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Women can experience perimenopause symptoms for years before officially hitting menopause, which occurs, on average, at around age 51. There are common signs such as irregular periods and hot flashes, but others that can be more subtle, like sleep issues or weight gain, which may be attributed to something else.

A new survey from the menopausal care company Kindra conducted with The Harris Poll finds one in three women between 45 to 54 are given an incorrect diagnosis before finding out their symptoms are related to menopause. What’s more, 32 percent of women were worried their doctor was not very knowledgeable about the topic.

“This recent poll shows us it’s much more of a concern than what was previously understood and fits into the larger context of women’s health concerns being poorly researched and misunderstood,” says Dr. Suzanne Gilberg-Lenz, an OBGYN and senior medical advisor for Kindra. While it’s important to rule out illnesses that share symptoms with menopause like lupus and fibromyalgia, she says perimenopause should be on every doctor’s list because of how common it is for this age group.

Over a million women in the US enter menopause each year. Here’s what to know to get help identifying and correctly treating symptoms of perimenopause.

How do menopause symptoms get misdiagnosed?

Perimenopause can create a wide range of changes in the body—because of this, they can often get misdiagnosed by a health care provider.

Menopause symptoms can mimic other health problems. Sleep disturbances are one of the most overlooked signs of menopause, especially since many people today are sleep deprived from overpacked schedules or other stressors. “People don’t directly connect difficulty falling asleep or waking up in the middle of the night to menopause, but it is absolutely associated with hormonal changes in our bodies,” explains Flow Advisory Council member Dr. Jennifer Lang, an OBGYN and CEO of Buzz Labs.

Another commonly misdiagnosed symptom? Joint pain. A full 71 percent of perimenopausal women experience some form of musculoskeletal pain as the drop in estrogen levels increases the risk of inflammation, making age-related wear and tear more painful. Still, Dr. Lang says joint pain is often attributed to developing arthritis or Lyme disease. This can delay getting treatment for perimenopause symptoms.

Women often aren’t getting enough guidance about menopause from their healthcare provider. In the Kindra survey, nearly 60 percent of women, who went to the doctor for menopause symptoms felt the advice was unhelpful. In today’s short appointment slots, there often isn’t time for the kind of nuanced conversation that might surface more helpful advice. Changing health insurance coverage can force a patient to switch to a doctor they haven’t known for a long time, increasing the odds that the provider might not recognize unusual symptoms.

Or worse, women will share a menopause symptom with a provider who minimizes it. “Many women will have the experience of having a symptom dismissed, discounted, or unheard,” Dr. Lang says, adding that a provider might attribute adult acne and insomnia, for example, to stress from a job or relationship issues. “If you know something is going on in your body that is different or uncomfortable, then really advocate for yourself until you get to the bottom of it.”

People don’t like to talk about menopause. Menopause is a subject that’s still a taboo subject in certain communities and sometimes in media. If one in three women don’t feel confident their doctor will understand menopause, Dr. Gilberg-Lenz says they’ll be less likely to ask about menopause or seek out less credible sources for medical advice. 

What are the consequences of menopause misdiagnosis?

If someone’s concern is dismissed entirely—maybe she’s told it’s all in her head—this medical gaslighting can harm someone psychologically. The frustration of feeling unheard can cause feelings of loneliness and isolation that could increase the risk for depression, Lang says.

Depending on the severity of the symptom a woman may affect her quality of life. Vaginal dryness, for example, is a symptom of menopause that can cause painful or uncomfortable sexual intercourse, which could have a big impact on the relationship with their partner.

On the flip side, Dr. Lang warns that there are some serious conditions that can masquerade as menopause symptoms. If a woman’s concerns are not taken seriously, they may miss important workup to catch it in time. “I can’t tell you how many women experience bloating, appetite changes, and weight gain and have been told it’s something that happens when you reach midlife. Meanwhile, they have ovarian cancer that’s going undetected.”

Menopause self-care: How to prepare for a doctor’s visit

Here’s how to advocate for the care you need when you visit your healthcare provider.

Keep a record of changes to your body. One of the most common signs that a women is entering perimenopause is period irregularity. Dr. Lang advises keeping track of the length of your periods, whether any were missed, and how long this has been occurring.

Do your homework. The North American Menopause Society has free online resources to educate people on the transition to menopause. There are also a range of helpful books about menopause; Dr. Gilberg-Lenz recently wrote The Menopause Bootcamp to help and empower women going through this phase of life.

Have a list of questions at the ready. Bringing questions allows you to maximize the time you have in your provider’s visit along with taking control of the conversation. Ask about the symptoms of menopause, how to know if you’re going through the change, how to manage symptoms, and what treatment options are available.

If you feel your doctor is still not listening to you, then it’s time to look for a new one. Telemedicine has made it easier to find a doctor without worrying about the distance. Dr. Lang encourages women to continue looking until they found a provider that is hearing them. “In this climate of changing doctors and changing health plans, we really are the only continuous advocate for ourselves.”