Why Perimenopause Gets Missed
Every September, Perimenopause Awareness Month draws attention to one of the most significant and most neglected transitions in a woman's life. World Perimenopause Day falls on September 22. And every year, I use this time to say what I wish someone had said to me — and to every woman sitting in my office who arrived after years of being told her symptoms were stress, or aging, or anxiety, or simply not serious enough to investigate further. Perimenopause is the hormonal transition leading up to menopause. It is not a moment. It is not the year before your last period. For many women, it begins in the mid-to-late thirties and continues for up to a decade — a significant stretch of a woman's most professionally and personally demanding years, unfolding largely without acknowledgment or accurate medical language. The numbers tell the story plainly. A 2025 national survey found that nearly 40 percent of women who sought care for perimenopausal symptoms felt misdiagnosed. Only 42 percent had a provider who initiated the conversation about perimenopause at all. And research from the Clue app found that 70 percent of women don't know what perimenopause is, while 90 percent do not feel well-informed about it. These are not minor gaps. They represent years of women's lives spent managing symptoms one at a time — with antidepressants, sleep aids, anti-anxiety medications, and GI referrals — while the underlying hormonal disruption driving all of it goes unnamed and untreated.
You deserve a provider who treats this decade of your life as the significant and consequential medical transition it actually is.
What Perimenopause Actually Is
Perimenopause is the transitional phase during which estrogen, progesterone, and other reproductive hormones begin fluctuating and gradually declining before the final menstrual period. The defining biological feature is not the absence of a period — it is hormonal volatility. Estrogen does not decline in a smooth, predictable line during this phase. It swings, sometimes surging above normal premenopausal levels before dropping, then surging again, creating a physiological environment that is anything but stable.
Because estrogen receptors exist throughout the body — in the brain, the cardiovascular system, the bones, the gut, the skin, and the urinary tract — this hormonal instability affects nearly every system simultaneously. The result is a symptom picture that can look, to a provider without training in menopause medicine, like several different conditions happening at once rather than one coherent hormonal transition.
Why Perimenopause Gets Missed
The challenge starts with diagnosis: there is no single blood test that confirms perimenopause. FSH levels can be checked, but they fluctuate so significantly during this transition that a single normal result does not rule it out. The diagnosis is clinical — meaning it is built from the pattern of symptoms, the timing of their onset, and a provider's familiarity with what perimenopause looks and feels like.
That familiarity is rare. Research has consistently found that a minority of OB/GYN residency programs include formal menopause training, and surveys of medical residents have shown that the majority report feeling unprepared to discuss or treat menopausal symptoms. When a forty-two-year-old woman presents with new anxiety, disrupted sleep, and a sense that she is simply not herself, a provider without perimenopause training is unlikely to connect those symptoms to fluctuating estrogen. They are far more likely to treat what they see — and write a prescription for what is visible rather than asking what is driving it.
The downstream consequences of this are real. Women spend months or years managing symptoms individually while accelerated bone loss, rising cardiovascular risk, and worsening metabolic function continue unchecked. The perimenopausal window is precisely the time when lifestyle interventions and, for appropriate candidates, hormone therapy, have their most significant impact on long-term health. Missing that window is not a neutral outcome.
The Symptoms That Should Start the Conversation
The most common early symptoms of perimenopause are not always the ones women or their providers associate with hormone change. Irregular periods, while classic, are often among the later signs. The symptoms that tend to arrive first include:
Changes in mood and emotional regulation. New or worsening anxiety, a lower threshold for stress, emotional reactivity that feels disproportionate to circumstances, crying more easily, and a persistent sense of internal unease are among the earliest and most underrecognized markers of the hormonal transition. Research published in the journal Menopause has specifically identified "not feeling like myself" as a clinically meaningful perimenopausal symptom — not a vague complaint, but a real and describable experience that deserves investigation.
Sleep disruption. Difficulty falling asleep, frequent waking, or waking in the early hours without being able to return to sleep — particularly when accompanied by night sweats — are hallmark features of perimenopause that are regularly attributed to stress or lifestyle factors without any consideration of hormonal drivers.
Cognitive changes. Brain fog, difficulty retrieving words, reduced concentration, and memory lapses are consistently reported by women in perimenopause. They are also consistently dismissed. The research on estrogen's role in cognitive function is substantive and growing, and these symptoms deserve the same clinical investigation as any other.
Vasomotor symptoms. Hot flashes and night sweats are the symptoms most strongly associated with menopause in the public imagination — and they can and do appear during perimenopause, sometimes years before the final menstrual period.
Physical changes. Joint aches, new digestive sensitivities, changes in skin texture, altered libido, heart palpitations, and shifts in body composition — particularly abdominal weight gain that does not respond to previous strategies — are all documented features of the perimenopausal transition.
What You Can Do Right Now
If any of this resonates with your experience, September is a meaningful time to act on that recognition.
The most important step is naming it. If you are in your late thirties, forties, or early fifties and something has felt persistently different — in your mood, your sleep, your energy, your body — bring perimenopause explicitly into your next medical conversation. Do not wait for your provider to raise it. Many will not, not because they are dismissive, but because the training system has not yet equipped them to recognize it.
Come prepared with a timeline — when symptoms started, how they have progressed, which ones are most affecting your quality of life. Ask specifically whether hormonal fluctuation could be contributing. If your provider dismisses the possibility without meaningful discussion, ask for a referral to someone with specific training in menopause medicine, or seek one out directly. The Menopause Society maintains a directory of certified practitioners.
You deserve a provider who treats this decade of your life as the significant and consequential medical transition it actually is. Awareness Month exists to remind you — and the healthcare system — that settling for less than that is optional.
Defy Menopause - Own the Change
Many women tell me: "One day I feel amazing. The next, I can barely get out of bed. Is this normal?"
Yes, it is. And no, you don’t have to suffer through it alone.
Hormonal fluctuations during perimenopause can make you feel like you’ve lost control of your body. But knowledge is powerful. And there are clear, science-backed ways to support your hormones, ease symptoms, and reclaim your energy.
That’s exactly why I created Defy Menopause: Own the Change — a 30-day program designed to give you the tools, knowledge, and support you need to move through these changes with clarity and confidence.
Inside, you’ll find:
Access to Dr. Tracy Verrico at one (1) live, group session
Clear action steps for managing symptoms naturally
Because you deserve more than just "putting up with it."
You deserve to thrive.
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Medical Disclaimer: The information provided in this blog is for general educational and informational purposes only and is not intended as, nor should it be considered, medical advice. This content does not establish a physician-patient relationship and is not a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified healthcare provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay seeking it because of something you have read in this newsletter. If you think you may have a medical emergency, call your doctor or emergency services immediately.
References
1.Biote. Nearly 40% of Women Say They Were Misdiagnosed During Perimenopause. 2025 Perimenopause Focus Survey. ir.biote.com. November 2025.
2. Clue. Perimenopause Awareness Survey. Cited in multiple media reports, September 2024.
3. Allen JT, Laks S, Zahler-Miller C, et al. Needs assessment of menopause education in United States obstetrics and gynecology residency training programs. Menopause. 2023;30(10):1002-1005.
4. The Menopause Society. Perimenopause and the Menopausal Transition. Clinical guidance. menopause.org
5. Santoro N. Perimenopause: From Research to Practice. J Womens Health (Larchmt). 2016;25(4):332-339.
6. Harlow SD, Gass M, Hall JE, et al. Executive summary of the Stages of Reproductive Aging Workshop + 10. Climacteric. 2012;15(2):105-114.
7. Perimenopause Awareness Month. perimenopauseawareness.com. September 2024.
