Over the past six months or so, I’ve been experiencing brain fog, fatigue, difficulty concentrating, fertility problems, and increased fat around my midsection. Being in my early 40s, I’m at the age when talk starts turning to perimenopause—also known as the menopausal transition, or the roughly 10 years leading up to the cessation of periods. When I’ve told friends and family members about what I’ve been going through, some have asked whether it could be perimenopause. I’ve had that thought a few times myself—and so, apparently, have my algorithms, which are now routinely serving me ads for perimenopause treatments and trackers.
But here’s the thing: I’m not actually in perimenopause.
I was fortunate enough to be able to ask my doctor and get a clear answer, because right now I’m doing IVF treatments that involve detailed monitoring of my menstrual cycles and frequent discussions of symptoms. I’m also having my hormone levels checked regularly, though for me that wasn’t necessary for confirming or ruling out perimenopause, which is typically diagnosed clinically—based on symptoms rather than blood tests.
In fact, there is no definitive perimenopause test, and hormone testing is widely considered to be unhelpful in diagnosis (with some exceptions, including in women aged 40 to 45 with menopausal symptoms or those under 40 where menopause is suspected) because levels fluctuate too much to give any clear picture of what’s going on. Instead, doctors are supposed to ask patients about symptoms in several key areas: vasomotor (including hot flashes, night sweats, and migraines), genitourinary (vaginal dryness and irritation, urinary frequency and urgency), musculoskeletal (joint and muscle pain), psychological (low mood, anxiety, mood changes), sexual (low sex drive, painful intercourse), and, of course, menstrual (irregular or missing periods). If a person experiences enough of these symptoms and they’re serious enough, they’re deemed to be in perimenopause—though in some cases, doctors will diagnose perimenopause just based on a combination of vasomotor symptoms and irregular periods. Menopause is a simpler diagnosis, and it’s made retrospectively: if you’ve gone 12 months without a period, you’ve been through menopause and are now considered post-menopausal.
For me, the symptoms of perimenopause don’t apply—and all the other ones I’ve been experiencing probably have different explanations.
The brain fog and difficulty concentrating likely stem from the fatigue, which is directly related to not sleeping enough: when I occasionally take time off and am able to catch up on sleep (to the extent possible with a young child, anyway), I feel much better. I also had a bout of back-to-back illnesses this winter, including Covid, which may account for some of these symptoms, though I know I was struggling with focus over the summer too. (And being more consistent in using the distraction-reducing features on my phone and computer has helped significantly.) The fertility problems certainly could be partially related to being in my 40s, but that’s not necessarily because of perimenopause. And as someone in long-term recovery from an eating disorder, I try not to worry about weight gain or stress too much about finding reasons for it, but the increased belly fat is clearly related to the hormone treatments I’ve been using for IVF.
The most obvious, Occam’s razor explanations for my symptoms all have nothing to do with perimenopause.
But then I think back to 10 or 20 years ago, when I was incredibly susceptible to wellness marketing. If I was still in that mindset, I could have easily self-diagnosed with perimenopause based on the nonspecific symptoms I was experiencing. I likely would have started tinkering with my diet, exercise, and supplements—which probably would have had no effect and may have just made everything worse. I even might have started working with a “perimenopause coach” who probably would have just confirmed my priors instead of testing for other explanations.
I feel lucky to have avoided these traps, but I know far too many others have been ensnared in them. As with many other kinds of symptoms, the non-specificity of some (purported) perimenopause symptoms leaves people vulnerable to wellness misinformation and grift.
Perimenopause is a real condition that can cause a variety of different symptoms. But when perimenopause is used as a catchall explanation for any symptom that a woman in her 40s experiences, it feels strangely similar to the dubious diagnoses we see in wellness culture, like adrenal fatigue, chronic candida, or leaky gut syndrome.
They all posit some universal explanation for all the symptoms you could be experiencing that isn’t actually rooted in reality. Perimenopause is a label that’s accurate in some cases, whereas adrenal fatigue et al. are not. Still, in some cases, the “diagnosis” of perimenopause is equally dubious.
So how can you know whether you’re truly in perimenopause, or whether you’ve been the target of meno-misinformation? And for people who really are experiencing perimenopause, what are some genuinely evidence-based treatments?
What, for example, can people like this reader do to take care of themselves without falling into wellness traps?
Hi Christy! I love your science-based approach to analyzing diet and wellness information, and your clear communication style! I’m a relatively new subscriber and have already benefited from your podcasts and Substack. As a middle-aged woman who is recovering from a long-time eating disorder, I realized I may also be entering perimenopause (hot flashes, brain fog, weight gain—may or may not be related, not sleeping as well). I’m curious your thoughts on hormone replacement treatment for women going through menopause. I’ve read conflicting things about the benefits and risks. If this isn’t too off topic, I’d love for you to address it in your podcast or newsletter.
