At 41 years old, the patient thought she was going crazy. It was perimenopause

At 41 years old, the patient thought she was going crazy. It was perimenopause

A pharmacist explains what is happening to millions of women who never received this information

She walked into the office with a list.

Not a shopping list a list of symptoms. Written by hand, on paper, because there was so much to say that she was afraid she would forget something. Anxiety. Insomnia. Irregular cycles. Joint pain. Brain fog. Palpitations. A persistent feeling that her own body had stopped being reliable.

She was 41 years old.

The tests were normal. The doctor had suggested antidepressants. She did not want antidepressants she wanted answers.

What she had was perimenopause.

The phase medicine learned to ignore

Perimenopause is the hormonal transition that precedes menopause. It can last from 2 to 12 years. It begins, on average, between ages 40 and 44 — but can start at 35.

Nearly half of all women in the world have never heard this word before they start feeling it.

This is not an accident. It is the consequence of decades of medicine that treated female hormones as relevant only in the context of reproduction and systematically ignored the transition that comes afterward.

The result is millions of women between 35 and 50 living with significant symptoms, receiving incorrect diagnoses generalized anxiety, depression, chronic fatigue syndrome or simply being sent home with the recommendation to “reduce stress.”

What actually happens to the hormones

Here is something most people including many doctors do not know: in perimenopause, estrogen is not the first hormone to drop.

Progesterone drops first.

Progesterone is the hormone of the second half of the menstrual cycle. It has a calming effect on the central nervous system, promotes deep sleep, and stabilizes mood. When it begins to decline sometimes years before any menstrual irregularity the first symptoms that appear are anxiety, insomnia, and mood changes.

Not psychologically caused depression. Not stress from “modern life.” Direct hormonal fluctuation affecting neurotransmitters.

And then estrogen begins to oscillate. It does not fall in a straight line it rises and falls erratically. Sometimes it is higher than before. Sometimes it drops abruptly. This instability, more than the decline itself, is responsible for the most intense and unpredictable symptoms of perimenopause.

The test that comes back “normal” and explains nothing

FSH — follicle-stimulating hormone is the standard test for evaluating menopausal transition. The problem: during perimenopause, FSH fluctuates enormously from week to week. A test done during a period of low fluctuation comes back within normal range even when the woman is in full transition.

This means a normal result does not rule out perimenopause. The correct diagnosis is clinical based on symptoms, menstrual history, and the patient’s stage of life.

The woman who left the office without a diagnosis after a normal FSH was not poorly served out of bad faith. She was poorly served because of a lack of information which is exactly what we are here to change.

The symptoms nobody connects to perimenopause

Hot flashes and menstrual irregularity are the best-known symptoms. But perimenopause has a much broader presentation:

That medicine frequently treats separately, without seeing the connection:

• New or intensified anxiety → treated with anxiolytics
• Brain fog and difficulty concentrating → investigated neurologically
• Joint pain → referred to rheumatology
• Recurring urinary tract infections → treated individually with antibiotics
• Depression → treated with antidepressants

Each of these symptoms can have other causes. But when they appear together, in a woman between 35 and 50, perimenopause needs to be in the differential diagnosis always.

The window that most women do not know they have

Here is the information that matters most and circulates least:

Perimenopause is not just a period of symptoms to be endured. It is a window of opportunity for the health of the next decades.

The decisions made during perimenopause what you eat, how you move, how you sleep, how you manage stress have proven impact on the risk of cardiovascular disease, osteoporosis, cognitive decline, and type 2 diabetes in the years that follow.

The woman who enters postmenopause with preserved muscle mass, healthy bone density, controlled inflammation, and a balanced microbiome will have a completely different experience from the one who arrived there without these foundations.

And all of this is built during the transition.

What works with evidence, not with hope

As a pharmacist, I am skeptical by nature. What I recommend is evidence-based: Strength training: It is the most effective intervention available for women in perimenopause. It preserves muscle mass, increases insulin sensitivity, improves bone density, and regulates mood. Two to three sessions per week produce measurable results in 8 to 12 weeks. If symptoms do not improve, consult your doctor for further evaluation.

Magnesium glycinate: Supports sleep, reduces anxiety, relieves cramps. Magnesium deficiency is extraordinarily common in women over 35 and rarely investigated.

Adequate protein: Minimum 1.2g per kilogram of body weight per day. Most women who try to lose weight during perimenopause eat less protein than they need which accelerates muscle loss and worsens insulin resistance.

Reducing alcohol: Even moderate amounts intensify hot flashes, disturb sleep, and burden the liver responsible for hormonal metabolism. The impact is immediate and measurable.

Ashwagandha: With growing evidence for cortisol reduction, improvement of anxiety, and sleep quality all central symptoms of early perimenopause.

For the woman who recognized herself in this text

If you are between 35 and 50, if your cycles have changed, if anxiety arrived out of nowhere, if sleep has never been so bad, if your body feels like it no longer belongs to you you are not exaggerating.

You are in transition.

And there is a name for what you are living. There is information. There is support. There are professionals who understand and who will listen to you without suggesting it is all in your head.

The first step is knowing that what you feel is real.

Vilma Mendonça is a pharmacist (CRF 9930RJ), specialist in Phytotherapy, Homeopathy and Cosmetology. She writes about menopause health at mariahchic.com/menopause

Also read: Perimenopause: What It Is, When It Starts and Why Nobody Prepared You for It