Is It Parkinson's or Menopause?

When people ask Posy to define her main symptom of Parkinson’s disease (PD), she declares, without hesitating, "Extreme fatigue." (Oh, hang on ... all her female friends claim to be permanently exhausted.)

Posy goes on to explain that she can manage only a couple of events in a week without needing extra "duvet time." (They say they feel the same way.) Posy describes how the reliance on a regime of pills shortens her day. (Her friends insist they can no longer burn the candle at both ends either.)

Maybe it's just the menopause?

People persist: "But you look so well."  Posy: "Haha! It‘s an effort!"

"And you seem fine!" Posy: "I have to pace myself, or I will spend tomorrow in bed." Posy’s words fall on deaf ears. Posy’s friends are mostly ladies "of a certain age." They readily describe their own health issues:

• "I am so tired."
• "I’m constantly exhausted and overwhelmed"
• "I’m anxious, depressed, angry and irritable."
• "I’m losing my memory."
• "I have terrible mood swings."
• "I am being treated for yet another UTI."
• "My joints are painful."
• "My muscles ache."
• "I get palpitations."
• "I seem to have adult acne, yet my skin is all itchy and dry."
• "My headaches are getting worse."
• "I’m all shaky."
• "I have dreadful hot flashes."
• "I’m tired ALL THE TIME!"
• "I’m EXHAUSTED!"

Overlapping symptoms

These complaints are not exclusive to estrogen-depleted, middle-aged females. Many of you, of whatever age or gender, may identify with some of them. Even elderly gentlemen can suffer from frequent UTIs! Everyone claims to be tired!

Posy is not suggesting any particular correlation between the menopause and Parkinson’s. However, as some parallels exist between the factors identifying them, just imagine the complexity involved in differentiating between Parkinson’s and other neurological and aging conditions.

Diagnosed incorrectly with early menopause

Posy had always felt the cold. Maybe she had poor circulation? Maybe she didn’t have enough fat on her frame? (Oh! The complacency of youth!)

One day, she had an uncharacteristic and rather startling hot flush. And then another. And another. These unpleasant events, compounded with the onset of panic attacks, sent Posy to her doctor. She was declared "far too young" to be menopausal.

A few days later, the doctor contacted her to say that the blood test results (taken, really, as back-up) had shocked him: "Your estrogen levels are very low and your follicle-stimulating hormone levels are high. I’m so sorry. You have gone into early menopause." he concluded.

The difficulties of an accurate diagnosis

Cut to 2017, Posy experienced déjà vu as her doctor happily dismissed her slightly shaky left hand. Maybe she had not had the opportunity to read Posy’s medical records and therefore did not recognize the possible signs of PD. (Posy hopes that the doctors of today can access an app that cross references symptoms in situations such as this?) She wrote:

"I reassured this young lady that she definitely does NOT have Parkinson’s disease." A second wrote: "Posy does not present as a person with Parkinson’s."

No conclusive test

Posy undertook physical examinations on 3 separate occasions before Parkinson’s was considered a possibility. Even then, it was not straightforward. Finally, a neurologist referred her for a DatScan. This revealed extremely low levels of dopamine. "You have got Parkinson’s," he concluded.

Blood tests picked up low-ish levels of iron and some inflammation, but blood tests cannot detect Parkinson’s. The DatScan measures dopamine levels in each side of the brain, and Posy’s were very low, but even DatScans are not heralded as definitive.

Hoping it was a mistake

Posy has always secretly hoped that the diagnosis of Parkinson’s was a mistake. Of course, Posy’s sweet friends reinforce this hope by laying claim to similar symptoms. They thereby reassure Posy that she is not as feeble as she thinks. It always works! Posy is instantly cheered. For a joyous few moments, Posy daydreams that she, too, is "just" middle-aged and menopausal. Parkinson’s was obviously a misdiagnosis!

A year after her diagnosis, Posy had enriched her brain with research into her condition. Brimming with hope, armed with this new-found knowledge, and buoyed up by conversations with friends, Posy tentatively questioned her PD nurse about the possibility of not having Parkinson’s. She was advised that the golden test is, if levodopa dramatically improves your symptoms, you obviously do need dopamine.

Welcome to the club

If making a diagnosis of Parkinson’s can elude our physicians, it is inevitably going to confuse a layman. Even with a doctor’s diagnosis, it can be difficult to convince others, especially if they see us only when we are "on," that we have a debilitating disease. ... And sometimes, it is hard to believe it ourselves!