Hi Friends,
I was in my mid-40s when it started. Not with hot flashes or any of the things I’d vaguely filed under “menopause stuff.” It started with anxiety…. out of nowhere, no real trigger, just this low hum of dread that would show up uninvited. And then some depression. Not crashing, not crisis-level, just a grey flatness that hadn’t been there before.
I thought maybe it was delayed grief. I’d been through a lot. That made sense, didn’t it? So I sat with it, worked through it, waited for it to lift. And parts of it did…. and then came back. And I’d cycle through feeling okay and then not okay, and nobody around me seemed particularly alarmed, and I started to wonder if maybe this was just who I was now.
What nobody said to me once…. not a friend, not a doctor, not a single person…. was: this could be perimenopause.
It took me longer than it should have to get there. I don’t want that for you.
WHY IT GETS MISSED
Here’s what I’ve since learned, and what I wish someone had told me earlier. Perimenopause isn’t a slow steady estrogen decline. It’s a volatile fluctuation…. levels swinging dramatically day to day, sometimes hour to hour. That instability is what drives most of the symptoms that feel hardest to explain. The mood piece, the sleep piece, the anxiety and the fog…. all of it connects back to the same hormonal chaos.
Estrogen and progesterone don’t just regulate your cycle. They have real effects on serotonin, dopamine, and your stress response. When they destabilize, so does everything else. The result looks clinically identical to depression and anxiety, which is exactly what most women get treated for instead. Not wrong exactly…. but incomplete.
The number that stopped me: the average woman spends 7 to 10 years in perimenopause. Most of them are treated for the symptoms without anyone naming the cause.
THE FULL PICTURE
The symptoms that tend to blindside women…. the ones beyond hot flashes and irregular periods:
- Waking at 3am, wired and anxious
- Brain fog, word loss, memory gaps
- Rage that appears without warning
- Joint and muscle pain
- Heart palpitations at rest
- A low, persistent sense of dread
- Crying at things that wouldn’t have touched you
- Feeling invisible in rooms you used to own
- Zero tolerance for what you used to manage fine
- Libido changes…. up, down, or gone
- Skin, hair, and nail changes
- Feeling like a stranger in your own life
That last one isn’t a metaphor. The identity disruption of this transition is real and almost never talked about. You’re not having a midlife crisis. You are navigating a neurological and hormonal shift that affects how you process emotion, memory, and meaning. That deserves more than a shrug and an antidepressant prescription.
WHAT I WISH I’D KNOWN TO ASK FOR
Track everything. Mood, sleep, energy, symptoms, cycle if you still have one. Patterns over weeks tell a story that a single appointment can’t. Bring that record with you and don’t let it be dismissed.
On treatment…. HRT has been unfairly maligned since a flawed 2002 study spooked a whole generation of doctors and patients. The research has been substantially revised since. For most women in perimenopause and early menopause, hormone therapy is safe, effective, and for many genuinely life-changing. It’s not the only path. But it’s a legitimate one, and you deserve that conversation with someone who actually has current knowledge.
Worth asking directly: “Do you have experience specifically treating perimenopause and menopause?” Not all GPs do, and that’s okay…. but the answer tells you whether you need someone else.
Grief and burnout and perimenopause can all be happening at the same time…. and often are. The point isn’t to pick one explanation. It’s to make sure the biological piece gets seen and named, so you can deal with everything else from solid ground.
You’re not imagining it. You’re not falling apart. You’re just not getting the full picture yet…. and that’s what we’re here for.
This Thursday: what the revised HRT research actually says, and how to have the conversation if you’ve been dismissed before.
Until then….
xo, Michelle ♥
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