Many women experiencing symptoms such as extreme tiredness, aching joints, low mood, and significant brain fog mistake them for perimenopause. However, these symptoms can also indicate lupus, an autoimmune disease that often goes undiagnosed for years.
Lupus occurs when the body's immune system mistakenly attacks healthy tissues, affecting joints, skin, kidneys, the heart, and the brain. While the exact cause is unknown, potential triggers include infections, certain medications, smoking, and exposure to UV light.
In the UK, lupus affects approximately 70,000 people, or about one in 1,000. Research indicates a long diagnostic journey for many patients, with an average wait of seven and a half years from the onset of symptoms to a confirmed diagnosis. Some individuals have reported waiting up to 40 years, and studies suggest that up to two-thirds of patients receive at least one incorrect diagnosis before the correct one is made.
The Great Imitator
Lupus is often called 'the great imitator' because its symptoms can closely resemble those of other conditions, particularly perimenopause. Fatigue, joint pain, brain fog, mood changes, and sleep disturbances are common to both. Lupus is significantly more prevalent in women, with 90 percent of diagnoses occurring among females. It typically manifests between the ages of 15 and 55, a period that overlaps with the onset of perimenopause.
General practitioners may initially suspect perimenopause, especially in women over 45, as it is far more common than lupus. Diagnosis of perimenopause usually does not involve blood tests, and hormone replacement therapy (HRT) is often prescribed to alleviate symptoms. While HRT is effective for menopause, it does not treat lupus.
Identifying Lupus
Certain symptoms can help distinguish lupus from perimenopause. These include a rash across the cheeks and nose that worsens with sun exposure, mouth ulcers, and unexplained low-grade fevers. Patients experiencing these signs are encouraged to discuss lupus testing with their doctor.
Treatment Advances
Lupus cannot be cured, but its symptoms can be managed effectively. Mild cases are often treated with anti-inflammatory drugs and hydroxychloroquine, an antimalarial medication that helps reduce immune system overactivity. More severe cases may require steroids, immunosuppressants, or newer targeted therapies.
Recent developments show promise in lupus treatment. Results from an international trial published in The Lancet demonstrated that a new oral medication, enpatoran, significantly benefited patients with moderate to severe lupus. The drug works by blocking immune signals that trigger lupus flares. Over half of patients on the drug showed a positive response, compared to about a third on a placebo. The medication is progressing to the final stage of clinical trials.
While not every woman in her 40s experiencing fatigue and joint pain has lupus, the possibility underscores the importance of thorough medical evaluation beyond common assumptions like perimenopause.