Perimenopause

What nobody tells women about perimenopause

It is not the hot flushes. And it explains far more than anyone lets on.

Yasmin, founder of Lysa Wellness

The numbers that do not add up

In 2022 the Fawcett Society ran the largest representative survey of menopausal women ever conducted in the UK, asking 4,014 women aged 45 to 55 what it was really like. Asked what held them back at work, the answers were not the ones the word menopause usually brings to mind.¹

Not hot flushes. Sleep, and memory, and mood.

It is not only that survey. At one UK menopause clinic, 94% of women reported memory problems, second only to fatigue.⁷ Among women logging their symptoms in the Balance app, brain fog is the single most recorded one, entered by 446,147 of them.⁸

Now here is the part that matters. The official symptom list does not lead with any of that. It leads with hot flushes and night sweats.⁶

That is what the guidance names first, and it is what your GP is working from. Which is why the appointment so often goes nowhere. In that same survey, almost half of women never raised it with a GP at all, and of those who did, only four in ten were offered HRT in what the researchers called a timely fashion.¹

What that means

• You were measured against a list that starts with hot flushes.
• You did not have those, or barely had them.
• So nobody said the word perimenopause to you.
• So you went looking for another explanation.

And the only one left was you.

The consequences follow. One in ten women who worked through it left a job because of their symptoms. Fourteen per cent cut their hours. Eight per cent decided not to apply for a promotion.¹

What is actually happening

One. They do not fade. They swing.

Everybody thinks perimenopause is a slow fade, hormones turning down a little each year until they are off. They do not decline in a straight line. They become extremely volatile, spiking higher than they ever went before and then dropping away. Progesterone goes first, so there is nothing steady underneath.⁹

Averages fall over years. But you do not live in the average. You live in the spikes and the drops.

Two. Your brain runs on the same hormones.

Most people think oestrogen and progesterone are for reproduction. Your cycle, having children, and then done with.

Researchers at Weill Cornell Medicine scanned women's brains through this transition and mapped where the receptors actually sit. They are in the regions that run memory, mood, sleep, temperature and thinking.⁴

In that 2024 study, receptor density in the hippocampus tracked with how women performed on memory tests, both immediate and delayed recall.⁴

So the supply is erratic, and the organ most densely wired to receive it is the one you use to remember your own postcode and hold your temper.

Which is why memory and patience go first. Not hot flushes.

Why it gets worse on its own

The swings cost you sleep.

Less sleep means less capacity for the next swing.

Less capacity means a bigger reaction, which costs you more sleep.

It is a loop. Waiting does not break it.

And it is not brief. In the largest long-term study of the transition, the median duration of vasomotor symptoms alone was 7.4 years.²

Why what you tried did not work

• Pushing through. A strategy for something that ends in a fortnight.
• The GP. Offered you something for the mood, not an explanation for it.
• Waiting for HRT you were never offered. Only four in ten were offered it in what the researchers called a timely fashion.¹

None of them touched the volatility. You were treating the wrong layer, because nobody told you there was another one.