That’s not Perimenopause!
Today was the day. I was finally going to get the answers that I was desperate to hear, the validation that I was doing the right things even though my body was behaving as if it was staging a mutiny, and the piece de resistance…by the time I left this appointment, I would have something in my hands that would help me get control of my body again.
I had prepared for this appointment…I had real concerns that were impacting every corner of my life. The faucet of sweat that would randomly turn on while I was sitting still in an air-conditioned restaurant enjoying brunch, sending streams of sweat down my head and face. The sleep that had been disrupted every night for months due to that same sweat showing up in the middle of the night. Anxiety was back, I had kept her under control for the last two years and now she was now creeping around at the most inconvenient times. Most concerning of all, the cavernous sadness that would sweep over me with no real cause. Even in situations where joy was surrounding me, it was hard to transform it into actually feeling joyful. I had high hopes that today, I had a trained professional that would look at all of the pieces of this puzzle and find a solution.
What I got was a prescription for an anti-depressant, a suggestion that eating less carbs would stop the steady increase on the scale, prior to even one single question about how many carbs I was actually eating. Not one. She didn't ask what a normal day of food looked like for me or how often I exercised. She didn't ask anything. More like dismissed. Each of my concerns was quickly dismissed with a “that’s not perimenopause” almost before I finished my sentence.
Each one felt like a gut punch.
I left holding a prescription for an anti-depressant to “help the hot flashes”, the only thing she admitted was attributed to perimenopause, a directive to lose weight, and still not knowing for sure why I felt like a stranger in my own body. That's the part nobody warns you about. It's not just that you don't get an answer. It's that you leave with less confidence in yourself than you walked in with.
She’s not alone
Here's what I've learned since I started this journey: almost every woman I have met has a version of this exact story. The details change. The ending doesn't.
She's told to try yoga. She's told it's probably just stress. She's handed a referral to a therapist before anyone has asked a single question about her hormones, as if a weighted blanket and a gratitude journal are going to fix a body that's mid-transition. She's told to lose weight, cut carbs, drink more water, sleep more, like the answer to a system-wide shift in her body will appear if she just calms down a bit.
Some of us get the pamphlet. Some of us get antidepressants. Some of us get the doctor who nods along, types something into a laptop without making eye contact, and sends us on our way with a “let's keep an eye on it" or the old favorite "lose 15 pounds and follow-up in six months.” I've heard every version of this story at this point, and there's a pattern underneath the specifics that would almost be funny if it weren't costing women years of their lives: whatever she's actually asking about, the answer somehow always circles back to something she's doing wrong. Not enough exercise. Too much stress. Not managing her weight. Never once, not once, is the answer "your hormones are doing something predictable and there are actual treatments for it."
This isn’t a small thing. Experiences like this can cause a woman to decide to stop advocating for herself, one dismissive appointment at a time. Women who don’t have the resources to pursue multiple appointments just to have their initial questions taken seriously may just accept that they are the problem. It can even create reluctance in the future with other concerns.
The System (briefly)
I want to be clear: this isn't about villainizing doctors. Most of them are doing their best inside a system that has not ever made it a priority to teach them what they needed to know about maturing women’s health.
I offer exhibit A, the research that will piss you off: in a 2023 survey of OB-GYN residency program directors, only 31.3% reported that their program had any menopause curriculum at all, even though nearly 93% of those same directors agreed residents nationwide should have one. A separate national survey found that only about 1 in 5 residents received formal menopause education during training, and fewer than 7% felt genuinely prepared to manage a menopausal patient. One OB-GYN professor at Yale has said, on the record, that she gets exactly one hour to teach medical students about menopause during their entire rotation.
One hour. For a transition every single one of their future patients will eventually go through.
This isn’t malice, but a gap in training. But a gap doesn't feel neutral when you're the one sitting in the exam room with your gown that opens in the front. It costs women years, sometimes decades, of feeling like the problem is them instead of the education their doctor never received. And it's not an isolated gap, either. Women's health research overall has been chronically underfunded for decades, which means the doctors who wanted to learn more about this often couldn't find the research to learn it from. It's a gap feeding a gap.
What we deserve instead is simple to say and apparently hard to build: a doctor who asks real questions before reaching for a prescription pad, who treats "I don't know yet, let's find out" as an acceptable answer, and who understands that midlife hormonal change is not a personality flaw to be managed with portion control.
My story
This is the abridged version, because the full version needs its own space…this is a blog, not a novel after all.
I'd had a hysterectomy in 2007, years before any of this started, which meant I didn't have the signs everyone tells you to watch for. No missed periods to track. No obvious calendar clue. Just a cloud that first showed up on a trip through Scotland, of all places, standing on the Royal Mile feeling like something was wrong in a country I'd been genuinely excited to visit. I couldn't explain it and didn't have a name for it. It followed me home and eventually settled into a fall I can only describe as the bottom falling out.
I was already in therapy, which I will never stop being grateful for. My therapist asked me one question, almost casually, that changed everything: are you in perimenopause? I honestly didn't know. The thought hadn’t even crossed my mind. Nobody had ever connected those dots for me, mostly because I didn't have the one dot everybody assumes you'll have. She encouraged me to go find out anyway.
I went. I sat across from a doctor who was supposed to be good with “aging women’s issues”, and I told her the truth about what I'd been experiencing. As I listed each symptom, she dismissed it as “not caused by perimenopause.” She offered me an antidepressant almost as if to placate me and moved on. At some point as she dismissed my symptoms, tears welled up. The tears were part frustration and part anger, she read them as sadness. I took my prescription for the antidepressant, got dressed, and left, feeling more alone than when I'd walked in.
I am forever grateful that my therapist asked that question. Looking back, it probably saved my life. Not the doctor's appointment. The question that came before it, from someone who was actually listening.
What to do
If you're sitting in a version of this appointment right now, or dreading the next one, here's what I wish someone had told me.
Write your symptoms down before you go in, specific and dated if you can. "I've been tired" is easy to wave off. "I've woken up at 3am four nights this week for the last two months" is much harder to dismiss.
Ask direct questions instead of describing feelings. Try: "What tests would rule perimenopause in or out?" or "What would you check before recommending a lifestyle change?" A vague complaint invites a vague answer. A specific question invites a specific one.
If you're offered a solution before you've been asked a real question, it's fair to say so out loud. Something as simple as "before we go there, can I tell you more about what I'm actually experiencing?" resets the appointment without starting a fight.
If the appointment starts wrapping up before you feel heard, you're allowed to slow it down. "I don't think we've gotten to the bottom of this yet, can we talk through what testing would actually tell us?" is a complete sentence, and you're allowed to say it even if the doctor's hand is already on the door.
If you tend to go quiet under pressure, and a lot of us do, bring backup. A written list of symptoms you can hand over instead of trying to explain everything out loud in the moment. A friend or your partner in the room, not to speak for you, just so there's a witness to what actually got said. There's no rule that says you have to do this alone, even though it usually feels like there is.
And if none of that works, it is completely okay to find another doctor. You are not required to keep going back to someone who has already shown you they're not going to listen. That is exactly what I did. I had to wait to avoid paying out of pocket, but it was worth it. You deserve to be heard.
Your body is not the problem
Your body is not malfunctioning. It is not being dramatic. It is not asking for attention it doesn't deserve. It is doing exactly what a body in this stage of life does, whether or not the person across from you in the exam room had access to training to recognize it or if there is something else that makes them not a good fit to facilitate your medical care in this area.
You are allowed to keep asking questions until you get real answers. You are allowed to leave an appointment and decide it wasn't good enough. You are allowed to trust what you know about your own body over a pamphlet that was written in generalities.
If you're looking for somewhere to start making sense of what you're feeling, outside of any appointment, the Radiant Day Starter Kit is free. It's a short, honest daily practice built for the reality of midlife, not the version where you have unlimited time, energy, and a doctor who already has all the answers. You can grab it here: [link].
What was your version of this appointment? What happened, and what did you leave believing about yourself? Tell me in the comments below. I have a feeling this is going to be a very long thread.
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