Perimenopause vs Multiple Sclerosis Symptoms: Understanding the Overlap
Perimenopause and MS share fatigue, brain fog, bladder changes, and mood shifts. Learn the key differences and when neurological evaluation is needed.
When Perimenopause Feels Neurological
Perimenopause produces a wide range of symptoms that can feel neurological in nature. Brain fog, tingling sensations, muscle weakness, bladder urgency, and profound fatigue are all reported by perimenopausal women and also feature prominently in multiple sclerosis (MS). This overlap creates genuine diagnostic uncertainty for some women, particularly those in their 40s when both conditions can first become apparent. Understanding how the two differ and what distinguishes MS as a distinct neurological disease helps women and their GPs determine whether perimenopause is the most likely explanation or whether further investigation is warranted.
Key Features That Distinguish Multiple Sclerosis
MS has a characteristic pattern of relapses and remissions, particularly in the most common form, relapsing-remitting MS (RRMS). Symptoms appear over days, then improve or resolve over weeks to months, sometimes partially and sometimes fully. This episodic course is distinct from the gradual, persistent symptom trajectory of perimenopause. MS symptoms that are unusual in perimenopause include significant limb weakness, coordination problems and unsteadiness when walking, double or blurred vision, and pronounced swallowing difficulties. Lhermitte's sign, an electric shock sensation running down the spine when bending the neck forward, is specific to MS-related lesions and does not occur in perimenopause.
MRI and the Role of Diagnostic Investigations
MS is diagnosed based on clinical presentation combined with MRI findings and, in some cases, cerebrospinal fluid analysis. MRI typically shows characteristic white matter lesions, known as plaques, in the brain and spinal cord. Blood tests alone cannot diagnose MS, though they are used to rule out other conditions. In perimenopause, there are no MRI findings associated with the hormonal changes, though some studies have found changes in brain structure related to midlife hormonal shifts. If a neurologist suspects MS, dissemination of lesions in both time and location must be demonstrated. This level of investigation goes well beyond what is needed to diagnose perimenopause.
When to Seek Neurological Evaluation
You should seek a neurological referral if you experience limb weakness or coordination problems that come and go, visual disturbances such as optic neuritis (pain with eye movement and blurred or lost vision), the Lhermitte's sign described above, severe balance difficulties, or symptoms that follow a clear relapsing-remitting pattern. A GP will typically begin with a neurological examination and decide whether an MRI referral is appropriate. It is entirely reasonable to ask your GP to assess you neurologically if you are uncertain, even if perimenopause is the working diagnosis. The two conditions can coexist, and MS does not disappear because perimenopause is present.
Hormonal Changes and MS: A Genuine Interaction
Research has shown that oestrogen has neuroprotective properties and that MS activity can change through the perimenopausal transition. Some women with established MS report a worsening of their MS symptoms during perimenopause, which can make it difficult even for them to separate hormonal symptoms from disease activity. For women not yet diagnosed with MS, oestrogen decline may lower the threshold at which neurological vulnerabilities become apparent. This does not mean perimenopause causes MS, but it does mean that the perimenopausal transition can be the period when MS-related symptoms become impossible to ignore. For women with a family history of MS or unexplained neurological episodes in the past, this is worth keeping in mind.
Tracking Symptoms Helps Both Diagnoses
Whether your symptoms turn out to be perimenopausal, related to MS, or some combination, systematic tracking provides valuable clinical information. A neurologist or GP benefits from knowing when symptoms began, how long they lasted, whether they resolved, and what worsened or improved them. An app like PeriPlan lets you log symptoms and track patterns over time, building a structured record that is far more useful in a consultation than recall alone. If your symptoms follow a cyclical pattern linked to your menstrual cycle or respond to sleep improvements, that favours perimenopause. If they progress independent of hormonal patterns or follow a clear episodic course, that supports seeking neurological review.
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