Perimenopause vs Coeliac Disease: Why the Symptoms Overlap and How to Tell Them Apart
Fatigue, bloating, brain fog, and mood changes appear in both perimenopause and coeliac disease. Learn the key differences and which tests to ask your GP for.
Two Conditions, One Confusing Symptom Set
Coeliac disease is an autoimmune condition in which the ingestion of gluten triggers an immune response that damages the small intestine lining. It is more common in women than in men and can remain undiagnosed for years, particularly when it presents in its non-classical form without obvious digestive complaints. Perimenopause, occurring in roughly the same age group (40s and 50s), shares several symptoms with coeliac disease: fatigue, abdominal bloating, brain fog, mood instability, joint pain, and disrupted sleep. When a woman presents to her GP with this cluster, the default assumption is often hormonal, and coeliac disease may go untested for years.
Features More Specific to Coeliac Disease
Certain features increase the likelihood of coeliac disease rather than perimenopause. Chronic diarrhoea or loose stools that follow gluten consumption is more typical of coeliac, though some people have constipation-predominant coeliac disease or no obvious gut symptoms at all (so-called silent coeliac). Unexplained iron-deficiency anaemia, vitamin B12 deficiency, or folate deficiency that does not respond fully to supplementation suggests malabsorption from intestinal damage. Weight loss despite adequate food intake is more consistent with coeliac than perimenopause, where weight gain is more typical. Dermatitis herpetiformis, a blistering skin rash on elbows, knees, and buttocks, is pathognomonic of coeliac disease and never caused by perimenopause.
Why Anaemia Is a Key Distinguishing Clue
Perimenopause can cause anaemia through heavy or prolonged periods, but this is typically iron-deficiency anaemia linked directly to blood loss. Coeliac disease causes anaemia through malabsorption: damaged intestinal villi cannot absorb iron, folate, or B12 adequately, regardless of dietary intake. A woman with anaemia that does not recover normally on iron supplements, or that recurs despite no obvious blood loss, should be screened for coeliac disease. The distinction matters because treating iron-deficiency anaemia without addressing underlying coeliac will only ever partially succeed. The intestinal damage continues, and nutrient deficiencies persist.
Testing for Coeliac Disease
The standard first-line test for coeliac disease is a blood test measuring tissue transglutaminase IgA antibodies (tTG-IgA), combined with total serum IgA (to exclude IgA deficiency, which causes false negatives). This test is highly sensitive when the person is eating gluten regularly. If the blood test is positive, the next step is a gastroscopy with small bowel biopsy to confirm villous atrophy. It is critical that patients continue eating gluten before testing; a gluten-free diet adopted before testing can normalise the blood tests and biopsy, making diagnosis impossible. If you have already reduced gluten intake because it seems to help your symptoms, discuss this with your GP before testing.
Why Both Can Co-Occur
Coeliac disease and perimenopause do not exclude each other; they can occur simultaneously. There is also evidence that autoimmune conditions, including coeliac disease, may be triggered or worsened by the hormonal shifts of perimenopause in genetically susceptible women. A woman who develops new digestive symptoms, fatigue, and brain fog in her mid-40s may have perimenopause, coeliac disease, or both. Treating perimenopause with HRT may improve some symptoms while leaving coeliac-related fatigue, anaemia, and gut symptoms unaddressed. If you are on HRT but still struggling with fatigue and bloating, coeliac disease is worth ruling out.
Tracking Symptoms to Support a Differential Diagnosis
Noting whether symptoms follow a hormonal pattern or a dietary pattern is one of the most useful things you can do before your GP appointment. Symptoms that worsen cyclically, linked to your menstrual cycle, point more toward perimenopause. Symptoms that worsen consistently after eating bread, pasta, or other gluten-containing foods, or that improve during gluten-free periods, raise the index of suspicion for coeliac disease. Using PeriPlan to log symptoms and track patterns over time makes this kind of dietary and hormonal correlation easier to see. A detailed symptom log that you can bring to your appointment gives your doctor far more to work with than a verbal summary from memory.
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