It's not just stress
What I wish I’d known about perimenopause in my forties
Twice in the past few weeks, I’ve had conversations with mothers saying, “I just don’t feel right. I just don’t feel like myself.”
The first mother: “My heart is racing. I don’t know what’s going on.” She had started a new job, relocated her family. Maybe it was stress? Turns out she had an undiagnosed thyroid problem. Once she got it taken care of, she felt much better. Total time from start to finish: about three weeks.
The second mother: “I just have brain fog. I can’t think straight.” She had also just started a new job, moved her family. Was it stress? ADHD? Perimenopause? All of the above? Still working on getting it resolved.
This last story feels all too familiar to me because it reminds me of my own.
For me, it took five years to get to the bottom of what was going on with my body. Five years of trying different approaches, seeing different providers, and advocating for myself. I was 46, going through multiple life crises, and wondering: how much of this is stress, and how much of this might be perimenopause?
The answer, it turns out, was both. And that’s what made it so hard to diagnose and treat.
Here’s what I wish I had known when I started this journey:
You have to advocate for yourself. Perimenopause care falls between specialties. Symptoms are diffuse. No one is automatically tracking the whole picture.
It might take multiple attempts. For me, the final formula included antidepressants, estrogen, progesterone, an IUD, and eventually testosterone. Each helped. It took time to see the full pattern.
Ask about an IUD. This was the missing piece for me, and I only learned about it from peers (it helps to have college roommates who specialize in women’s health!). Eliminating menstrual cycles changed everything.
Find a menopause-certified provider. Look for certification from the Menopause Society. It matters.
You’re not imagining this. If you’re in your 40s and feel off, it may be stress and perimenopause.
Study up. I did a lot of my own reading and I’m so glad I did. If you’re new to this, or just entering your forties, here’s where I’d start:
Rachel Rubin is a sexual medicine physician and an evidence-based advocate for menopause care. She did a terrific introductory podcast with Peter Attia, and her website includes both clinical and educational resources.
The New Menopause by Mary Claire Haver (2024) is recent, comprehensive and readable. One solid book is probably enough.
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