About two years ago, at the age of 49, I tried to type the word perimenopause into a text, and autocorrect didn’t give me any help. The first four letters yielded period or periods. The first five letters resulted in perimeter. Eventually, I typed the full word myself.
You may be thinking, Oh, what a hardship—you had to type out an entire word. But this situation was a telling one; it was as if perimenopause, as a term and as a phase of life, didn’t exist. Though people with ovaries had been going through it since the literal dawn of humanity, it wasn’t part of the lexicon.
Celebrities like 55-year-old Jennifer Lopez didn’t mention it, even though they surely were in it or had gone through it. Perimenopause wasn’t as acceptable a thing to discuss as, say, menstruation, because people who menstruate are young and fertile and bounce on trampolines with the utmost confidence in their period protection. This is a society obsessed with aging and with women doing anything they can to stop it, lest they become dry and withered and fade into invisibility. God forbid we talk about a phase of life that’s associated with getting older.
Around the time of that text about perimenopause, pharmaceutical advertisements focused on erectile dysfunction and various medications that might make you bleed from your eyeballs. Drug ads for women were more likely to zero in on how depression can make you sad at a family barbecue or how arthritis can make gardening painful and unpleasant, even when you’re wearing your favorite floppy hat.
I first heard the word menopause when I was a teenager and, believing this phase would be fantastic—“No more periods! Hooray!”—vowed I’d throw a menopause party when I’d used my last pad (ah, youth). But no one told me about perimenopause.
In case you’re just as unfamiliar with this phase of life: Perimenopause marks the time when ovaries gradually stop working. The body releases eggs less regularly, estrogen levels dip, periods become irregular, and fertility decreases. Hormone levels can whip around as wildly as a teenager’s, bringing on PMS symptoms and issues such as hot flashes—which can occur over a year or two, or maybe a decade, or maybe you’ll never be free of them—poor sleep, depressed mood, increased anxiety, heavy or erratic periods, and vaginal dryness.
These final years of a woman’s reproductive life can last four years. Or maybe just a few months. Or maybe you’ll go 10 years before your periods cease and menopause begins. Frankly, there’s a lot we don’t know because this kind of research has traditionally been underfunded. Patients and practitioners alike are often basing decisions on outdated, conflicting, or simply scarce data.
Menopause seems to be better understood. It is described as “the one universal” experience for people with ovaries in The M Factor: Shredding the Silence on Menopause, a film released in 2024 that was marketed as the first documentary on the topic.
“If you are born with ovaries, you will be menopausal,” Dr. Sharon Malone, an OB-GYN and an expert on menopause, says in the film. “You may or may not be pregnant. You may or may not have fibroids. You may or may not have many things that primarily affect women. Menopausal, I guarantee you, you will be.”
But, as I’ve learned firsthand, there are no other guarantees, particularly in perimenopause—no guarantees that a doctor will listen, that treatments will be offered and that they’ll work, that health influencers and Oprah can be trusted to tell the truth, that your hair won’t thin and your joints won’t ache and you won’t lose a tooth.
The only guarantee I can give you, from my experience, is that the journey can be a perilous, painful one that can leave you questioning your health and your sanity.
Photograph by Getty Images
Perimenopause was believed to have first been described in the 1850s by a clinician named Dr. Edward John Tilt, who would author a book with a title that revealed the thinking of the time: The Change of Life in Health and Disease: A Practical Treatise on the Nervous and Other Affections Incidental to Women at the Decline of Life. The book talks about, among other things, women’s “hysteria” and includes a gem of an anecdote about a patient in perimenopause.
The woman was hanging clothes in the garden when she suddenly “felt giddy and fell down, remaining insensible for 10 minutes,” the book states. “Some time after, while in apparent good health, and talking to her husband, she was all at once deprived of speech. She was perfectly conscious, knew what she wished to say, but could not utter the words.”
She went on to complain of headaches. The doctor prescribed what was, essentially, an enema.
“The patient was discharged, still complaining of being once a day utterly unable to give utterance to her thoughts, but the speechlessness is of short duration,” Tilt writes. “She was in good circumstances, had a kind husband, seemed in fair health, and the change of life could alone account for her fits.”
Hormones had not been discovered at this time, and for decades, research was very limited. “It wasn’t until the 1980s and 1990s that we saw more focused research on perimenopause as a distinct physiological state,” says Einat Shinar, a health coach and perimenopause specialist who owns the Alpharetta-based wellness practice Food for the Body and Soul.
A turning point came when researchers began incorporating hormonal markers into their studies and examining a broader range of symptoms. In 1990, for example, researchers looked at biological females aged 35 to 55 and focused on symptoms of perimenopause, like heavy bleeding.
“Despite these efforts, comprehensive research remained limited until recent years, and even now in 2025, experts say there’s an urgent need for robust research,” Shinar says. “It’s been a perfect storm of silence, stigma, and science playing catch-up.”
Part of the problem, she says, is the medical education system. Consider this: 20 percent of medical students in a 2017 National Institutes of Health study said they received no menopause-related lectures during residency. “That’s unacceptable when you consider that about half of the population goes through [perimenopause and menopause].”
Although women and other people with ovaries were once expected to suffer quietly, many Baby Boomers and Generation X patients are now “louder, more informed, and not willing to be ignored,” Shinar says. “They’re demanding better care, sharing their stories publicly, and pushing for change.”
When I was attempting to write that text about perimenopause to a friend, I was experiencing bloating, cramping, irritability, deepened depression, and weight gain, and I didn’t know why.
My depression was brushed off by an OB-GYN nurse who handed me a pamphlet on sadness. The weight gain was perplexing for me, as I’m a personal trainer and fitness coach. She said weight gain came with aging and that maybe I should try working out more. But there was no healthy way to do “more”; I was already in the gym five days a week and eating healthily. I also played sports, and the extra 15 to 20 pounds was inhibiting my ability to move and perform.
She asked, “Are you having hot flashes?”
“No,” I answered.
She sent me on my way.
I next saw another OB-GYN provider about cramps and a hard, bloated feeling in my lower belly. She performed an ultrasound. “You might have adenomyosis, which involves an enlarged uterus,” she said.
“What can I do about that?” I asked.
“A hysterectomy,” the provider said. “We can’t really diagnose it or alleviate the symptoms without doing that surgery.”
I burst into tears. Bafflingly horrified that I’d be so upset at the prospect of having my uterus forcibly removed, she scrambled to find a colleague who then casually mentioned that, actually, an IUD might help manage my symptoms. So I signed up to get the Mirena inserted as soon as possible.
Photograph by Katya Vilchyk
When I recently shared these experiences with obstetrician and gynecologist L. Dawn Mandeville, MD—who delivered my sons, now 13 and 15, but whom I hadn’t seen for care since—she sighed quietly. For decades, doctors like her had readily prescribed hormone therapy [also known as hormone replacement therapy] to help alleviate symptoms of perimenopause and menopause.
Indeed, the first hormone therapy drugs were approved by the Federal Drug Administration in 1942, though the treatment was not popularized until the 1960s. In the mid-1970s, research indicated that hormone therapy was linked to an increased risk of endometrial cancer. But newer research found that adding progesterone to hormone therapy minimized this risk, and its use resumed.
In 1991, the Women’s Health Initiative enrolled more than 160,000 women in a long-term study to look at strategies for preventing heart disease, breast and colorectal cancer, and osteoporosis in postmenopausal women. Then, in 2002, administrators of the study abruptly stopped it, having discovered that hormone therapy might raise the risk of those diseases.
The study linked hormone therapy to breast cancer, blood clots, and stroke. This created some panic among hormone users and forced healthcare providers to consider new guidance when prescribing hormone replacement.
Like most doctors, Mandeville relied on the study’s findings to help inform her decision-making with patients. “I might have been dismissive, handing a patient a pamphlet,” she says.
In the years following 2002, the Women’s Health Initiative data came under scrutiny after it was determined that the study only used synthetic hormone drugs instead of also using natural hormones such as estradiol and micronized progesterone.
The study also focused on older women who had already spent over 10 years in menopause without hormone therapy. It also didn’t look at whether subjects were predisposed to get cancer or have blood clots. Newer research has determined that younger patients with no history of these medical conditions can use hormone therapy with very low risk while treating symptoms, improving bone density, and helping to prevent dementia.
(The Women’s Health Initiative study, which has measured the effects of preventative care interventions on thousands of people over more than three decades, remains the largest such effort focused on women’s health. The study’s future is facing uncertainty under the administration of President Donald Trump.)
I don’t have any family history of breast cancer or the other issues associated with hormone therapy, so—after being dismissed by the OB-GYN nurse and the second OB-GYN provider—I took my case to my primary care physician. I was 50, and my blood work showed I was still fertile (my mother didn’t go through menopause until her 60s, so perhaps I was on that same path). The doctor brought out a list of perimenopausal symptoms, and I checked off at least 10.
She prescribed an estrogen patch, to head off hot flashes and any vaginal irritation or dryness; progesterone capsules, which work with estrogen and are said to help regulate menstrual cycles, improve mood, and promote better sleep; and a tiny daily dab of testosterone cream, to slow age-related decreases in muscle mass.
During the first week, I began to feel a little bit better. And then, as if an air conditioner had fallen from a high window and onto my head, my mood collapsed. I called my doctor, and she told me to take the estrogen patch off immediately and throw it away. I did, and within a day I was more emotionally stable.
The testosterone, which can overstimulate oil glands in the skin, was starting to make my face break out, so I stopped using that. And the progesterone didn’t seem to be doing anything on its own, so I ceased taking that as well. I ended up back at the beginning.
Then other symptoms started to show up. About six months after my 51st birthday, I began to experience intense brain fog. I couldn’t locate keys or later a giant gym bag or remember the words to a song I’d sung with my band for a decade. Once a prime pick for pop culture knowledge on trivia night, I became the person who says, “You know—that guy? The one in the thing? With the brown hair?” While teaching indoor cycling classes, I wouldn’t just play song mash-ups; I’d mash up words and cues as they came out of my mouth. I’d repeat myself to friends and have no memory of having told a story before.
“Brain fog is a very weird phenomenon,” says Dr. Lisa Mosconi, an associate professor of neuroscience in neurology and radiology and director of the Alzheimer’s Prevention Program at Weill Cornell Medicine/NewYork-Presbyterian Hospital, in The M Factor. “It doesn’t even really have a term in medicine—cognitive fatigue or mental fatigue. The brain won’t turn off, everything is a huge effort, you’re having trouble accessing information, words won’t come to mind.”
In the documentary, Mosconi continues, “What is really concerning, I think, is that these changes can be so severe as to prompt fears of either going crazy or developing dementia.”
Those thoughts certainly crossed my mind, particularly once my migraines—typically confined to once or twice a year as a result of exercising in hot weather—began hitting me as often as three times per month. I’d also developed a small tremor in my hands. So I made an appointment to see a neurologist, and an MRI showed no tumors, bleeds, or strokes. The test did, however, determine that I had a small amount of cerebral small vessel disease, also known as white cell vessel disease or white matter disease.
Cerebral small vessel disease is damage to the brain’s white matter from a lack of blood flow to those tissues and can be caused by migraines and sleep apnea, which I also have. Research also shows that, as we age, we are more likely to have damage in the brain’s white matter, and that damage can instigate or exacerbate issues with cognition, memory, learning, and communication among different parts of the brain.
“There are so many things going on during perimenopause that it can be hard to connect the dots. You don’t know what’s going on—only that you have more migraines and your memory isn’t what it used to be and your moods are down,” Mandeville tells me. “All of these things can happen when your brain receptors are not nourished by hormones. If you don’t have nourishment, you don’t function as well.”
In my case, it was difficult to say whether my perimenopause and cerebral small vessel disease were connected or just similar. Either way, my neurologist did not seem concerned. Still, I felt anxious and frustrated. Another symptom? Another issue to contend with as my reproductive life was ending? I did the hard work of bearing two children. The reward was that I got to dry up, fall apart, and potentially lose my faculties?
Frustration is, as you might imagine, common among perimenopausal women. Amanda Vaughn, now a 47-year-old Oak Grove mom to 13-year-old identical twin girls, recently posted to the private Facebook group DAMES (Decatur Area Moms Enjoying Sanity) about pain in her tailbone.
That area had been “hurting for months,” she later tells me. “I’ve bought all those stupid old-people pillows with the cutout for the tailbone for the car and a seat at home where I work. Several DAMES asked me if I was perimenopausal or menopausal because they’ve had the same thing.”
Vaughn, a graphic designer with her church, reached out to me in April after I posted on the DAMES page a particularly horrifying finding cited in The M Factor: that 30 percent of women will lose a tooth within the first five years of menopause. This claim has since been batted about and argued ad nauseam, and ultimately there appears to be no strong research to support the suggested prevalence of this nightmare scenario.
(Anecdotal evidence from the DAMES group, however, showed that some people do lose teeth, and many others experience significant dental problems. But that could be due to oral hygiene or, again, the beauty of aging.)
After Vaughn saw that other women her age were having tailbone pain, she brought her case to her doctor and was not taken seriously. She sought another. “She agreed with all of my thinking about symptoms and said it was normal for perimenopause and gave me some HRT,” Vaughn says. “Now that I’m on board and know more about what’s going on with me, I want to share it with all the people.”
Mandeville, for her part, wishes she’d known more about perimenopause and menopause decades ago. “Hindsight is 20/20,” she says. “I have called several patients to apologize. I just didn’t know.”
In recent years, armed with better data, she has resumed prescribing hormone therapy—and was even planning to start a regimen herself. Then, one day, she felt shortness of breath and sharp, nearly unbearable pain in her back. She ignored both and went to work, but soon enough, she could not stand it and went to the hospital. There, she was told she had a pulmonary embolism, which is a blood clot blocking an artery in the lungs.
“This kind of diagnosis is either you diagnose it early enough and you’re alive, or you diagnose it because you’re dead,” she says. “My next thought was, Oh no, I can’t take hormones [because of blood clot risk].”
She began to deep-dive into the research, findings, and remedies, becoming an expert in perimenopause and menopause. She hosted a screening of The M Factor and leads a sip-and-learn series called Menopause and Mocktails to “break down stigmas while fostering a supportive community and offering treatment options for those navigating this journey,” she says.
Now Mandeville is so booked with perimenopausal and menopausal patients, she barely has time for regular OB-GYN appointments and delivering babies. “I’ve had patients cry because I’ll listen to them,” she says.
The market is listening, too. Once treatment options were nearly impossible to find, but today perimenopause- and menopause-related creams, supplements, and incontinence prevention devices are a multibillion-dollar business.
“Midlife women are a powerful economic force,” says Shinar of Food for the Body and Soul. “Companies are finally paying attention, because there’s real money to be made in supporting women’s health properly.”
Celebrities are, of course, jumping into the market. In April, there was An Oprah Winfrey Special: The Menopause Revolution, which saw her talk with Naomi Watts, Maria Shriver, and Halle Berry about their journeys of misdiagnosis and painful symptoms.
On her own website, Berry says she found out she was in perimenopause at the age of 54. She had “no warning from my doctors. I was not prepared and did not know where to turn for support.”
Her doctors told her she was just aging. So she went to see a specialist and, according to her website, spent a lot of time and money to end up more confused about her options. That’s when she turned her need for menopausal care into a business opportunity and founded Respin, a “12-week, expert-backed program, scientifically designed to help you build and stick to a plan to help you navigate menopause and help you feel better,” she says on the site.
What do you get for a $149-per-month membership? Connections with a “community of women who really get it”; access to chats and events; live discussions with experts; a content library; and early access to Berry-approved products.
The global perimenopause and menopause market is $15 billion and growing. “There are so many menopause-branded products on the market that are making a huge amount of money for companies,” says Dr. Louise Newson, a perimenopause and menopause specialist who serves on the UK Government’s Menopause Taskforce. “Brands know that they can now put the word meno in front of any product and use it as a marketing tool.”
This “menowashing” of brands should be challenged, Newson says, and consumers should do their research and be careful with unregulated supplements, vitamins, and other remedies. “Perimenopause and menopause are caused by low hormones,” she says. “So washing your hair with a menopause shampoo or taking an herbal supplement will not replace the missing hormones.”
Shinar compares the exploding market to mushrooms popping up after the rain. “My social media feed is full of ads for menopause supplements, hormone-balancing teas, cooling sleepwear, tracking devices, and more. It’s like a whole new wellness industry has appeared overnight, and it’s clearly targeting women in midlife,” she says.
Some of these offerings seem like a cash grab, she says.
“When you’re already dealing with brain fog, exhaustion, or mood swings, trying to figure out what actually works—and what’s just expensive hype—can be overwhelming,” Shinar says. “Not every woman can afford $80 supplements or $200 sleep trackers. Support during this transition shouldn’t be reserved for those who can spend the most.”
I’d love to take a magic (and reasonably priced) pill that would take away my perimenopausal symptoms. Instead, under the continued guidance of my primary care physician’s office, I’m considering the estrogen patch again. I’ve scheduled more tests for my brain. I’ve also started taking semaglutide, one of the diabetes drugs made famous for its weight-loss side effect. The medication has helped me even out my blood sugar and return to my comfortable weight. I can now move the way I want and need to, and I feel more like myself, which is helping my mood. I still have the IUD, which has brought my periods to a halt, and that means I’m not having as much bloating and cramping.
I’m encouraged by these changes, and I’m glad to see that perimenopause is becoming less and less a taboo topic. I know there are medical journeys much more challenging than this one, and that there are patients whose concerns receive even less attention.
But I still can’t help but feel anxious and frustrated. It’s as if perimenopause has made me a prisoner in my own body, unsure of what will happen next, what I can do about it, and whether someone or something will ever help.
This article appears in our July 2025 issue.
