Perimenopause, the transition phase before menopause, is one of the most under-recognized and misdiagnosed stages in a woman’s life. It can begin as early as a woman’s late 30s to early 40s and span up to a decade, yet many women and even their healthcare providers don’t recognize it until symptoms become debilitating or periods cease entirely.
This lack of awareness contributes to unnecessary suffering, misdiagnosis with psychiatric or autoimmune conditions, overmedication, and a profound sense of invisibility. It’s time to bring perimenopause into the spotlight.
What is Perimenopause?
Perimenopause is the transitional phase before menopause, during which the ovaries gradually begin to produce less estrogen, progesterone, and other key hormones. Menopause is defined as going 12 consecutive months without a menstrual period. But the years leading up to that milestone are biologically active and turbulent—and that’s perimenopause.
Why is Perimenopause So Often Missed?
1. Symptoms Are Often Misattributed
Perimenopause symptoms can mimic or overlap with other conditions, especially mental health disorders. Common symptoms include:
New-onset anxiety or depression
Sleep disturbances
Brain fog and memory issues
Mood swings or irritability
Fatigue
Weight gain and changes in body composition
Hair thinning or loss
Irregular or heavy periods
Increased sensitivity to stress
Too often, women are prescribed antidepressants or sleep aids without a single question about their menstrual history or hormonal fluctuations.
2. Outdated Medical Training
Many medical providers are not trained to recognize or treat perimenopause. The curriculum in medical and nursing schools has traditionally underemphasized women’s midlife hormonal health, and hormone therapy was demonized for years due to misinterpretations of the Women’s Health Initiative (WHI) study published in 2002. As a result, generations of clinicians learned to avoid hormone replacement therapy (HRT) altogether—leaving patients untreated.
3. Hormonal Testing is Often Misleading
Hormonal labs during perimenopause can be unreliable due to the dynamic fluctuations that occur daily or even hourly. A normal lab result doesn’t mean hormones are balanced—it means they were within range at that moment in time. Diagnosis should be based on symptoms and menstrual pattern, not just labs.
4. Cultural Silence and Shame
Many women don’t talk about what they’re experiencing. Some blame themselves, think they’re “just getting older,” or worry that speaking up might make them seem unstable, especially in professional or caregiving roles.
What Should We Be Doing Instead?
🔹 Listen to Women’s Stories
The most accurate diagnostic tool we have is still a thorough, empathetic history. When a woman in her 40s presents with new anxiety, depression, or fatigue—especially if she has a history of PMS, PMDD, or hormonal sensitivity—we must consider perimenopause.
🔹 Educate and Empower
Perimenopause is a biological transition, not a disease—but it can disrupt every aspect of a woman’s life. Education allows women to make informed choices about treatment options including lifestyle changes, supplements, and bioidentical or FDA-approved hormone therapy.
🔹 Normalize Hormone-Informed Mental Health
Many mental health symptoms in midlife women are hormone-related. It’s not “all in your head.” Hormones influence neurotransmitters, sleep architecture, stress regulation, and emotional resilience. Hormone-informed psychiatry can be life-changing.
The Cost of Missing Perimenopause
When we miss this diagnosis, women lose trust in their bodies—and often in their providers. They may leave with prescriptions but no answers, or be told “everything looks fine” while feeling like they’re falling apart.
Untreated perimenopause can lead to long-term consequences including:
Burnout
Relationship strain
Career disruption
Cardiometabolic risks
Osteoporosis
Worsened mental health
A Call to Action
It’s time to reframe how we view midlife in women—not as a decline, but as a portal. With proper support, this stage can be one of transformation, power, and healing.
We must stop gaslighting women by ignoring their hormonal realities. Instead, let’s validate their experience, offer real solutions, and empower them to reclaim their health.
Perimenopause isn’t rare. Missing it shouldn’t be either.
If you’re in your late 30s to 50s and feel like something is “off,” trust yourself. You deserve providers who see you, hear you, and understand what you’re going through.