7 Serious Conditions Misdiagnosed as Anxiety in Women Over 45—and How To Avoid Being Gaslit
Plus, the one thing to say at your next appointment that could change everything
Key Takeaways
- Many serious health conditions in women are still misdiagnosed as anxiety or 'nerves.'
- A symptom log is your most powerful tool—bring one to every single doctor's appointment.
- During perimenopause, hormonal shifts make an anxiety misdiagnosis even more likely.
You know your body better than any doctor—and a heartbreaking story from the hantavirus-stricken cruise ship MV Hondius is a powerful reminder of why that matters. When a French passenger reported that she felt unwell to health officials, she was promptly misdiagnosed with anxiety. Soon after she was in “very critical” condition.
While hantavirus remains rare, women having a serious medical condition dismissed as stress or nerves is all too common. A big reason: The research used to create diagnosis criteria has largely been done on men, “so women frequently don’t present with ‘classic’ symptoms,” explains women’s health expert and integrative gynecologist LaKeischa Webb McMillan, MD. This is an especially big concern during perimenopause and menopause, when hormonal shifts lead to increased feelings of anxiety. So when symptoms aren’t textbook and anxiety is present, it can be the easy default.
Which health problems are most commonly mistaken for anxiety, and what can you do to keep it from happening to you? Read on for everything you need to know.
Woman's World Answers
How to stop a misdiagnosis before it happens
The single most powerful thing you can do is keep a symptom log. “Document when symptoms started, what the symptoms feel like, how long they last, what may trigger them and what seems to make them better or worse,” says Dr. McMillan. “Those details can help identify patterns that may not be obvious during a short office visit.”
Also smart: Bring someone you trust to your appointment when possible—a spouse, family member or close friend who has witnessed your symptoms can offer perspective you might not think to mention.
And never stop trusting your gut. If you sense something beyond anxiety is behind your symptoms and you feel dismissed, say so directly: “Tell your provider, ‘I understand anxiety may be part of what I’m experiencing, but I would also like to rule out other possible medical causes,’” Dr. McMillan recommends.
Now let’s run through what some alternate medical causes may be.
7 conditions commonly misdiagnosed as anxiety
These aren’t the only ones, but they’re the biggies, says Dr. McMillan.
Thyroid disorders
“Thyroid hormones directly affect metabolism and the electrical activity of the heart,” Dr. McMillan notes. An overactive thyroid can cause physical symptoms that can be mistaken for anxiety—including a racing heart rate and trembling when thyroid is overactive thyroid or fatigue and brain fog when thyroid is underactive. Suspect it’s thyroid issues? Ask your doctor to run a thyroid panel.
Heart rhythm disorders
They can cause sudden palpitations, shortness of breath, chest tightness and lightheadedness that mirror a panic attack. Because episodes are sporadic and hard to capture on an ECG, women are routinely sent home with an anxiety label—and a Scandinavian Cardiovascular Journal study found women are disproportionately impacted. This is a case where a symptom log can be very helpful, says Dr. McMillan.
PCOS (now PMOS)
The hormonal disruption of polycystic ovary syndrome (recently renamed polyendocrine metabolism ovarian syndrome, or PMOS)—mood swings, fatigue, sleep disruption—overlaps heavily with anxiety disorders and general anxiety. The WHO estimates up to 70 percent of women with PMOS don’t know they have it, and the largest study of PMOS diagnosis experiences found many women faced significant delays in getting a correct diagnosis. You may need to say “I’d like to rule out PCOS before we move forward with an anxiety diagnosis.”
Anemia
“Anemia can cause the heart to work harder to deliver oxygen throughout the body” producing palpitations, jitteriness and fatigue that feel like symptoms of anxiety, Dr. McMillan explains. A 2019 survey of more than 1,000 women found 35 percent received an incorrect initial diagnosis—most often depression, burnout or anxiety—before iron deficiency was identified. You can ask for bloodwork that includes an iron test.
Vitamin B12 deficiency
Low B12 disrupts the nervous system, causing tingling, brain fog and mood instability. A British survey of people with anemia found anxiety and depression were among the most common misdiagnoses given before the true cause was found. A blood panel with B12 levels can rule this out.
Multiple sclerosis (MS)
MS often begins with vague, episodic symptoms—numbness, fatigue, dizziness—that are easy to attribute to stress. A 2025 PMC review found women consistently face longer diagnostic intervals for MS diagnosis than men, with symptoms frequently attributed to mood and anxiety disorders. If you suspect something serious is wrong, you can ask your healthcare provider to rule MS out.
Sleep apnea
Women with sleep apnea often present with insomnia, irritability and fatigue rather than obvious snoring, and those subtler symptoms are routinely mistaken for anxiety. If you find yourself dozing off during the day, mention this possibility to your doctor.
What to do if you suspect you’ve been misdiagnosed with anxiety
A second opinion is not a betrayal of your doctor—it is your right, and it could be the decision that changes everything. Not sure where to turn? “Referrals can be one of the best resources when looking for a second opinion,” says Dr. McMillan. “Ask trusted friends, family members or other healthcare professionals whether they have a doctor they feel truly listens to them and takes their concerns seriously.”
When you meet with a new provider, bring your symptom log, your timeline, previous lab work and any notes you have kept. Dr. McMillan also offers this reassurance: You don’t need to speak negatively about your previous doctor to advocate for yourself. “You can simply say, ‘I still feel there may be more to investigate, and I was referred to you to help me continue looking into these symptoms,'” she shares. “That approach keeps the conversation focused on collaboration, curiosity, and finding answers.” To learn more from Dr. McMillan, visit TalkHormones.com.
The bottom line on health problems mistaken for anxiety
Remember: Your instincts about your body are powerful and valid. By staying informed, keeping detailed records and speaking up for yourself, you’re not just a patient—you’re a partner in your own healthcare. And that partnership can make all the difference in getting the answers and care you deserve.
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