Perimenopause — The Life Stage No One Warned Us About (And Why Doctors Keep Missing It)

Understanding Your Conditions
Written By Totally Fine Co

Nobody sat us down and explained what perimenopause (the transitional phase leading up to menopause — typically starting anywhere from your late 30s to mid-40s, sometimes earlier) actually looks, feels, and sounds like. Most of us were told about menopause (when periods stop entirely) as some distant future event. We were not told that the years leading up to it could involve anxiety that appears from nowhere, sleep that falls apart, brain fog (difficulty concentrating or remembering things) so thick you can't finish a sentence, rage that doesn't match the situation, or periods that are suddenly heavier, lighter, or completely unpredictable.

And when we took those symptoms to our doctors? Many of us were told we were "too young," "too stressed," or given antidepressants (medication for low mood) before anyone mentioned hormones.

What is perimenopause, really?

Perimenopause is the hormonal transition your body undergoes before your final period. During this time, levels of oestrogen (a key female hormone) fluctuate (rise and fall unpredictably) rather than declining smoothly. It's those fluctuations — not the eventual decline — that cause most of the symptoms. Perimenopause typically lasts four years on average, but can last up to ten years for some women (Joinmidi, 2024).

Symptoms can include — but are not limited to — the following:

  • Hot flushes and night sweats (vasomotor symptoms — relating to blood vessels expanding and contracting)

  • Disrupted sleep

  • Mood changes, including low mood, anxiety, and irritability

  • Brain fog — difficulty with memory, concentration, and word-finding

  • Fatigue

  • Joint pain

  • Changes in libido (sex drive)

  • Irregular or heavier periods

  • Vaginal dryness or discomfort

  • Heart palpitations (feeling your heart beating faster or irregularly)

  • Skin and hair changes

The critical thing to understand is that not all women will experience hot flushes. For some, the most prominent symptoms are psychological — mood, cognition (thinking), and energy. This means that perimenopause is frequently missed, and women are often treated for depression or anxiety separately when the underlying driver is hormonal.

Why are doctors missing it?

Research is stark on this point. An estimated 80% of OB/GYNs (obstetrics and gynaecology doctors) are untrained in menopause care (Joinmidi, 2024). Women are frequently sent to different specialists for individual symptoms — a psychiatrist (mental health specialist) for mood changes, a cardiologist (heart specialist) for palpitations, a sleep clinic for insomnia — when a joined-up hormonal picture would explain all of them at once (Yale School of Medicine, 2024).

A 2024 study by the University of Virginia found that perimenopause symptoms are "understudied and often dismissed by physicians" — with many women describing their GPs (family doctors) as having invalidated or dismissed their concerns (UVA Health, 2025). Research conducted in the UK found that women described perimenopause as a "hidden phenomenon" — something they reached midlife entirely unprepared for, with no education about it at all (PMC, 2022).

You are not falling apart. You might be perimenopausal.

If you are in your late 30s or 40s and suddenly feel like a completely different person — exhausted in a way that sleep doesn't fix, anxious in a way that doesn't make sense, unable to remember words you definitely know — please know that your symptoms are not a character flaw. They are a physiological (physical, relating to your body's systems) event.

You deserve a doctor who asks about your cycle, your hormones, and your history — not just one who asks if you've "been under stress."

References:

This post is for educational and informational purposes only. It does not constitute medical advice or diagnosis. If you are concerned about your symptoms, please speak with a qualified healthcare provider.

Totally Fine Co
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