By Dr. Lisa Saul, Chief Medical Officer of Women’s Health for UnitedHealth Group
You’re wide awake at 3 a.m. for no obvious reason. Your patience is gone by 9 a.m. You walk into a room and forget why. You reread the same email three times and still don’t get it.
So you blame stress. Work. Kids. Aging parents. The Tuesday that somehow has three things happening at once.
And sure, life is doing a lot right now. But for many women in their late 30s through early 50s, there may be another explanation hiding in plain sight: perimenopause.
Menopause officially begins after 12 consecutive months without a period. Perimenopause is the transition leading up to menopause, when hormone levels begin to shift unpredictably.
The tricky part is that perimenopause doesn’t always start with the signs people expect. Often before hot flashes or obvious period changes, women notice sleep problems, fatigue, mood changes, trouble focusing or just a sense that something feels off. It can also show up as night sweats, anxiety, joint aches, vaginal dryness or headaches.
Why women don’t always connect the dots
Perimenopause can be easy to miss because, for some women, it looks a lot like modern life.
You’re exhausted, but you have a full-time job and a full-time everything else. You find yourself losing your train of thought or struggling to focus, but figure it’s because you’re juggling a hundred things at once.
You’re more irritable than usual, but there is always a reason. Deadlines. Family schedules. Caregiving. Not enough sleep. Too much on your plate. So the dots don’t always get connected right away. Women may spend months, or even years, trying to push through before realizing those changes may be connected.
That can be especially frustrating because perimenopause isn’t just about one symptom. It can affect multiple aspects of daily life at once.
When it follows you to work
Brain fog is annoying when you forget why you opened the fridge. It feels different when you’re in a meeting and suddenly lose your train of thought, or when a task that used to take 20 minutes now takes all morning.
But it’s not always just about focus and memory. Many women describe feeling more anxious, depressed or emotionally depleted.
And that can be especially challenging because this stage of life often arrives during one of the busiest chapters of adulthood. Many are building careers, managing households, caring for kids, supporting aging parents or doing all of it at once. So when sleep is disrupted, focus slips or anxiety spikes, the effects can also show up at work.
Nearly 3 in 4 women say menopause symptoms have negatively affected some aspect of their work life, and 1 in 5 say those symptoms have affected their income. That doesn’t mean women are less capable. It shows how disruptive this stage can be when it overlaps with careers, caregiving and everything else women are already managing.
Why it doesn’t look the same for everyone
One reason perimenopause can be so confusing is that there is no single version of it.
Some women may have mild changes they can manage with lifestyle adjustments. Others experience symptoms severe enough to disrupt their daily life.[1] Health history, stress, access to treatment and support, and whether their concerns are taken seriously can all shape that experience.
Black and Hispanic women often carry more of that weight. They’re more likely to start perimenopause earlier, stay in it longer, and deal with more severe symptoms. Those differences are shaped in part by long-term health inequities – often called weathering, or the toll chronic stress can take on the body over time.
If your experience feels harder than what you’ve heard described, or if you have had to work harder to get answers, you’re not alone.
Why answers can be hard to get
One of the most frustrating parts of perimenopause is that symptoms are often discussed one at a time.
Sleep issues are treated as sleep issues. Anxiety is treated as anxiety. Concentration issues are written off as stress. When those pieces are not viewed together, the bigger picture can be missed.
Women often find themselves piecing together answers across multiple appointments and providers. Menopause care is not consistently taught across clinical training, which can contribute to delayed answers or women feeling unheard when they seek help. In fact, 70% of OB-GYNs report no menopause-specific training during residency, and only 57% of practicing physicians are current on hormone therapy guidance.
That is not a reason to skip the doctor. It is a reason to walk in prepared.
How to advocate for yourself
If changes in sleep, mood, focus, periods, or energy are affecting your daily life, it’s worth starting a conversation with a health care provider.
A few ways to make that conversation more useful:
- Track patterns. Keep a running note in your phone of anything that feels different. Over time, it may help you spot patterns and have a more productive conversation with your doctor.
- Name the impact. Instead of saying, “I feel off,” try, “I am waking up at 3 a.m. most nights,” “I am having trouble concentrating at work,” or “My mood feels different and it is affecting my life.”
- Ask directly. A simple question like, “Could this be perimenopause?” can help connect concerns that may otherwise seem unrelated.
- Ask about options. Depending on your health history and needs, support may include lifestyle changes, mental health resources, hormone therapy or nonhormonal treatments.
- Keep asking if you don’t feel heard. If your concerns are brushed off or you leave without a clear path forward, it’s reasonable to ask more questions or seek a provider with experience in perimenopause and menopause care.
You know your body. If something feels different, that matters.
Why this is a good time to put yourself back on the list
Open enrollment is often the only time of year when people can review their health coverage and consider whether it still fits their needs.
Women often spend so much time taking care of everyone else that they don’t think about their own health until they can no longer ignore it. Open enrollment is an opportunity to put yourself at the top of the list.
As you compare plans, consider whether you have access to the providers, treatments, mental health support and womens health resources that fit your needs today. That may include behavioral health support, hormone therapy, nonhormonal treatment options or specialized resources, depending on your benefits. UnitedHealthcare, for example, helps connect eligible members with treatment options, information and care resources that may help them better understand and manage these symptoms.
The health coverage you had last year may not be the best match for the stage of life you’re in now. That is okay. Your health needs are allowed to change.
Perimenopause is natural, but that doesn’t mean you have to simply push through it. Pay attention to what your body is telling you. Ask questions. Seek support. And remember – taking care of yourself is what helps you keep showing up for everyone else.
