Rage, fatigue, brain fog, night sweats, memory loss, hair thinning, sore joints, low libido, hot flashes, itchy ears, weight gain, anxiety, incontinence — these may sound like a catalog of unrelated ailments, but they’re all potential signs of perimenopause.
As more Gen X and millennial women reach their 40s and early 50s, they’re challenging outdated attitudes about menopause and the years leading up to it. Perimenopause, a transitional phase marked by fluctuating hormones, is entering the spotlight as more women push for answers — and treatment. Social media has amplified the conversation, with influencers marketing supplements and lifestyle changes. But distinguishing symptoms from normal midlife stress, or even other health issues, is not easy.
Unlike menopause, which begins when menstrual periods stop for 12 months, perimenopause can start years earlier and be harder to diagnose. Many women, and even doctors, mistake it for burnout or mental health issues. Michelle Rockwell, a 40-year-old forensic scientist and athlete, was told she was “too young” for menopause when she sought help for severe sleep disruption. After visiting multiple providers, she found a specialist trained in menopause care who helped her fine-tune hormone therapy. “I feel more like myself now than I have in years,” she says.
Hormonal shifts during this phase aren’t always due to estrogen deficiency, says Dr. Monica Christmas of the Menopause Society. Instead, it’s the erratic surges and dips that wreak havoc — triggering everything from mood swings to memory lapses. The good news? For many, symptoms improve after entering menopause, once hormones stabilize.
However, midlife is also a time of other changes — aging, career stress, family responsibilities — making it harder to pinpoint perimenopause as the root of discomfort. Some patients say simply validating the experience helps. “Just knowing it’s not all in my head — that’s been huge,” one woman told Christmas.
Doctors often begin by ruling out other conditions. Autoimmune diseases, early-onset diabetes, thyroid disorders, hypertension and even fibromyalgia often emerge in one’s 40s and can mimic perimenopausal symptoms. “I do a thorough check before assuming hormones are to blame,” says gynecologist Dr. Nanette Santoro. She also notes that standard hormone tests can be unreliable unless timed precisely in the cycle — and still might not offer clarity.
Treatment varies. Hormone therapy, once controversial, has gained renewed attention. Though a 2002 study raised concerns about cancer and stroke risks, newer research suggests those fears may have been overstated. Today’s hormone therapies are safer and more individualized, but not risk-free. Family history and personal health factors must be considered, and some patients experience unpleasant side effects like bloating or breast tenderness.
Not all patients choose hormones. Rockwell’s treatment journey was highly personalized, and specialists increasingly offer alternatives, from antidepressants to IUDs for controlling heavy bleeding. “We have more tools now than ever,” says Christmas.
Early perimenopause, particularly before age 40, may benefit most from hormone therapy. Krista Russell-Adams, who entered this phase at 37, experienced a wide range of symptoms including anxiety and itchy ears. Hormone treatment, she says, made a dramatic difference.
Regardless of treatment, lifestyle changes remain critical. “Some symptoms are simply about getting older,” says Santoro. Around 45 and 60, both men and women experience metabolic shifts. “It’s not all hormones,” she says. That’s why exercise — especially strength training — healthy eating and quality sleep matter more than ever.
“You can’t just rely on medications,” says Christmas. “What we eat, how we move, how we rest — it all matters. We don’t get a second body.”
As more women speak out, the medical community is being pushed to take perimenopause seriously. And for those navigating the rollercoaster of midlife, awareness, advocacy and the right support can help bring back a sense of control — and well-being.
