It’s ‘just the perimenopause’. It’s a refrain I’ve increasingly heard from friends and patients – and it’s left me worried. Many might argue that more women talking about the perimenopause is a good thing. After all, our understanding of this pre-menopausal condition – where female sex hormone levels begin to fluctuate causing periods to become irregular – has come on in leaps and bounds in recent decades.

With that greater understanding has come greater awareness – and better treatment – for those experiencing uncomfortable perimenopause symptoms. However, there has been a dangerous downside – because as research into perimenopause has grown, so too has the list of possible symptoms.

At the same time, perimenopause has become a massive talking point on social media. Self-appointed perimenopause ‘experts’ have made whole careers from making TikTok videos and Instagram posts about the symptoms and treatments.

I’m beginning to worry we are getting to a point where our obsession with perimenopause means other medical conditions are being missed. These might be psychological problems such as depression or anxiety – but they could be life-threatening too.

Take some of the women who recently told me about supposed perimenopause troubles. One told of new vaginal bleeding, another of pain while peeing and one had a sudden loss in weight.

All these symptoms could be due to the perimenopause – but they all could be signs of cancer too. Crucially, none of these women had been tested for the deadly disease – or anything else. Instead, they’d been handed hormone replacement therapy [HRT].

My fear is there are countless women who are being wrongly told they have perimenopause – meaning they are not being treated for the true cause.

So, how can you know whether your symptoms are down to perimenopause? First, it’s important to explain what is occurring in the body during perimenopause. The condition occurs when levels of female sex hormones oestrogen and progesterone begin to fluctuate. This usually happens when women are in their mid to late 40s.

My fear is there are countless women who are being wrongly told they have perimenopause – meaning they are not being treated for the true cause, writes Dr Ellie

Perimenopause and menopause are often used interchangeably, but they are not the same. Menopause is when sex hormone levels drop permanently and periods stop. While many still experience symptoms after the menopause, the most uncomfortable and distressing issues tend to occur during perimenopause as this is when sex hormones are most erratic.

The most common of these are hot flushes, sleep issues, mood swings and vaginal dryness.

But the list of perimenopause symptoms has grown. For my recent book, The Little Book of HRT, I tallied up an astonishing 45.

The problem is when doctors assume any middle-aged women who develops vague symptoms is experiencing perimenopause. There are so many other explanations. Psychological issues such as trouble sleeping or brain fog could be due to mental health problems.

Many stressful events happen around this age, such as children leaving home, parents dying or divorce. The best treatment might not be HRT but antidepressants.

Urinary issues – like incontinence and pain while peeing – are also considered common perimenopause symptoms. But these problems are often triggered by a urinary tract infection.

Also, I’ve seen women with rheumatoid arthritis who have gone untreated for far too long because they were initially told their pains were due to perimenopause.

Most worrying is when women are told their heavy period bleeding is down to perimenopause and receive no further examinations.

It’s true this is one of the most common perimenopause symptoms but it also could be a sign of womb or ovarian cancer and any delay to diagnosis may be deadly.

The only way to know if heavy bleeding is down to cancer is by testing for it. The answer is not to give HRT and hope for the best.

If doctors assume every symptom that affects a woman in her 40s is down to the perimenopause, real issues are missed – and people get the wrong treatment.

GP referral bounce-backs are making patients wait too long

I was shocked to read that a quarter of patient referrals to hospital are now being rejected and returned to GPs.

Many of these so-called bounce-backs are occurring – according to the healthcare magazine Pulse – because hospital doctors are asking for ‘advice and guidance’ from GPs before they will accept the referral.

Essentially, this means they have questions about the referrals.

However, some GPs say this is leading to long delays for patients who are desperately in need of treatment.

I happen to agree. Often these referrals are for tests for life-threatening conditions, such as heart disease and cancer.

The NHS already takes too long to diagnose these conditions – we can’t afford to make patients wait any longer.

Have you recently had a referral refused by your hospital? Did it affect your health? Write and let me know.

Your questions answered...

I am a fit 65-year-old man and I’ve started having fainting spells. These occur every few weeks and come out of nowhere. What could be the problem?

Dr Ellie replies: Anyone who regularly faints should see their GP immediately.

Fainting can be a sign of serious heart disease. The most common heart problem linked to this problem is atrial fibrillation – a heart rhythm disorder.

Crucially, there is a particular form called paroxysmal atrial fibrillation where the heart’s rhythm is only occasionally disrupted – say, once or twice a month.

When this occurs, it can trigger fainting. However, the condition can be difficult to diagnose as a standard heart rhythm test might miss these episodes.

For this reason, patients with these symptoms need to wear a 72-hour monitor that can spot fleeting rhythm changes. This would be fitted out by a cardiologist in hospital. Another cause of fainting is low blood pressure – where the heart is not pushing the blood around the body hard enough.

This can trigger dizziness, blurry vision, fatigue and fainting. Low blood pressure is often caused by dehydration, certain medicines and even standing up too fast. A GP should be able to carry out a check.

Heart issues are not the only cause of fainting. Two vitamin deficiencies – iron and B12 – are linked to fainting. A lack of iron is often triggered by a lack of red meat, beans, lentils or dark green vegetables. In women, it can be triggered by heavy periods.

Meanwhile, B12 deficiency is often down to a vegan or vegetarian diet. This is because the vitamin is only found in animal products.

But before exploring these possibilities, it is crucial that heart issues are ruled out.