Lyme Disease in Women: Why Symptoms are Often Overlooked and Misdiagnosed
You’ve been told 'everything looks normal’ but you still have substantial symptoms and don’t feel like yourself. There may be more going on beneath the surface.
By: Dr Cynthia Hall, ND
4 min read
Quick Answer
Lyme disease is a bacterial infection most commonly caused by Borrelia burgdorferi and transmitted through the bite of an infected tick. While many people recover with early diagnosis and treatment, Lyme disease can sometimes be difficult to recognize because its symptoms overlap with many other health conditions. Persistent fatigue, brain fog, joint pain, headaches, hormone-related symptoms, and cognitive changes may have many possible causes, and Lyme disease is one condition that healthcare providers may consider based on a person's history, symptoms, and risk factors.
Key Takeaways
Lyme disease symptoms can overlap with many other medical conditions.
Not everyone with Lyme disease develops the classic bull's-eye rash.
Fatigue, brain fog, joint pain, headaches, and cognitive symptoms are commonly reported.
Tick-borne infections such as Babesia and Bartonella may occur alongside Lyme disease.
A thorough history, physical examination, and appropriate testing help determine whether Lyme disease should be considered.
What Is Lyme Disease?
Lyme disease is an infection caused primarily by the bacterium Borrelia burgdorferi, which is transmitted through the bite of infected black-legged ticks.
When diagnosed early, Lyme disease is often successfully treated with antibiotics.
However, if diagnosis is delayed, symptoms may become more widespread and can involve multiple body systems.
Why Can Lyme Disease Be Difficult to Recognize?
One of the challenges with Lyme disease is that there is no single symptom unique to Lyme disease.
Instead, many symptoms overlap with other common conditions.
Someone experiencing Lyme disease may also be evaluated for:
Thyroid disorders
Chronic fatigue syndrome
Fibromyalgia
Autoimmune diseases
Hormonal changes
Perimenopause
Anxiety or depression
Sleep disorders
Because these conditions share many symptoms, determining the underlying cause often requires a careful review of a person's medical history, symptoms, and potential tick exposure.
Does Everyone Get the Bull's-Eye Rash?
No.
One of the biggest misconceptions about Lyme disease is that everyone develops the classic bull's-eye rash.
In reality, while erythema migrans is the most common early sign of Lyme disease, it does not always have the classic target or bull's-eye appearance. Many rashes are simply uniformly red without central clearing, and some people never notice a rash or a tick bite at all. Because of this, the absence of a classic bull's-eye rash does not rule out Lyme disease, and healthcare providers consider your symptoms, medical history, potential tick exposure, physical examination, and appropriate testing together when making a diagnosis.
Can Lyme Disease Testing Miss Some Cases?
Laboratory testing is one important part of diagnosing Lyme disease, but testing also has limitations.
Conventional testing primarily measures your body's immune response rather than detecting the bacteria directly.
Depending on the stage of infection, timing of testing, and other clinical factors, false-negative results may occur.
Healthcare providers consider laboratory results together with a patient's symptoms, history, physical examination, and possible exposure to ticks when determining whether Lyme disease should be considered.
Common Lyme Disease Symptoms in Women
Symptoms vary from person to person and may change over time.
Physical Symptoms
Persistent fatigue
Joint pain
Muscle aches
Headaches
Neck pain
Sensitivity to light or sound
Cognitive Symptoms
Brain fog
Difficulty concentrating
Memory concerns
Poor sleep
Feeling mentally "slowed down"
Hormone-Related Symptoms
Some women report:
Changes in menstrual cycles
Worsening PMS
Mood changes
Thyroid dysfunction
Difficulty conceiving
These symptoms are not specific to Lyme disease and have many possible causes. However, Lyme disease may be considered as one potential contributor in the appropriate clinical context.
If you would like to learn more,
Check out my other related articles:
What is a Normal Period?
How Inflammation Directly Impacts Your Hormones
Why am I Not Getting Pregnant?
When Should Lyme Disease Be Considered?
Lyme disease may be worth discussing with your healthcare provider if you:
Continue experiencing symptoms despite previous evaluation
Have persistent fatigue or brain fog without a clear explanation
Spend time outdoors in areas where ticks are common
Recall a tick bite or unexplained rash
Notice symptoms that seem to come and go
Have multiple unexplained symptoms affecting different body systems
Many different conditions can produce these symptoms, so a comprehensive medical evaluation is important.
A Root-Cause Approach to Persistent Symptoms
When symptoms remain unexplained, a comprehensive evaluation may include:
A detailed medical history
Review of previous laboratory testing
Assessment of hormone health
Thyroid evaluation
Nutritional assessment
Evaluation of inflammatory patterns
Appropriate testing when clinically indicated
The goal is not simply to manage symptoms but to better understand the factors that may be contributing to how you feel.
Clinical Perspective
One of the most common things I hear from patients is:
"I've been told all my lab work is normal, but I still don't feel like myself."
or more commonly,
“My symptoms have been dismissed by every doctor I have seen so far.”
Persistent symptoms deserve thoughtful evaluation.
While Lyme disease is not the explanation for every case of fatigue, brain fog, or chronic pain, it can be one possibility that deserves consideration when symptoms, medical history, and exposure risk suggest it may be relevant.
Looking at the whole clinical picture—not just individual symptoms or laboratory results—often provides the most meaningful insights.
Frequently Asked Questions
Can Lyme disease cause brain fog?
Yes. Cognitive symptoms such as brain fog, memory difficulties, and trouble concentrating are commonly reported by people with Lyme disease, although these symptoms can also occur with many other medical conditions.
Can Lyme disease affect hormones?
Lyme disease does not directly cause hormone disorders, but chronic illness and inflammation may influence how people experience hormone-related symptoms. Hormonal changes should always be evaluated comprehensively.
Can Lyme disease be mistaken for another condition?
Yes. Lyme disease shares symptoms with thyroid disorders, autoimmune diseases, fibromyalgia, chronic fatigue syndrome, and other conditions, which can sometimes make diagnosis challenging.
I have seen many cases where patients have two underlying conditions, Lyme disease and something else.
Can you have Lyme disease without a bull's-eye rash?
Yes. Not everyone develops or notices the characteristic erythema migrans rash.
Can Lyme disease testing be negative even if someone has Lyme disease?
Laboratory testing has limitations, particularly early in infection. Healthcare providers interpret test results alongside symptoms, medical history, and exposure risk.
The Bottom Line
Lyme disease can present differently from one person to another, and many of its symptoms overlap with other medical conditions.
If you've been experiencing persistent fatigue, brain fog, joint pain, or other unexplained symptoms, it's important to work with a healthcare provider who will take a thorough history, consider a broad range of possible causes, and develop an individualized evaluation plan.
A comprehensive approach can help identify potential contributors to your symptoms and guide the next steps in your care.
Comprehensive Lyme disease consultations are available via telehealth throughout California and New Hampshire.
Join Dr. Hall's appointment waitlist to be the first to know when she begins accepting new patients in Fall 2026.
References
Centers for Disease Control and Prevention (CDC). Lyme Disease: Signs and Symptoms, Diagnosis and Testing.
Lantos PM, Rumbaugh J, Bockenstedt LK, et al. Clinical Practice Guidelines by the Infectious Diseases Society of America (IDSA), American Academy of Neurology (AAN), and American College of Rheumatology (ACR): 2020 Guidelines for the Prevention, Diagnosis and Treatment of Lyme Disease. Clinical Infectious Diseases. 2021. PMID: 33417672
Skar GL, Blum MA, Simonsen KA. Lyme Disease. StatPearls Publishing. Updated 2024. NCBI Bookshelf: NBK431066.
Edlow JA. Erythema migrans. Medical Clinics of North America. 2002;86(2):239–260. PMID: 11982300