Reflecting on my perimenopause experience
You know you’re mid age when the conversation with girlfriends focuses more on menopause than on men. Sound familiar?!
And since I’m writing about mid age and how it’s impacting my longevity and vitality health journey, it made sense to dedicate a post to it here. I’d like to say upfront that when it comes to the subject of perimenopause, it’s extremely personal. It can be easy to advocate for one approach and I want to be clear that my approach and experience is unique to me, and isn’t supposed to persuade you to approach your experience in a similar way.
Okay, so let’s get into it. Perimenopause didn’t arrive for me in a sudden moment or a hot flash. Instead, it unfolded slowly, in the background of a life that otherwise felt steady and familiar.
Changes beneath the surface
In my early to mid-forties, I felt broadly well. My periods were still mostly regular, I wasn’t experiencing hot flushes or night sweats, and there was no obvious sense that I was suffering from any symptoms. And yet, beneath that apparent normality, my hormonal landscape was changing, with oestrogen fluctuating more unpredictably and less efficiently – whether I noticed it or not.
How do I know this? Because it’s biology. This is what happens to women as we enter our forties – sometimes earlier, sometimes later – but it happens nonetheless, and it happens gradually, over many years. Perimenopause (unlike menopause) isn’t a single event, it’s a prolonged transition, marked by a range of symptoms for many, arising from hormonal shifts that affect multiple systems in the body.
At the time, I considered myself, one of the “lucky” ones. Around 25% of women don’t experience the classic or severe symptoms we associate with perimenopause, and I thought I fell into that category. I have close friends who really suffered with difficulty sleeping, with brain fog, with increased anxiety (to name only a few symptoms) but I never took my relative ease for granted. All the while, I was waiting and worrying whether I was going to get symptoms and when, or whether it simply meant the changes were happening beneath the surface without me knowing it?
Like many of my friends, I grew up with a very different narrative. My mum’s attitude to menopause – shared by many women of her generation – was that you just suffer through it, in silence. You certainly wouldn’t be talking about it around the dinner table or over drinks! Grit your teeth, get on with it, and eventually it passes. That is so sad and I feel so lucky that there have been so many advancements since then in terms of medical research and generally, in society. It left me adamant that I didn’t want to just suffer in silence like she did. I was also doing the research at this point, and was learning from the work of neuroscientist Dr Lisa Mosconi and her book The XX Brain, about the links between perimenopause and increased Alzheimer’s risk.
At this point mum didn’t have a diagnosis of dementia, but she was experiencing cognitive decline, and given her father had dementia, we were certain this was what mum was experiencing.
Wait and worry or intervene early?
Dr Lisa Mosconi’s research reframes Alzheimer’s not as something that suddenly appears in later life, but as a disease that begins decades earlier, influenced by hormonal, metabolic and lifestyle factors that accumulate quietly over time. Oestrogen, is as she puts it neuroprotective. It plays a role in brain energy metabolism, synaptic health, and neural resilience. This explains why 75% of those who are diagnosed with Alzheimer’s are women – not as previously thought because they live longer.
So, if my body is naturally losing oestrogen, but I can ‘replace’ it in a supportive, informed way, why wouldn’t I? I was coming to learn from my research that there didn’t seem to be a downside to trialling hormone therapy. Although I should clarify that there is no current research to show that taking HRT reduces the risk of Alzheimer’s.
I knew I didn’t want to wait and see whether symptoms would arrive, or how bad they might become. I wanted to intervene early enough to support my body through a transition that was likely happening anyway. And given I may be more pre-disposed to dementia from a genetics perspective, I wanted to do as much as I could to protect myself.
By this point, my periods while still pretty regular, were changing – they were shorter in duration, but heavier in flow. But that wasn’t enough from my GP’s perspective. I didn’t tick a sufficient number of symptoms and they weren’t interfering with my life sufficiently to justify considering hormone replacement therapy (HRT).
But I knew by then that I wanted to go on HRT (I’ll come to my thoughts on this terminology shortly). I was concerned about my brain health and my risk of Alzheimer’s increasing as a result of the hormonal changes taking place. As I read more of the research by Dr Lisa Mosconi, I began to see perimenopause through a very different lens. Her work shows that oestrogen is not just a sex hormone, but it assists in brain metabolism, neural resilience, and long-term cognitive health. She talks about perimenopause as a neurological transition as much as a reproductive one.
This way of thinking is echoed in broader midlife health research, including work by Professor Sarah Berry at ZOE, which highlights how hormonal changes influence metabolic health, inflammation, insulin sensitivity, and cardiovascular risk long before symptoms or diagnoses appear. Once again, the message is consistent – just because we can cope, doesn’t mean nothing is happening.
Advocating for myself
Armed with this research, I went back to my (female) GP not asking for symptom relief, but asking questions, and, disappointingly, having to do a fair amount of educating along the way. Eventually she agreed for me to have a blood test, even though there’s again a lot of evidence to show that hormone levels during perimenopause are notoriously unreliable and blood tests don’t tell you very much in isolation. But it was the next step in the process and it was what was needed in order to be considered for HRT.
Ironically, the blood test revealed something I hadn’t been expecting at all – I had severely low iron levels, likely, the nurse said, as a result of the heavier periods I’d been experiencing. The nurse, thankfully, was a bit more pragmatic about HRT and she encouraged me to trial it out for 3 months.
When I started hormone therapy, almost immediately, my energy levels lifted quite dramatically. Yes, this fatigue can be explained by the iron deficiency, but I’d completely normalised a low-grade, ever-present fatigue without really questioning it. I must have just assumed that it was normal, or age-related, or simply part of my busy life. I should say I also started iron supplements, and remained on those for a while until my iron levels returned to normal and I wasn’t experiencing the heavy bleeds anymore.
The combination of estradiol patches for oestrogen and the Mirena coil as the progestogen component of my hormone therapy helped reduce my bleeding to almost nothing.
HRT or MHT, what’s the difference and does it matter?
We talk of Hormone Replacement Therapy (HRT) in the UK but I prefer the term Menopausal Hormone Therapy (MHT), following the language used by researchers like Dr Stacey Sims. “Replacement” implies deficiency or failure, as though something has gone wrong, whereas MHT frames this stage of life as a natural transition that may benefit from support. That distinction matters to me, because it shifts the narrative away from fixing something broken, towards working with the body in a more respectful, informed way.
I want to be clear that hormone therapy isn’t right for everyone. I’m generally cautious about taking any form of medication (or supplements), and lifestyle remains the foundation of my approach to my health now and in the longer term – movement, nutrition, sleep, stress management and connection are all my wellbeing non-negotiables. For me, hormone therapy sits alongside these lifestyle habits, offering support at a time when my body’s own hormone production is less reliable.
Over three years on, and I’m still very interested in the subject of HRT, the research and to listening to experts like Dr Mosconi. Most recently she was interviewed about her work by Dr Peter Attia – you can listen to their conversation here.
I also spoke to Dr Sarah Berry on the POINT3 podcast about menopause and how we can support ourselves through lifestyle and HRT – you can listen to our conversation here.
Underpinning all of this interest is my ongoing concern about my brain health. Alzheimer’s disease remains front of mind (pun intended!) for me and the research increasingly suggests that the years of perimenopause represent a critical time for brain ageing.
I’m under no illusion that hormone therapy is a guarantee, or that it replaces the importance of everything else I know matters – a healthy lifestyle. But for me, choosing Menopausal Hormone Therapy is about adding to the toolkit of protection.
I also think about the generational shift here. My mum’s approach – to endure perimenopause quietly and just get through it – came from a time when women had less information and fewer choices and there was little specific female medical research to learn from. I didn’t want to wait and see whether symptoms would arrive loudly enough to justify action, particularly knowing that I might never experience severe symptoms at all. I wanted to respond to what was happening biologically, not just what was happening symptomatically.
Debunking the concerns
There’s still a lot of concern out there around HRT due to the Women’s Health Initiative study that took place back in the 1990s in the US. Most experts now agree that the initial findings from this trial were widely misinterpreted and communicated without sufficient nuance. Subsequent reanalysis has shown that its conclusions were overgeneralised, particularly when applied to younger women or to modern hormone therapies. Despite this, a lingering hangover from those early media headlines continues to shape perceptions and concerns around hormone therapy today.
If you have concerns, the Menopause Society have created the following one pager outlining some key facts and debunking many myths that are common place around HRT.
I recommend speaking to your doctor, doing your own research and speaking to friends to find out about their experience.
Thanks for making it all the way here to the bottom of this blog!
Happy Friday x
Not The Mayo Clinic 