Monday morning, I sit across from Grace. “This can’t be normal,” she says, half-laughing, half-pleading. “Surely it’s my thyroid? Or maybe my iron?” When I tell her her results are fine, she forces a smile that doesn’t reach her eyes. “So maybe it’s all in my head, then.” I meet women like Grace every day, not quite feeling like themselves and desperately searching for answers but not entirely sure they’ll find them. Grace wasn’t imagining it, and she’s certainly wasn’t losing her mind. She was entering perimenopause , the hormonal transition that can begin years before the final period and quietly influence almost every system in the body.
We’ve long been told menopause means a few months of hot flushes and mood swings, then it’s over. In truth, perimenopause is far messier, and far more individual. For many, the first changes are silent ones: restless sleep, brain fog, a flicker of anxiety. And when no one talks about it, women are left in consulting rooms like mine wondering, what’s wrong with me?
So what is perimenopause… It’s Sophie, 49 , a COO at the peak of her career. But lately she’s been second-guessing herself, misplacing her keys, and blanking on words mid-presentation. Terrified she’s loosing her edge… or even her mind.
Amira, 47, juggles work, teenagers, and caring for her mother. Calm by nature, she now wakes at 3 a.m. with her heart racing. Her husband tells her it’s “just stress.” But surely it’s something more.
It’s Lucy, 43, finally a Mum to twins after years of IVF. She jokes she dreamed of this chaos and the sleepless nights, but no-one told her that the night sweats might never leave after breastfeeding.
It’s Kate, 45, a high-school teacher who’s had to take a term off school and apologises for
cancelling her appointment… yet again. Her periods have become so heavy she just can’t leave the house.
It’s Emily, 36, thrust into menopause after bowel-cancer treatment. She handled surgery and chemo with quiet grace, yet the hot flushes are what finally breaks her composure.
And It’s Anna, 51, who feels guilty when she admits she’s has “no symptoms” but the fear of having her mother’s osteoporosis keeps her awake more than any hot flush ever could.
Different women, different lives yet all navigating the same season of change.
The science behind the chaos
During early perimenopause, ovulation still happens, just not as efficiently, and with this progesterone doesn’t rise as high as it use to, fast forward and the ovaries can’t keep to schedule anymore, as ovulation becomes irregular and estrogen levels can fluctuate unpredictably. These ebbs and swings don’t only just effect periods, the can alter mood, sleep, cognition, temperature control, bleeding, libido, bone health and more. For some, the shifts are subtle; for others, they can turn life upside down.
A long-overdue spotlight
For decades, women’s health has been a blind spot in medicine: under-researched, under-funded, and often dismissed. In the menopause space, the cherry on top was the WHI study. A single piece of research that deepened confusion and sparked years of fear around hormone therapy – prompting a generation of women to abandon their hormone therapy, another to avoid it altogether and their daughters now conflicted between the science and fear. Now, at last, the tide is turning. Doctors are looking past the headlines to the science, and a new conversation is emerging. Podcasts, posts and
panels are shining a long-overdue spotlight on women’s health.
When Care Becomes Conversation
As a women’s health GP and the founder of a female-led practice, I want to see this growing recognition translate into lasting change. I’ve built my work on one core principle: women should be heard, respected, and empowered to understand their own health. Good care isn’t prescriptive; it’s a partnership , guided by science, shaped by evidence, and grounded in what matters to each woman. My role is to bridge the gap between research and real life, so every woman can make choices that feel right for her.
Reclaiming this Chapter
Today, we have both the science and the courage to talk about it. What women need next is confidence in their bodies, in their doctors, and in the systems that support them. They need clinicians who listen, communities that share, and a healthcare culture that values lived experience as much as lab results. It’s time to see this stage not as an ending, but as a powerful new beginning. The conversation has begun, one grounded in science, compassion and the belief that women deserve better.