Perimenopause Misdiagnosis Remains Widespread as Clinicians Miss Hormonal Transition Explains Bruce Dorr, MD, URPS, IFM-CP

Misdiagnosis during perimenopause remains strikingly common. Nearly 40% of women responding to a recent national survey reported receiving treatment for anxiety or depression when their symptoms were actually hormonally driven. The overlap between perimenopausal symptoms and those captured on common mental health screening tools, such as the PHQ-8, compounds the challenge: 7 of 8 criteria used to diagnose depression can also reflect fluctuating estrogen and progesterone levels. Yet most women surveyed said they never had a meaningful conversation with their clinician about perimenopause, and many felt their concerns were minimized or dismissed.

In a recent interview with Patient Care,^© Bruce Dorr, MD, URPS, IFM-CP, senior medical advisor at Biote, the company that commissioned the Perimenopause Focus survey, discussed how structural pressures in US clinical practice contribute to these missed diagnoses. He noted that with only 10–15 minutes per patient, clinicians often default to “naming and taming” a diagnosis in order to keep pace with demanding schedules. The result, he explains, is that women presenting with fatigue, sleep disruption, mood changes, or cognitive fog, all symptoms that may be rooted in hormonal transition, frequently leave with a prescription for an antidepressant or anxiolytic, having had no discussion of the initial presentation of the climacteric.

Dorr acknowledged that differentiating mental health conditions from hormone-related changes can be complex, and he emphasized the need for more time, better tools, and more deliberate assessment strategies in primary care and OB/GYN settings. His comments offer a candid look at how diagnostic shortcuts arise and why so many women feel misunderstood at a pivotal stage of life, even as the survey data call for deeper, more informed clinical engagement.

The following transcript has been lightly edited for style and flow.

Patient Care: About 40% of the women who responded to this survey said they felt misdiagnosed by their clinician while in the perimenopause stage of life: 33% said they received diagnoses and treatment for anxiety, 27% for depression, 25% for mood swings, and 13% for panic attacks. What’s going on in the exam room that leads to that kind of miss?

Bruce Dorr, MD, URPS, IFM-CP: The whole work model is being on a treadmill. You get 15 minutes with a patient, or 10 minutes. The point is to get in there, diagnose them with a problem, give them something, and get them out of there because you’ve got another patient in 10 minutes. This is not easy. Hormones are not easy, and these symptoms are not easy. You need other tools, or as a provider you need more time, and patients need more time—time to understand what they’re feeling. They may not understand what’s going on with them, either. So you need the tools and the time to assess that, rather than “name, blame, and tame” a diagnosis. That’s what goes on in American healthcare in a 10-minute encounter.

PC: There are some short, easy-to-use tools that could help in a brief clinic visit. One of them is the Patient Health Questionnaire depression scale. But seven of the eight criteria overlap with perimenopause. What are some of those overlapping symptoms, and is there any clear way to differentiate them in that short period?

Dorr: Sure. We’re all puzzle pieces. There are many components that go into healthy minds and healthy bodies. Many symptoms overlap because hormones can contribute to the same feelings, loss, depression, anxiety. Some people think, “Why am I feeling this way? Life is pretty good for me.” And yes, there are many overlapping signs and symptoms.

When we look at a depression-scale survey, fatigue, lack of sleep, concentration issues—those are very overlapping symptoms, and it is confusing. That’s why some people are more comfortable prescribing an antidepressant. So many of these women went on anxiety or antidepressant medications because it was, “Okay, you’re depressed, here’s a medication,” and they’re out the door in 10 minutes. That’s easy. But filtering in the overlapping symptoms that go along with perimenopause or menopause is much more difficult and requires a better and longer assessment.