Many women entering perimenopause struggle to put words to what they are experiencing. They often say, “I don’t feel like myself anymore,” even when they can’t identify a single symptom that feels concrete or diagnosable. Emotionally, something feels different. Physically, their bodies feel unfamiliar, more aches, more pains, weight changes, or a sense that it’s harder to “get back on track.” Cognitively, many notice brain fog or a lack of sharpness that feels especially alarming for professional women whose confidence is tied to their mental clarity.
What’s most striking is not just the symptoms themselves, but the meaning women assign to them. In midlife, many women report a growing sense that they are no longer enough, or no longer who they used to be. This experience is particularly common during perimenopause, a phase marked not by hormonal absence, but by fluctuation. Unlike menopause, where estrogen and testosterone levels are more consistently low, perimenopause is defined by variability. Estrogen, progesterone, and testosterone rise and fall unpredictably, affecting energy, mood, cognition, and stress tolerance.
This transition often coincides with one of the busiest seasons of a woman’s life. Many are at the peak of their careers, stepping into leadership roles or finally enjoying the fruits of decades of work. Others are raising young families, caring for aging parents, or juggling both. When capacity shifts during this phase, it can feel like too many balls in the air, and when one drops, self-blame often follows. Instead of asking what might be changing biologically or environmentally, many women internalize the experience as personal inadequacy.
When I describe hormones as the language of the body, I mean this quite literally. Hormones are messengers. They allow organ systems to communicate with one another through intricate feedback loops. A change in one hormone often prompts a compensatory change in another. These interactions are nuanced, dynamic, and deeply individualized. Yet in clinical practice, hormones are frequently reduced to numbers on a page. Lab values matter, but they do not tell the whole story. Numbers must be interpreted in the context of the person sitting in front of us: her symptoms, her stress load, her life stage, and her lived experience. Perimenopause is not simply a problem of low or high hormone levels. It is a shift in signaling, and signaling changes how the body experiences the world.
Many women are socially conditioned to feel responsible for everything: keeping the peace, meeting expectations, accommodating others, and functioning smoothly no matter the cost. When they start to feel less resilient, less patient, or less capable, the instinct is to turn inward rather than outward. Instead of asking, “What support do I need during this transition?” the question becomes, “What is wrong with me?” Perimenopause and menopause are natural developmental stages. They are not failures of discipline, mindset, or effort. Yet culturally, we have not normalized these transitions. Instead, women are often made to feel that they are declining, falling apart, or losing something essential. This narrative does real harm.
In conventional medicine, women are frequently reassured that their labs are normal. While this may be technically accurate, it can also be profoundly invalidating. Symptoms persist. The body feels different. And without an explanation, women are left searching for answers, often concluding that the problem must be them. From a functional and preventive perspective, we look beyond normal versus abnormal. We look at optimal ranges, patterns, and early shifts that may not yet meet diagnostic thresholds but still affect quality of life. When care stops at “everything looks fine,” women are left without language for what they are experiencing.
Culturally and medically, women are taught to push through symptoms and stay productive. When they are younger, this often works because youth provides resilience and recovery. Over time, however, chronic override catches up. Repeatedly ignoring the body’s signals (whether hormonal or nervous system-related) can lead to chronic fatigue, persistent dysregulation, and a sense of disconnection from one’s own body. It becomes increasingly difficult to show up fully, whether as a physician, professional, partner, parent, or friend. Listening is not weakness. It’s a form of intelligence.
Listening to the body begins with awareness. Many of us live “from the neck up,” disconnected from physical sensations and internal cues. The first step is noticing: symptoms, patterns, trends, and changes over time. This might mean keeping notes, journaling, or simply pausing long enough to observe what is happening internally before rushing to fix it. Not every symptom requires immediate medicalization, but patterns deserve attention. Listening also involves compassion. If the body is asking for more rest, that request matters. If energy is lower, support must change. This includes basics that are often overlooked: sleep, hydration, protein intake, vitamin D, time outdoors, moments of stillness, and nervous system regulation. Only after listening comes investigation, whether with a primary care clinician, gynecologist, or practitioner trained to look at hormonal patterns through a broader lens.
Perimenopause can begin in the 30s and is a normal part of female development. Yet many women are afraid to name it, discuss it, or acknowledge it. If we framed perimenopause as a developmental transition rather than a decline, the experience would change dramatically. Language matters. Perspective matters. This phase does not signal loss of worth, vitality, or relevance. It signals change, and change requires new support.
We do not need to personally experience perimenopause to care for women going through it well. What we do need is the willingness to listen, to honor the information women bring us, and to recognize that symptoms without clear explanations still deserve validation. Time constraints and system pressures are real. Fifteen-minute visits are challenging. But even within those limits, clinicians can offer something powerful: presence, empathy, and belief. When we are regulated ourselves, we can become a safe container for patients navigating uncertainty. Sometimes being an empathetic witness is as impactful as any prescription. Perimenopause is not a failure of women’s bodies. It is a conversation, one we need to learn how to hear.
Claudine Holt is an occupational medicine physician and life and embodiment coach.
