Perimenopause vs Hypermobility Syndrome: How to Tell the Difference
Joint pain, fatigue, and brain fog appear in both perimenopause and hypermobility syndrome. Learn how the two conditions differ and overlap.
Why These Two Conditions Get Confused
Perimenopause and hypermobility syndrome share a frustrating amount of common ground. Both can cause widespread joint pain, fatigue, digestive difficulties, anxiety, and cognitive symptoms. Women who have lived with hypermobility syndrome, also called hypermobile Ehlers-Danlos syndrome or hEDS, often find that their symptoms intensify in their late thirties and forties, which coincides with the perimenopause window. The result is a diagnostic puzzle that leaves many women unsure whether their worsening symptoms reflect hormonal change, a connective tissue condition, or both happening at once.
What Perimenopause Looks Like
Perimenopause is the transitional phase before the final menstrual period, typically beginning in the mid to late forties though it can start earlier. Falling and fluctuating estrogen levels drive most symptoms. Hot flashes, night sweats, and irregular periods are the hallmark signs. Joint aching is common because estrogen plays a role in maintaining cartilage and reducing inflammation. Brain fog, low mood, and anxiety also feature heavily. Fatigue is nearly universal. Symptoms tend to come in waves that track loosely with hormonal fluctuations, and they often improve following menopause when hormone levels stabilise at a lower baseline.
What Hypermobility Syndrome Looks Like
Hypermobility syndrome is a heritable connective tissue condition in which joints move beyond their normal range. The underlying collagen is more elastic than it should be, which affects not just joints but also skin, blood vessels, and the autonomic nervous system. Core symptoms include joint instability, chronic widespread pain, fatigue, and proprioception difficulties. Many women with hypermobility syndrome also experience dysautonomia, which produces dizziness on standing, heart palpitations, and temperature regulation problems. Gastrointestinal issues such as bloating and slow motility are common. Anxiety and sensory sensitivity are frequently reported. Unlike perimenopause, symptoms do not follow a hormonal cycle and they persist year round.
Where the Overlap Creates Confusion
Estrogen has a direct effect on collagen integrity, which means that declining estrogen during perimenopause can genuinely worsen hypermobility symptoms. A woman with mild, well-managed hypermobility may find that her joints become unstable, her pain increases, and her fatigue deepens as she enters perimenopause. At the same time, perimenopause-related joint pain, dizziness, and palpitations can mimic hypermobility-related dysautonomia. The two conditions amplify each other, and sorting out which symptoms belong to which condition requires careful assessment. The key distinction is that hypermobility syndrome does not start at perimenopause. There is usually a lifetime history of flexibility, frequent sprains, or being told joints are loose.
How Diagnosis Works for Each
Perimenopause is assessed through symptom history and, where helpful, blood tests measuring FSH and estradiol levels, though hormone levels fluctuate widely and a single result is not conclusive. A GP or gynaecologist usually leads this assessment. Hypermobility syndrome is diagnosed using criteria such as the Beighton score, which measures joint flexibility across several sites, alongside a detailed symptom history. There is no blood test for hypermobility syndrome. A rheumatologist or a specialist familiar with connective tissue conditions typically makes the formal diagnosis. If a woman is presenting with both hormonal symptoms and longstanding joint instability, she may benefit from referral to both specialties.
Management Approaches for Each Condition
Perimenopause is managed through lifestyle measures including regular exercise, dietary changes, and sleep improvement, as well as hormone replacement therapy where appropriate. HRT can have a notable effect on joint pain because restoring estrogen supports cartilage health. For hypermobility syndrome, physiotherapy focused on joint stabilisation and proprioception is the cornerstone of treatment. Strengthening the muscles around unstable joints reduces injury risk and pain. Pain management, pacing, and strategies for dysautonomia such as increased salt and fluid intake round out care. When both conditions are present, HRT may ease the hormonal amplification of hypermobility symptoms, making physiotherapy more effective and comfortable.
Tracking Symptoms to Understand Your Patterns
Keeping a detailed symptom log is genuinely useful when two overlapping conditions are in play. If joint pain and fatigue worsen in the week before a period and ease afterwards, that pattern points toward a hormonal driver. If symptoms are constant regardless of cycle phase and have been present since early adulthood, hypermobility is the more likely explanation. An app like PeriPlan lets you log symptoms daily and view patterns over time, which gives you concrete evidence to share with a doctor rather than relying on memory. Seeing several months of data laid out clearly can accelerate the process of getting an accurate assessment and a management plan that addresses both conditions properly.
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