Perimenopause vs Ehlers-Danlos Syndrome: Shared Symptoms Explained
Joint pain, fatigue, and brain fog appear in both perimenopause and Ehlers-Danlos syndrome. Learn what separates the two and how to get answers.
A Confusing Symptom Picture for Many Women
Ehlers-Danlos syndrome (EDS) is a group of heritable connective tissue disorders that affect collagen structure throughout the body. Because collagen is present in joints, skin, blood vessels, and organs, EDS produces a wide range of symptoms that can look very similar to perimenopause, especially in women who reach their 40s without a prior diagnosis. The hormonal shifts of perimenopause can also cause connective tissue changes, because estrogen plays a significant role in collagen production and maintenance. Understanding where the two conditions diverge, and where they interact, can help women advocate more effectively for appropriate investigation.
What Ehlers-Danlos Syndrome Involves
There are thirteen recognised subtypes of EDS. Hypermobile EDS (hEDS) is by far the most common and is the type most frequently discussed alongside perimenopause. Its features include joint hypermobility, joint pain and instability, frequent sprains and subluxations, soft or stretchy skin, fatigue, and autonomic nervous system dysfunction. Because hEDS currently has no confirmed genetic test, diagnosis is made on clinical criteria including a positive Beighton score for hypermobility and a detailed symptom history. Many women with hEDS are not diagnosed until their 30s or 40s, precisely the years when perimenopause also begins.
Symptoms That Appear in Both Conditions
Joint pain is highly prevalent in both. During perimenopause, declining estrogen reduces the natural cushioning and lubrication of joints, leading to aching, stiffness, and inflammation. In hEDS, joint pain arises from instability and impaired collagen structure. Fatigue is significant in both conditions, though its character differs. Brain fog and difficulty concentrating are common to each. Headaches, particularly tension-type and those related to neck instability, appear in EDS and are also frequently reported in perimenopause. Gut issues including bloating and slow digestion occur in both. Skin changes, including dryness and reduced elasticity, are features of each.
Symptoms That Point More Strongly to EDS
Joint hypermobility, specifically the ability to bend joints well beyond their normal range, is the most distinctive EDS feature. If you can bend your thumbs back to touch your forearms, hyperextend your knees or elbows, or place your palms flat on the floor with legs straight, this points toward a hypermobility condition rather than perimenopause. Frequent dislocations or partial dislocations (subluxations) without significant trauma are another strong indicator. Skin that is unusually soft, velvety, or stretchy, or that bruises or scars unusually easily, is a connective tissue sign that does not arise from hormonal change alone.
Symptoms That Point More Strongly to Perimenopause
Hot flashes, night sweats, and changes to the menstrual cycle are specific to the hormonal transition of perimenopause and do not arise from EDS. Vaginal dryness and changes in libido driven by declining estrogen are perimenopause-specific. Mood changes that track with the menstrual cycle, including premenstrual anxiety or low mood that is more intense than in previous years, point toward hormonal fluctuation. A gradual shortening or lengthening of the cycle over several years is a clear perimenopause indicator. These reproductive and temperature regulation features are not features of connective tissue disorders.
How Declining Estrogen Affects EDS Symptoms
Estrogen supports collagen synthesis and helps maintain the integrity of connective tissue throughout the body. When estrogen declines during perimenopause, women with pre-existing EDS often report a significant worsening of their symptoms. Joints that were previously manageable may become more unstable. Fatigue may intensify. Autonomic symptoms, including the heart rate and blood pressure irregularities that frequently accompany hEDS, may worsen. This means that for women with EDS, perimenopause can represent a substantial step-change in how their condition affects daily life, and both issues may need to be addressed simultaneously.
Getting the Right Support
If you suspect EDS alongside perimenopause, asking your GP for a referral to a rheumatologist or a specialist hypermobility clinic is a useful starting point. Self-assessment using the Beighton score is freely available and gives you something concrete to bring to your appointment. For perimenopause, tracking your symptoms in relation to your menstrual cycle over two to three months provides the clearest picture. PeriPlan lets you log symptoms and monitor patterns over time, which can make it much easier to see whether your joint pain or fatigue spikes at particular points in your cycle or follows no hormonal pattern at all. Both conditions are manageable with the right team, but getting to the right team requires a clear symptom history.
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