Perimenopause is the seemingly never-ending transition leading to menopause, marked by significant hormonal changes. This period often brings the onslaught of life-interrupting symptoms such as hot flashes, night sweats, "brain fog," heightened anxiety, and mood swings, to name a few.
For women with a history of mental illness, "diagnostic overshadowing" can occur, where healthcare providers mistakenly attribute new symptoms to the existing condition rather than recognizing them as part of perimenopause. This can result in misdiagnosis, delays in appropriate treatment, and prolonged suffering for the patient.
Because many perimenopausal symptoms eerily mimic symptoms of common mental health conditions, several factors contribute to the dangerous phenomenon of diagnostic overshadowing:
- Mood swings, irritability, and low mood can be dismissed as a recurrence of depression or bipolar disorder.
- Anxiety, panic attacks, and heightened stress can be seen as a return of an anxiety disorder.
- Sleep disturbances, fatigue, and difficulty concentrating ("brain fog") can be attributed to worsening depression, anxiety, or even conditions like ADHD.
- Even paranoia or increased sensitivity can be mistakenly linked to a past psychotic disorder.
Healthcare providers, even with the best intentions, may subconsciously prioritize a patient's known mental health history. If a patient presents with mood changes, the immediate assumption might be a psychiatric relapse rather than considering hormonal influences. Furthermore, many clinicians lack comprehensive training in recognizing the diverse and often subtle mental health impacts of perimenopause.
Not only that but patients themselves, especially those who have battled mental illness for years, may also assume their new symptoms are a relapse. They might struggle to articulate the specific nuances of their feelings or dismiss them as "just my usual" mental health struggles, making it harder for providers to identify the true cause.
The focus often becomes solely on managing the "relapse," leading to adjustments in psychotropic medications without exploring the underlying hormonal drivers. This reductionist approach misses the opportunity to treat the root cause of the perimenopausal symptoms.
The consequences of diagnostic overshadowing can, in reality, harm women. Many suffer unnecessarily due to:
1. Delayed Relief: Persistent perimenopausal symptoms that could be treated with options like Hormone Replacement Therapy (HRT) remain unaddressed.
2. Unnecessary Medication Adjustments: Patients may receive increased doses of psychotropic medications or new prescriptions that do not tackle their perimenopausal symptoms, leading to unwanted side effects.
3. Increased Distress: Feeling unheard and seeing symptoms persist despite treatment can lead to frustration and despair.
4. Reduced Quality of Life: Untreated perimenopausal symptoms can negatively impact relationships, work performance, and overall well-being.
5. Erosion of Trust: Frequent misdiagnoses can diminish a patient's trust in healthcare providers, making them less inclined to seek future help.
To address diagnostic overshadowing, a multifaceted approach is vital. Healthcare providers need training on perimenopausal symptoms, especially their psychological aspects and interactions with mental health conditions. Clinicians should inquire about symptoms in all women of relevant age and review menstrual changes and cognitive shifts.
Collaboration between mental health specialists and menopause experts is crucial for a comprehensive understanding of patients. Women with a history of mental illness should be informed about perimenopausal symptoms to advocate for themselves, and caregivers should recognize new symptoms. Discussing hormones when new mental health issues arise is crucial. Patients should track their physical and mental symptoms, as well as well as menstrual changes, for an accurate diagnosis.
Perimenopause is a complex and often under-recognized stage in a woman's life. When combined with a history of mental illness, it becomes even more intricate. By recognizing and actively combating diagnostic overshadowing, we can ensure that women receive the timely and appropriate care they deserve, allowing them to navigate this transition with greater understanding, support, and ultimately, better health outcomes. It's time to see the whole woman, not just her medical history.
Sources:
https://www.health.harvard.edu/womens-health/perimenopause-rocky-road-to-menopause
https://www.medicalnewstoday.com/articles/what-are-the-34-symptoms-of-menopause#symptoms
https://menopausenetwork.org/perimenopause-whats-normal-whats-not/
https://www.verywellhealth.com/mental-illness-5113353
https://pmc.ncbi.nlm.nih.gov/articles/PMC9599119/
https://www.verywellhealth.com/hormone-replacement-therapy-5271199
