care.

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