Feeling Foggy, Flat or Forgetful? The Hidden Hormone Shift We Need to Talk About

Originally published in Women's Agenda, October 2025.

A version of this piece was first published in Women's Agenda. We've shared it here for our community.

On a Monday morning, a woman I will call Grace sits across from me, half-laughing and half-pleading. "This can't be normal," she says. "It must be my thyroid. Or my iron." When I tell her those results have come back clear, her smile tightens. "So it's all in my head, then."

It isn't. And she is certainly not losing her mind. Grace is in perimenopause, the hormonal transition that can begin years before a woman's final period, and quietly reach into nearly every system in the body.

We have been taught to expect a tidy version of menopause: a few hot flushes, some mood swings, and then it is over. The reality is far messier, and far more personal. For many women, the earliest signs are the quiet ones. Broken sleep. A fog that settles over the mind. A thread of anxiety that was not there before. And because so few people talk about it, women end up in consulting rooms like mine asking the same question: what is wrong with me?

The answer is often nothing wrong at all. It is a body in transition, doing something entirely natural, with very little warning and even less acknowledgement.

The many faces of perimenopause

Perimenopause looks different on every woman, and even on that same woman, every month.

It is the senior executive in her late forties who has started second-guessing herself in meetings, losing words mid-sentence, quietly terrified she is losing her edge.

It is the woman who has always been the calm one, now waking at three in the morning with her heart pounding, told by everyone around her that it is "just stress."

It is the new mother of twins after years of trying, who was never warned that the night sweats and insomnia might outlast the newborn phase.

It is the teacher whose periods have become so heavy and unpredictable that some days she cannot leave the house.

It is the woman pushed abruptly into menopause by cancer treatment, who met surgery and chemotherapy with composure, and finds it is the hot flushes that finally undo her.

And it is the woman with no troublesome symptoms at all, who lies awake worrying about the osteoporosis she watched her own mother live with.

Different women, different lives, all moving through the same season of change.

Perimenopause is a transition that deserves the same clinical attention as every stage that came before it.

The science behind the shift

In early perimenopause, ovulation still happens, just less reliably, and progesterone often does not rise as high as it once did. Over time, the ovaries fall further off schedule. Ovulation becomes irregular, and oestrogen levels begin to swing unpredictably. Those ebbs and surges do not affect periods alone. They can influence mood, sleep, memory and concentration, temperature regulation, bleeding patterns, libido and bone health. For some women the changes are subtle. For others, they can turn daily life upside down.

A long overdue conversation

For decades, women's health has been a blind spot in medicine: under-researched, underfunded, and too readily dismissed. In the menopause space, a single large study in the early 2000s deepened the confusion, sparking years of fear around menopausal hormone therapy (MHT, once known as HRT). A generation of women stopped their treatment, the next avoided it altogether, and their daughters are now caught somewhere between the science and the fear.

That is finally changing. Clinicians are looking past the old headlines to what the evidence actually shows, and a more honest, more nuanced conversation is taking hold. For many women, particularly those who begin it around the time of menopause, MHT is both safe and effective. The blanket fear was never the whole story.

Care as partnership

As a women's health GP, and the founder of a female-led practice, I want this growing recognition to translate into something lasting. Good care is not prescriptive. It is a partnership, guided by science, shaped by evidence, and grounded in what matters to the woman in front of me. Much of my work is simply bridging the gap between the research and real life, so that every woman can make the choice that is right for her.

Reclaiming this chapter

We finally have both the science and the willingness to talk about this openly. What women need next is confidence: in their own bodies, in their doctors, and in the systems meant to support them. Clinicians who listen. Communities that share honestly. A healthcare culture that values lived experience as much as it values lab results.

This stage is not an ending. It is a powerful new beginning, and the conversation has well and truly begun.