“I Thought I Was Losing My Mind.” How Many Women Discover It’s Perimenopause

At 45, one NHS worker began to notice changes she could not easily explain. Her periods became irregular and her moods unpredictable. Then came anxiety, exhaustion and a fog that seemed to settle over her thoughts. “Some days I struggled to string a sentence together,” she recalled. Work became difficult, but she said nothing because she assumed it was something all women simply had to endure.

For many women, that is the frightening part of perimenopause: not necessarily a hot flush or a missed period, but the feeling that something fundamental has changed. A familiar name disappears midway through a conversation. A routine task suddenly feels overwhelming. Sleep becomes fragile, confidence falls away and anxiety appears in someone who has never previously considered herself anxious.

It can feel like losing control of your own mind. Yet these changes may begin months or years before periods stop, and some women do not initially connect them with their hormones.

When the change does not look like menopause

Perimenopause is the transitional stage leading up to menopause, during which hormone levels fluctuate and periods may change. It usually affects women between 45 and 55, although it can begin earlier. Menopause is reached when someone has not had a period for 12 months.

The NHS recognises low mood, anxiety, mood swings, poor memory and difficulty concentrating among the possible symptoms of perimenopause and menopause. Poor sleep can intensify the problem, leaving someone more tired, irritable and mentally foggy during the day.

That combination can be deeply unsettling. A woman may worry that she is developing dementia, becoming incapable at work or experiencing a serious mental health problem. Others blame themselves, assuming they are simply failing to cope with the pressures of employment, caring responsibilities and family life.

Not every woman experiences perimenopause in the same way. Some notice hot flushes and obvious changes to their periods. Others first experience disrupted sleep, heart palpitations, headaches, anxiety or an unfamiliar loss of confidence. Symptoms can arrive gradually, fluctuate or temporarily improve, making the pattern difficult to recognise.

There is no reliable figure showing exactly how many women initially believe they are experiencing another illness before discovering perimenopause. What is clear is that its cognitive and emotional effects can have a significant impact on work, relationships and everyday life—and may not resemble the narrow picture of menopause many women were taught to expect.

It should not automatically be blamed on hormones

Recognising perimenopause matters, but so does avoiding the opposite mistake: deciding that every change in a woman in her forties or fifties must be hormonal.

Tiredness, low mood, poor concentration and changes to periods can also occur with an underactive thyroid. Iron-deficiency anaemia may cause exhaustion, headaches and palpitations, while vitamin B12 or folate deficiency can affect memory, judgement and mood. Depression, anxiety disorders, medication side effects, pregnancy and persistent sleep problems can also produce symptoms that overlap with perimenopause.

Several things can also be happening at once. A woman may be perimenopausal and have iron deficiency following increasingly heavy periods. Hormonal changes may be disrupting her sleep while pressures at home or work are worsening her anxiety. A proper assessment should consider the whole picture rather than forcing every symptom into a single explanation.

Sudden confusion should never be assumed to be menopause. Neither should new difficulty speaking, facial weakness, weakness in an arm or other abrupt neurological changes. These can be signs of a medical emergency and require immediate help.

How to ask for help

A useful first step is to keep a short record of what is changing. Note alterations in periods, sleep, mood, memory and physical symptoms, as well as when they began and how they affect work, relationships or daily tasks. The aim is not to arrive at the appointment with a self-diagnosis, but to give the clinician a clear pattern to assess.

Women over 45 with typical symptoms can often be diagnosed with perimenopause from their symptoms and menstrual changes without hormone blood tests. Hormone levels fluctuate during this stage, so a single result may not provide the certainty people expect. NICE recommends considering specific blood testing in more limited circumstances, including some people aged between 40 and 45 and those in whom menopause is suspected before 40.

A GP may also consider whether other investigations are appropriate, particularly when symptoms are unusual, severe or could have another cause. It is reasonable to ask: “Could this be perimenopause, and what else should we rule out?”

Treatment depends on the symptoms, medical history and the woman’s preferences. Hormone replacement therapy can help many menopausal symptoms, but its suitability and potential risks need to be considered individually. Non-hormonal medicines and cognitive behavioural therapy may be options for some symptoms, while support for sleep, mental health and workplace difficulties can also form part of care.

Most importantly, women should not feel they have to wait until their lives become unmanageable before asking for help. Forgetfulness, anxiety or a sudden loss of confidence may be part of perimenopause, but they still deserve to be taken seriously. The question is not simply whether a symptom is “normal” at this stage of life. It is whether it is causing distress, interfering with daily life or signalling something that needs attention.

For the woman who feels she has become a stranger to herself, discovering that perimenopause may be involved can bring enormous relief. It does not mean every difficulty has an instant solution, but it replaces fear and self-blame with something more useful: an explanation, a medical conversation and a way forward.

Medical disclaimer: This article is for general information only and is not a substitute for individual medical advice, diagnosis or treatment. If you are concerned about changes in your mood, memory or other symptoms, contact your GP or another qualified healthcare professional. Seek urgent medical help if symptoms are sudden or severe. If you may harm yourself or are in immediate danger, call 999 or go to A&E.

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