Perimenopause vs Addison's Disease: How to Tell the Difference

Why These Two Conditions Get Confused

Perimenopause and Addison's disease are quite different in origin, but they can produce a surprisingly similar cluster of symptoms. Both can leave you exhausted, low in mood, dizzy when you stand up, and struggling to hold a stable weight. Because perimenopause is far more common, it is often the first diagnosis considered in women in their 40s and early 50s. Addison's disease, also called primary adrenal insufficiency, is rare, affecting roughly 1 in 10,000 people. However, it is underdiagnosed, and some women spend years attributing adrenal symptoms to the menopause transition before the true cause is identified. Understanding the differences matters because Addison's disease requires specific, life-saving treatment.

What Addison's Disease Actually Is

Addison's disease occurs when the adrenal glands, which sit just above the kidneys, fail to produce enough cortisol and often aldosterone as well. In most cases the cause is autoimmune: the immune system attacks the adrenal cortex over time. Without adequate cortisol, the body cannot regulate blood pressure properly, maintain blood sugar levels, or mount an effective stress response. Without aldosterone, sodium and fluid balance becomes disrupted. The result is a gradual decline in wellbeing that can go on for months or years before a diagnosis is made. Women with other autoimmune conditions such as thyroid disease or type 1 diabetes are at higher risk, which adds another layer of confusion since autoimmune thyroid disease is also more common during the perimenopause years.

Symptoms That Overlap With Perimenopause

The shared symptoms between the two conditions include persistent fatigue that does not improve with rest, low mood or mild depression, difficulty concentrating, weight changes, reduced libido, and a general sense of feeling unwell. Salt cravings are common in Addison's disease, and some women in perimenopause also report craving salty foods, which makes this less distinctive than it might seem. Both conditions can disrupt sleep and affect energy levels throughout the day. The hormonal shifts of perimenopause cause their own form of HPA axis disruption, so cortisol rhythms can become irregular during the menopause transition, blurring the picture further.

Symptoms That Point More Strongly to Addison's Disease

There are several features that are more characteristic of Addison's disease than perimenopause. Skin darkening, particularly in skin folds, scars, gums, and areas exposed to friction, is a hallmark sign caused by elevated ACTH levels. Severe postural hypotension, meaning a significant drop in blood pressure when standing, is more pronounced in Addison's than in typical perimenopause. Nausea, vomiting, abdominal pain, and unexplained weight loss with poor appetite are also more common in adrenal insufficiency. Fainting or near-fainting episodes, especially under physical or emotional stress, warrant investigation. An adrenal crisis, where the body is unable to respond to a stressor at all, is a medical emergency that does not occur in perimenopause.

Symptoms That Point More Strongly to Perimenopause

Vasomotor symptoms are the clearest distinguishing feature of perimenopause. Hot flashes, night sweats, and the sudden sensation of heat spreading through the body are driven by fluctuating oestrogen and do not occur in Addison's disease. Irregular menstrual cycles, changes in flow, and skipped periods are central to the perimenopause experience and are unrelated to adrenal insufficiency. Vaginal dryness and changes in skin texture related to declining oestrogen are also specific to the menopause transition. Joint stiffness and breast tenderness that vary with the menstrual cycle are perimenopause-associated patterns. If your symptoms track with your cycle in any way, perimenopause becomes more likely.

How Doctors Test for Each Condition

Managing Both Conditions and Tracking Your Symptoms

Addison's disease is treated with daily oral hydrocortisone to replace cortisol, plus fludrocortisone if aldosterone replacement is needed. People with the condition carry emergency hydrocortisone injections for crises. Perimenopause is managed through lifestyle measures and, for many women, HRT. The two conditions can coexist, and a woman with Addison's disease may still experience perimenopause separately. Tracking symptoms carefully over time is valuable in both cases. Recording daily energy levels, any postural dizziness, mood patterns, and menstrual cycle changes can help a doctor see patterns that single appointments often miss. Apps like PeriPlan allow you to log symptoms and track them over time, which can give you a clearer picture to share with your healthcare team.