Your Doctor Calls It Anxiety. Your Body Calls It Perimenopause.

You are Googling things at 2 a.m. that you'd be embarrassed to say out loud: Why is my heart racing for no reason? Why do I feel rage at a cereal box? Why do I suddenly hate everyone I love? Am I going crazy or is something actually wrong with me? You've closed seventeen tabs without answers. You've taken the anxiety quiz three times and gotten three different results. You've started sentences and forgotten what you were trying to say mid-thought, like someone pulled the plug on your brain.

And then there's the other thing. The thing you can't quite name. The way you wake up at 3 a.m. soaked through the sheets and convinced something terrible is about to happen. Or the way your whole body feels like it belongs to someone slightly angrier, slightly more exhausted, and considerably less patient than you used to be.

You mentioned it to your doctor. You got fifteen minutes and a prescription.

Maybe the prescription was for antidepressants. Maybe you were given a pamphlet about yoga. Maybe it was the look, the one that says great, another whining woman overreacting about nothing while your hormones never enter the conversation. Welcome to medicine's longest-running gaslighting campaign, where a woman's body in transition gets relabeled as a woman's emotions out of control.[1]

And to add guilt frosting on your already unbearable anxiety cake, your spouse wants to know “where the woman he married” went, because that version of her didn't snap at him for chewing and breathing too loudly and she still enjoyed sex (or was better able to pretend to). She also didn't cry in the car over a song from her 20’s when life was easier and she still liked herself.

I understand the guilt you secretly carry: the guilt of being different and misunderstood while also being too much and somehow not enough at the same time.

Here's what I want you to know before we go any further: you are not going crazy. Your body is not broken. Your patience is not the problem, your inability to function like you did at 35 is not a character flaw. It is biology, babe. Specifically, it is perimenopause, and it started years before you recognized the symptoms.

What Is Perimenopause?

Perimenopause is the hormonal transition before menopause and it can start anywhere from your late 30s to your mid-40s, sometimes earlier.[2] It is not a single event. It is not hot flashes and done. It is a 7-10 years-long hormonal shift, during which estrogen and progesterone levels (and testosterone to a lesser extent) stop behaving predictably and start doing whatever the hell they want; spiking, crashing, going erratic in ways that affect virtually every system in your body.[3]

Your brain runs on estrogen [4] and when estrogen tanks? So long memory, and hello brain fog and forgetfulness. Your sleep is powered by progesterone and when that tanks, well, you know where this is going.[5] Your mood, your memory, your ability to regulate body temperature, your heart rate, your joints, your gut health— all of it is in conversation with your hormones (including those from your thyroid—a topic of its own). So when those hormones go whacko, your whole system goes whacko with them. What you experience is not anxiety, not depression and not stress (although stress plays an indirect part). That is your endocrine system doing something real and measurable that your doctor may have completely failed to investigate.[6] Why? Medical schools don’t teach hormone transitions beyond post partum, but thankfully, that has started to change. Slowly.

The clinical definition, if you want it: perimenopause begins when the ovaries start producing less estrogen and ends twelve months after your last menstrual period — at which point you are technically in menopause.[2] To make it more confusing, menopause is a one-day event: the day after 12 months without a period. The day after that? Post-menopause for the rest of your life.

But the transition itself? That's where most women are quietly suffering. Irregular cycles. Sleep disruption. Brain fog thick enough to cut with a knife. Heart palpitations. [7] Mood swings, weight gain, hair loss, new food intolerances, joint pain, anxiety, rage and sadness with no obvious source. Currently, there are over 30 perimenopause symptoms and counting.

No wonder you feel crazy.

These are not separate, mysterious, unrelated symptoms. They are one coherent story your body is telling. The problem is that most doctors were never trained to hear it [1] and instead, treat each symptom individually to the point you might me on several medications with a host of new side effects and still no relief.

Couldn’t doctors just check your labs for menopause? Sadly, no. There are no widely standardized lab tests to diagnose perimenopause (at the time of this writing 4/26)— FSH (Follicular Stimulating Hormone) levels fluctuate too much to be definitive, so diagnosis is largely clinical, meaning it should be based on your symptoms as well as your age.[8] While there are over-the-counter menopause tests, they only confirm your FSH levels are fluctuating, not the degree to which you are in perimenopause, if at all (there could be another underlying cause). This means a doctor who dismisses your symptoms without asking about your cycle, your sleep, your brain fog, your mood history, and your age is not giving you adequate care. They are giving you a prescription and shooing you out the door.

Your symptoms are not imaginary! Your body has been trying to tell you something for years. You just weren't given the vocabulary to understand it — or the medical appointment long enough to say it out loud.

That ends here.

What To Do Next

First, stop apologizing for how you feel because it’s not within your control.

Next, stop explaining your exhaustion like it's a personality flaw. Stop shrinking the conversation to whatever fits inside a fifteen-minute appointment. Stop accepting "your labs are normal” and “you need to drink more water” as a diagnosis when you feel anything but normal.

Then hop over to this article, Why The Medical Gaslighting of Women Over 40 Starts Way Before Menopause.

Normal labs don't cancel out real symptoms. And a doctor who tells you otherwise is working from an outdated script.

Here's what actually moves the needle:

• Find a menopause-literate provider. This is not a small ask, and I won't pretend it is. The Menopause Society maintains a directory of certified menopause practitioners at menopause.org. Start there. Your current doctor may be excellent at other things and genuinely under-trained on this one — that's not a conspiracy, it's a curriculum gap.[9] It does, however, mean you may need to find another doctor for this.

• Track your symptoms before you go. Not because you need to prove anything, but because "I feel terrible" is easy to dismiss and "I have been waking between 2 and 4 a.m. four nights a week, my cycles gone from 28 days to 36 days”, and “I have had heart palpitations at rest for the past three months" is considerably harder to wave away. The more specific you are, the harder you are to gaslight.

• Know that treatment exists. Hormone therapy has been through decades of fear-mongering that the research has largely walked back except when there are legitimate risks involved.[10] There are non-hormonal options too. Just know there is no single right answer because perimenopause is not one-size-fits-all but there are answers, and you are allowed to know what they are. You do not have to white-knuckle your way through a decade of this.

• Stop waiting to feel like yourself again. She's not gone, she's in transition. What comes out the other side of this — when you have the right support, the right information, and the permission to stop pretending you’re fine, is a stronger, wiser version of who you were.

And I should know, I found my fierce at age 60 (after years of suffering needlessly) and you’re reading this blog as a result of my journey through midlife (and beyond).

If something in you refused to accept that your symptoms are just anxiety, just stress, just aging, just life, I’m proud of you for sticking with your search for answers. Welcome to Finding My Fierce.

If this article spoke to you or answered questions you don’t have answers to, leave me a comment below, I respond to every comment. You might inspire other women who are struggling with their identity.

Melissa

Sources

1. Maki PM, et al. "Guidelines for the Evaluation and Treatment of Perimenopausal Depression." Menopause.2018;25(10):1069–1085.

2. The Menopause Society (formerly NAMS). Menopause Practice: A Clinician's Guide. 6th ed. 2022.

3. Santoro N, et al. "Menopausal Symptoms and Their Management." Endocrinology and Metabolism Clinics of North America. 2015;44(3):497–515.

4. McEwen BS, Alves SE. "Estrogen Actions in the Central Nervous System." Endocrine Reviews. 1999;20(3):279–307.

5. Schüssler P, et al. "Progesterone Reduces Wakefulness in Sleep EEG and Has No Effect on Cognition in Healthy Postmenopausal Women." Psychoneuroendocrinology. 2008;33(8):1124–1131.

6. Shifren JL, Gass ML. "The NAMS Recommendations for Clinical Care of Midlife Women." Menopause.2014;21(10):1038–1062.

7. Avis NE, et al. "Duration of Menopausal Vasomotor Symptoms Over the Menopause Transition." JAMA Internal Medicine. 2015;175(4):531–539.

8. Harlow SD, et al. "Executive Summary of the Stages of Reproductive Aging Workshop." Menopause.2012;19(4):387–395.

9. Kaunitz AM, Manson JE. "Management of Menopausal Symptoms." Obstetrics and Gynecology. 2015;126(4):859–876.

10. The Menopause Society. "2022 Hormone Therapy Position Statement." Menopause. 2022;29(7):767–794.