I’ve been thinking a lot recently about the intertwined relationship between physical and mental health and just how inadequate a lot of information and education about our bodies is (particularly for women/afab folks). Perimenopause is an area where this comes up in a big way and I’ve found myself wanting to write the blog about perimenopause that I needed in my mid-late thirties. If you don’t have time to go any further, my main takeaway for you would be:
Menopause is not a cliff you fall off in your 50s*
This matters, because from personal experience I know that when you think it is, you’ll file anything about (peri)menopause in the box marked ‘for another day’, or ‘a long way off’ and then return to putting out whichever fires you are fighting which are currently most in danger of turning into a large inferno. When I look back now, I can see that I didn’t really realise ‘perimenopause’ was even a thing. I’m sure I’m not the only one in this position – overlooking it makes sense when big chunks of our society and medical profession also fail to acknowledge it. This knowledge gap results in missing symptoms, mis-attributing causes and missing out on doing the things that are helpful.
Why we avoid perimenopause
As well as the effects of fluctuating hormones, there are psychological and existential reckonings which often accompany this time of life. Complex feelings about having, or not having children, aging, (internalised) misogyny and ultimately…death? It’s no wonder lots of us have shoved perimenopause into a box for another day.
But (peri) menopause is not an inevitable decline and this transition can even have some positives, which I’ll talk more about later.
Additional barriers to perimenopause for queer folks
Alongside the general barriers to wanting to engage with perimenopause outlined above, healthcare and resources for this subject are often provided from and for a CisHet audience. The language around perimenopause is centred around women’s experience which can exclusionary and trigger dysphoria for trans and non-binary folks. Shout out to the Queer menopause project for the work they are doing to challenge this.
Early perimenopause symptoms
Our hormones often start fluctuating in our mid-30s. I didn’t realise that symptoms like hot flushes, or your periods stopping are often experienced towards the end of perimenopause, or menopause proper, and what tends to show up first in perimenopause are mental health symptoms. Firstly, progesterone starts to become more variable and then decline and this can manifest as worsening sleep and anxiety. Later, as oestrogen also starts to fall, along with the more widely recognised physical symptoms, brain fog, forgetting words, fatigue, and depression can also manifest (it’s important to note that all these symptoms can also be due to a range of causes, so it’s wise to get them checked out by a medical provider rather than assuming that perimenopause is the culprit). Hidden trauma and neurodivergence can also surface at this age, when declining and fluctuating oestrogen and progesterone can make masking, emotional regulation and executive function more difficult. Testosterone also starts declining in your 20s with an impact on libido, muscle and mood.
Another thing I didn’t realise is that Oestrogen is responsible for a wide range of jobs in our body and these go way beyond fertility and sexual function– blood sugar control, bone density, cardiovascular and brain health can all be impacted at this time.
Boring self-care becomes even more important
The good news is that there are things we can do to prepare and respond to the changes perimenopause brings. The bad news is that much of this is what I call ‘boring self-care’, the unglamourous, difficult taking care of yourself stuff, which becomes particularly important at this time. Oestrogen, in particular, helps you get away with a lot, so things like sleep hygiene, eating nutritious food, exercising (particularly strength-based work) and supporting your mental health become even more important when it starts fluctuating. If you can get this stuff in place before perimenopause rocks up in earnest, things become easier.
Beyond this, HRT is helpful/suitable for some people. When you’re younger and experiencing perimenopause symptoms, GPs can be hit and miss and private specialists can be useful if this is financially accessible.
Perimenopause – dare I suggest a bright side?!
We often avoid engaging with perimenopause because it’s presented as a relentlessly negative, terrible thing that’s going to happen to us. We’re hard-wired to avoid discomfort, so why would we want to engage? We’re particularly unmotivated for this before we ‘have to’, but as I’ve outlined here, these changes might start happening earlier than we think. Although hormone levels fluctuate and decline, that’s not the end of the story. Some people look forward to the end of periods. Beyond this there can also be positive psychological changes which emerge at this time. People with a history of people-pleasing may find that looking after themselves finally becomes a priority and that they stop caring quite so much what others think of them. I recently read Sara Szal relate perimenopause changes to the stages of life in Hindu philosophy and the ‘forest dweller’ (Vanaprashta ashram) involving “gradual withdrawal from worldly concerns and the sharing of one’s wisdom with others”. Modern society and/or capitalism means not all of us are able to change the pace of our lives in this way. We also might not want to! But re-visioning this period as a reduction in unwanted social obligations and a move towards simplicity, nature and peace definitely seems appealing to me as an introvert.
Further resources
https://www.saragottfriedmd.com/what-happens-to-our-hormones-after-35/
https://thebms.org.uk/wp-content/uploads/2026/01/17-NEW-BMS-TfC-What-is-the-menopause-JAN2026-A.pdf
https://www.queermenopause.com
https://drbrighten.com/adhd-and-menopause
* credit to Sara Szal for this expression
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