I was forty-two years old when I started feeling like I was losing my mind. What I didn’t know yet was that I was experiencing perimenopause symptoms — and that no one was going to connect those dots for me.
Not dramatically. Not all at once. It was more like a slow dimming — the kind where you don’t notice the room getting darker until you’re sitting in the shade and wondering when the sun moved.
My brain felt foggy in a way I couldn’t explain. I would walk into a room and have absolutely no idea why I was there. I would be mid-sentence and lose the word I needed — not a complicated word, a normal one. I would lie awake at 2am with a low-grade hum of anxiety that had no apparent source.
I made an appointment with my doctor — my PCP, a man I trusted. He listened, he took me seriously, and then he referred me to the female nurse practitioner in his practice to discuss it further. I don’t think it was dismissal. I think he genuinely believed she would be better equipped to navigate the conversation. He may have been right. But it was also the beginning of my realization that hormonal health and perimenopause symptoms in women falls into a gap — not always from indifference, but often from a system that simply hasn’t built the infrastructure to address it well.
That appointment sent me looking for something better.
What Perimenopause Actually Is
Perimenopause is the transition phase before menopause — the years (sometimes a decade or more) during which your body’s hormone production begins to shift. Estrogen and progesterone, the two primary female hormones, start fluctuating in ways they never have before. Some months you have too much estrogen. Some months not enough. Progesterone drops. The whole system becomes less predictable.
Menopause itself is defined as twelve consecutive months without a menstrual period. Everything leading up to that is perimenopause. And for many women, that transition starts in their late thirties or early forties — far earlier than most people expect.
The average age of menopause in the United States is 51. Which means for many of us, perimenopause starts somewhere around 40. Sometimes earlier.
And yet most women arrive at it completely blindsided, because no one told them what to look for.
Perimenopause Symptoms No One Warned Me About
Hot flashes are well known as one of the main perimenopause symptoms that most everyone knows about. They are not the only one. They are not even the one that disrupts most women’s daily lives the most.
Here is what actually showed up for me — and what shows up for a lot of women I’ve talked to and cared for as a nurse:
Brain fog. This one hit me the hardest. Not being able to think clearly, losing words mid-sentence, feeling like you’re operating through a layer of gauze. It is genuinely frightening when you don’t know what’s causing it. I had moments where I worried something was seriously wrong neurologically. It wasn’t. It was hormones.
Anxiety. Not situational anxiety — not anxiety about anything in particular — but a low, persistent sense of dread that seemed to have no cause. Waking at 3am with a racing heart and no explanation for it. This kind of anxiety in perimenopause is driven by declining progesterone, which has a calming, GABA-like effect on the brain. When it drops, the nervous system feels it.
Memory issues. Forgetting things you would never have forgotten before. Names, appointments, conversations. This is one of the more distressing symptoms for many women because it mimics the early signs of cognitive decline. It is usually not that. It is usually hormones.
Sleep disruption. Waking at the same time every night. Difficulty falling back asleep. Feeling exhausted no matter how long you’ve been in bed.
Mood changes. Irritability, sadness, emotional reactivity that feels out of proportion to the situation. Often attributed to stress or depression — and often medicated as such — when the root cause is hormonal.
Irregular periods. Cycles that shorten or lengthen. Heavier or lighter bleeding. Skipped periods. Your body is recalibrating.
Why So Many Women Are Dismissed
When I went to my doctor with brain fog and anxiety at forty-two, I was not offered a hormone panel. I was not told that what I was describing sounded like early perimenopause symptoms. I was offered a referral to talk to a nurse practitioner about “women’s concerns.”
This is not an unusual experience. It is, in fact, an extremely common one.
The consequences of dismissal are not always minor. My mother went to her doctor because her periods had stopped. She was told her labs were fine and sent home. She kept going back. By the time anyone took her seriously — prompted by new symptoms, not her original concerns — she had been diagnosed with choreocarcinoma, a uterine cancer that had already metastasized. She was not fine. She had never been fine. She had just been a woman whose symptoms weren’t investigated thoroughly enough, soon enough.
I think about her every time I hear a woman say her doctor told her everything looked normal.
Women’s hormonal health has been historically undertreated, undertested, and underfunded. The Women’s Health Initiative study in 2002 — which created widespread fear about hormone replacement therapy — has since been significantly reanalyzed and its conclusions substantially revised. But the cultural hangover from that study persists in exam rooms across the country, where women in their forties are still being handed antidepressants or told their labs are “normal” when they feel anything but.
Normal labs do not mean optimal function. And a practitioner who doesn’t specialize in hormonal health may not know how to read them even if they run them.
Why I Chose a Naturopath
After that appointment, I started looking for a different kind of care. I found a naturopath who approaches care differently — she looks at the whole person, not just isolated symptoms. My first appointment lasted over an hour. She asked questions I hadn’t been asked before, she didn’t rush, and she never made me feel like she was trying to get to the next patient. And honestly, part of what made the difference was simply being heard. She listened in a way I hadn’t experienced in a conventional exam room.
She ran a full hormone panel on day 3 of my period. A single hormone panel gives you a snapshot, not the full picture. Hormones fluctuate significantly throughout your cycle, which means one test on one day can look completely normal while another day tells a very different story. Many functional medicine and naturopathic practitioners recommend testing at multiple points in the cycle for a more complete picture — day 3 for baseline estrogen, testosterone, and FSH, and day 21 or 22 for progesterone, when it peaks after ovulation. A practitioner who understands this will test accordingly. One who doesn’t may miss what’s actually going on.
I am not anti-doctor. I am a nurse. I believe deeply in evidence-based medicine. But I also believe that the conventional medical system is not well designed for the nuanced, individualized management of hormonal transitions in women. That is not a criticism of individual physicians — it is a structural reality.
For hormone-related concerns, I have found naturopathic care and functional medicine practitioners to be far more thorough, more knowledgeable, and more willing to treat the whole picture rather than isolated symptoms.
If you want the fuller story of how I got here — the diabetes diagnosis, the keto journey, and why I eventually started writing about all of it — you can read that here.
A Note on HRT — Because We Need to Talk About It
Hormone replacement therapy has a complicated reputation. For a long time, many women were told to avoid it. That fear is largely outdated.
For most healthy women under 60 who are within ten years of menopause onset, hormone replacement therapy is safe, evidence-supported, and can be genuinely life-changing. The risks that generated so much fear in the early 2000s were primarily associated with synthetic oral progestins — not bioidentical hormones, not transdermal estrogen, not the individualized protocols that modern practitioners now use.
HRT can reduce hot flashes and night sweats. It protects bone density. It supports cardiovascular health when started early in the menopause transition. It improves mood, sleep, cognitive function, and quality of life for many women. The Menopause Society, the British Menopause Society, and many leading endocrinologists now support its use for appropriate candidates.
I am not saying every woman needs HRT. I am saying every woman deserves to have an honest, informed conversation about it — with someone who is actually current on the literature and not operating from twenty-year-old fear.
If your practitioner dismisses HRT without a real conversation, that is information. Find someone who will have the conversation.
What I Would Tell My Forty-Two-Year-Old Self
Your brain fog is real. Your anxiety is real. Your memory issues are real. Your perimenopause symptoms are real. None of it means you are losing your mind. It means you are in a hormonal transition that your body was never taught to prepare you for — and that the medical system often fails to address adequately.
Find a practitioner who specializes in women’s hormonal health. A naturopath, a functional medicine doctor, a menopause specialist. Someone who will run a full panel, look at the whole picture, and build a protocol that treats you as an individual rather than a symptom.
Pay attention to the basics that support hormonal health: sleep, stress management, blood sugar stability, anti-inflammatory nutrition. These are not replacements for medical care, but they are genuinely significant levers.
And know this: These perimenopause symptoms can be hard. But it does not have to be endured in confusion. There is real information out there, and there are practitioners who know how to help. You deserve both.
Kelli Roulette, BSN, RN, is a registered nurse with clinical experience in home health and behavioral health nursing. She writes about women’s health, perimenopause, and ketogenic living from both her professional background and personal experience.
Disclaimer: This article is for informational purposes only and does not constitute medical advice. Always consult with your healthcare provider before making changes to your health regimen.