I want to start by saying that I am incredibly glad we’re finally talking openly about the menopause transition. For generations, women were given very little information about this stage of life. Symptoms were dismissed, misunderstood or simply endured. So, the fact that women now have more awareness of what can happen as ovarian hormone production begins to change is a very good thing. More understanding means more support – both of which are sorely needed.

Yet, I do wonder whether the pendulum has swung a little too far at times. Because today, almost anything a woman experiences from the age of about 38 to 55 can seemingly be attributed to perimenopause.

Fatigue. Poor sleep. Anxiety. Brain fog. A racing mind. Weight changes. Low mood. Hot flushes. Heart palpitations. Changes to her cycle.

When we say a symptom is due to ‘perimenopause’ we are attributing the cause of that symptom solely to changes in sex hormones. And of course these can be the driver – or one of them. But so can other things.

Just because we are between 38 and 55 doesn’t mean that our thyroid function, iron status, whether we are insulin resistant or not, how well our bile flows, whether we have been living with our fight + flight response elevated since our Rushing Woman Syndrome days set in 15 years ago… stop contributing to how we feel. They do and they do more than ever once the buffering effect of our sex hormones start to fade.

The problem with overlapping symptoms.

→ Fatigue. What if it’s iron deficiency, insufficient sleep, thyroid dysfunction, insulin resistance, inadequate nourishment, alcohol and/or numerous other physiological states?

→ Anxiousness. What if it’s iron deficiency, our Rushing Woman’s Syndrome stress response, poor sleep, caffeine intake and/or roller coaster blood glucose regulation?

→ Brain fog. What if it’s iron deficiency, poor sleep, prolonged stress, poor blood glucose regulation and/or other health scenarios that can affect cognition?

→ Heat. What if it’s the liver requesting attention, alcohol, dietary sugar and/or fat patterns, the thyroid, a never-ending stress response?

→ Changes in waist circumference. What’s if it’s iron deficiency (because iron impacts a broad array of metabolic processes), a thyroid issue, insulin resistance, prolonged stress, alcohol, too much poor quality food, not enough movement, muscle loss from a lack of exercise, poor sleep, and/or an endless stress response that’s impacting your metabolic health?

The overlap matters.

Because when we decide we already know why something is happening, we usually stop asking questions, we stop investigating – and that’s what concerns me. At any other stage of our lives, if these symptoms were to arise, hormones would be one consideration as a contributing factor, not the entire explanation. Now, if someone is aged between 38 and 55, ‘perimenopause’, aka ‘hormones’ are blamed for anything that arises and we can be missing what else is happening. Because if changes in sex hormones were the sole driver of symptoms, everyone would suffer (because all women go through this transition) yet that is not the case. Many women experience little or no suffering.

And what about hormone regulation?

Another – and significant – aspect of hormone health involves the systems that regulate both hormone production and clearance. These are primarily the liver (including bile production) and gut, as well as the hypothalamic pituitary ovarian (HPO) axis, the latter of which is disrupted by the persistent production of stress hormones. Ever since the Rushing Woman’s Syndrome days, there has been a tendency for us to believe that stress is just part of life now and that there’s nothing we can do about it. That is not the case.

Our ‘stress’ can be one of our biggest teachers at any stage of life. Never is this clearer than during perimenopause. Symptoms can act as a prompt for us to address situations and perceptions that we once adopted but that no longer serve us. This work might feel hard, yet ignoring it will likely bring its own set of challenges.

So let’s consider hormones of course, while also not forgetting their regulatory and clearance systems, along with the other aspects of women’s health that have always contributed to how we feel and function.

Perimenopause can be part of the explanation without being the whole explanation.

Or it might not be an explanation. I don’t want women to go back to having their experiences dismissed. Yet, I also don’t want “that’s just perimenopause” to become the new version of “that’s just part of being a woman”.

If you’re exhausted, I want to know why. If your periods have suddenly become incredibly heavy, I want to know why. If you’re waking at 3am every night, experiencing heart palpitations or feeling anxious in a way you never have before, I want us to remain curious about what your body is communicating.

Sometimes changing ovarian hormone production will be a part of that explanation. Sometimes there will be other contributors. Often, there may be several things happening at once. Perimenopause gives us an incredibly useful lens through which to understand what may be happening in a woman’s body during this stage of life.

I just don’t want it to become the only lens we look through.