By Laura Monti
Despite affecting nearly all women in midlife, perimenopause remains poorly understood, frequently misdiagnosed, and often dismissed as depression, anxiety, or even personality disorders. Misdiagnosis can result in inappropriate prescriptions, delayed intervention, and long-term harm to health and quality of life.
Perimenopause is the transitional phase before menopause, typically occurring in a woman’s forties and early fifties, marked by fluctuating hormones and symptoms that may last several years. Fatigue, brain fog, anxiety, mood swings, and disrupted sleep are common, with up to 90% of women experiencing symptoms that impact their working lives.
Yet arguably as a result of historical gender bias and gaps in medical education, this stage of life for women, has only recently begun to receive serious medical and legal acknowledgment, and because its symptoms mimic conditions such as depression, ADHD, or anxiety disorders, perimenopause is particularly vulnerable to misdiagnosis. Women are frequently prescribed antidepressants rather than offered hormonal therapy, or told their symptoms are “just stress” or “part of ageing.”
Legal implications
More women are reporting that their symptoms are not just misunderstood, but misdiagnosed, sometimes with serious consequences. These outcomes may reasonably reflect systemic problems, such as the underrepresentation of women’s health and the persistent minimisation of menopause as a health concern.
However, given the increasing public awareness of perimenopause, including recognition of its impact in the workplace and a clearer understanding of associated symptoms, medical care standards are likely to face greater scrutiny. Failures by clinicians to recognise, diagnose, or appropriately manage perimenopausal symptoms may increasingly be viewed as falling below the expected standard of care, creating potential grounds for a claim in medical negligence.
The negligence framework is well established. That is, if a health care provider fails to exercise the care of a reasonably competent practitioner, and that failure causes harm, liability may follow.
Not every misdiagnosis amounts to negligence, but ignoring red flags, failing to take adequate history, or overlooking perimenopause as a differential diagnosis when it should reasonably be considered, may cross the threshold into breach of duty. As awareness grows, dismissing menopausal symptoms is increasingly inconsistent with evolving expectations of reasonable care.
Developments in the UK
While no reported Australian cases exist, early signs are emerging from the UK. Several firms have highlighted settlements where menopause featured centrally in negligence claims.
Bridge McFarland reported the case of Mrs M, a case which highlighted the dangers of misattributing symptoms to menopause without thorough evaluation (Bridge McFarland LLP, Mrs M Case Study: Failure to Diagnose Menopause (UK)). Hatch Brenner pursued claims arising from premature menopause and its consequences (Hatch Brenner Solicitors, Clinical Negligence Claim – Premature Menopause (UK)). Leigh Day has emphasised the role of NICE guidelines in menopause management, and the risk of liability when those standards are not observed (Leigh Day LLP, Menopause and NICE Guidelines – Clinical Negligence Cases (UK)).
These matters have largely settled outside court, without producing binding precedent, but they suggest that menopause related negligence claims are beginning to test the boundaries of clinical law in the UK.
The Australian position
In Australia, the issue is gaining momentum. Menopause Alliance Australia has drawn attention to misdiagnosis, highlighting the risks where symptoms are mistaken for unrelated conditions and stressing the need for accurate diagnosis to guide treatment. The Australasian Menopause Society, which provides information for doctors and other health practitioners in supporting women through midlife health and the menopause has also emphasised the importance of medical education and adherence to evidence-based guidelines in menopause management. Its position statements provide benchmarks for competent care, and failure to following such standards could, in time, be scrutinised in negligence claims. The 2023 Senate Inquiry into menopause and perimenopause also identified significant gaps in care and education, pointing to systemic shortcomings. Recommendations were made to include menopause and perimenopause in the Graduate Outcome Statements of the Standards for Assessment and Accreditation of Primary Medical Programs. The committee also recommended that all governments and medical colleges work together to require and facilitate further education on menopause and perimenopause for physicians practicing in the public health system across Australia (Australian Senate, Inquiry into Menopause and Perimenopause (Interim Report, 2023)).
Given this increasing awareness, it is only a matter of time before Australian courts are asked to consider whether dismissal or mismanagement of perimenopause symptoms amounts to substandard care.
Implications for practitioners
For medical negligence lawyers, this is an area to watch. Success in litigation will depend on careful briefing of gynaecology and endocrinology experts, a clear understanding of evolving guidelines, and recognition of the broader societal context in which women’s health has long been minimised.
As medical negligence law continues to evolve in line with medical knowledge and social expectations, perimenopause misdiagnosis has the potential to become an emerging area of claims. The issue of causation will remain central, for a negligence claim to succeed, the plaintiff must show that the lack of diagnosis or mismanagement directly led to significant adverse effects, such as inappropriate medication, delayed relief of severe symptoms, or preventable long-term health consequences. Nonetheless, these issues are increasingly being brought to the forefront of legal discussions.
Conclusion
Perimenopause is a natural but often disruptive life stage for women. The historic tendency to dismiss its symptoms is becoming more widely recognised as unacceptable. While Australia has not yet seen reported negligence cases in this area, the UK experience shows that claims are already being explored. For Australian practitioners, the pressing question is not if, but when, these issues will reach the courts.
