The Soulful GP Perimenopause Series | Part One
You are not going mad.
Let me say that again, because I need you to really hear it.
You. Are. Not. Going. Mad.
You are not suddenly “bad at your job.” You are not becoming a bad mother. You are not developing early dementia. You are not “just stressed.” And you are absolutely, categorically not imagining it.
What you are is a woman in perimenopause - and nobody warned you.
The moment everything changed
Picture this. You are 42. Maybe 38. Maybe 45. You have always been the person who holds everything together - the career, the family, the friendships, the mental load of a small nation.
And then, almost overnight, something shifts.
You wake up at 3am drenched in sweat, heart hammering, convinced something terrible is about to happen - but nothing is. You walk into a room and forget why you are there. You snap at your children over something small and then cry in the bathroom because you don’t recognise yourself. Your shoulder has been frozen for six months and three different doctors have told you it’s “just tension.” You’ve started getting hives. You’ve put on weight around your middle despite eating the same way you always have. You feel anxious in a way that is new and nameless and frightening.
You Google your symptoms. The results say anxiety disorder. Depression. Early-onset Alzheimer’s. Autoimmune disease.
Nobody - not one website, not one GP, not one well-meaning friend - says the word perimenopause.
This is the story I hear every single week. And it has to stop.
So what actually is perimenopause?
Here is the truth that the medical system has been slow to communicate, and that our cultures have been even slower to discuss.
Perimenopause is not just a few hot flushes before your periods stop. It is a whole-body biological transition that can begin in your late 30s or early 40s - sometimes a full decade before your last period - and it is driven by fluctuating levels of two of the most powerful hormones in your body: oestrogen and progesterone.
Here is why that matters. Oestrogen receptors are not just in your uterus. They are in your brain, your joints, your gut, your skin, your immune system, your heart, and your blood vessels. Oestrogen is, in many ways, the body’s great regulator. When its levels begin to fluctuate wildly - spiking and crashing unpredictably before eventually declining - the effects are felt everywhere.
And progesterone? That is your calming hormone. The one that helps you sleep, keeps anxiety at bay, and gives you that sense of steadiness. Crucially, progesterone often drops first, before oestrogen, leaving many women in a state of relative hormonal imbalance that produces anxiety, insomnia, and emotional volatility - sometimes years before their periods even become irregular.
This is not weakness. This is biology.
The symptoms nobody talks about
We have all heard about hot flushes. Fine. But let me tell you about the symptoms that are sending women to neurologists, rheumatologists, and psychiatrists - when what they actually need is a conversation about their hormones.
Brain fog and memory lapses. Oestrogen regulates how your brain uses glucose for energy. When levels fluctuate, your brain’s fuel supply becomes unreliable. The result? You lose words mid-sentence. You re-read the same paragraph four times. You forget the names of people you have known for years. Brain fog is a well-recognised symptom of perimenopause - though any persistent or concerning cognitive changes should always be properly assessed by a clinician to rule out other causes.
New-onset anxiety and panic attacks. If you have never been an anxious person and suddenly find yourself waking at 3am with a racing heart and a sense of impending doom, it is worth knowing that hormonal changes are a recognised and common driver of these feelings. The loss of progesterone’s calming effect on the nervous system, combined with erratic oestrogen fluctuations disrupting serotonin and dopamine pathways, can produce anxiety that feels entirely new and unfamiliar. That said, anxiety and depression during this time deserve proper assessment - sometimes hormonal changes and mental health conditions overlap, and both may need attention.
Joint pain and frozen shoulder. Oestrogen is naturally anti-inflammatory. It lubricates your joints. When it declines, inflammation rises - and it often shows up first in the shoulders and hands. Countless women are referred to physiotherapy or rheumatology for what is, at its root, a hormonal problem.
Histamine intolerance. This one surprises people. Oestrogen regulates the enzyme that breaks down histamine in your body. When oestrogen fluctuates, histamine builds up - causing hives, worsening allergies, asthma flares, headaches, and even heart palpitations. If you have suddenly developed “allergies” in your 40s, this may be why.
Weight gain around the middle. Declining oestrogen reduces your insulin sensitivity and shifts where your body stores fat - from the hips and thighs to the abdomen. This is not a failure of willpower. It is a metabolic shift driven by hormonal change.
Vaginal dryness and painful sex. The genitourinary tissues - vagina, bladder, urethra - are richly supplied with oestrogen receptors. As oestrogen declines, these tissues thin and dry out. This is called Genitourinary Syndrome of Menopause (GSM), and it affects the majority of women. It does not go away on its own. It is treatable. And it is nothing to be ashamed of.
The pattern here is consistent: these symptoms are real, they are biological, and they are being missed - particularly in women from ethnic minority communities, where cultural silence and systemic healthcare bias create a double barrier to diagnosis and treatment.
The ethnic divide: why your experience may be different
Here is something the mainstream menopause conversation almost never addresses: perimenopause is not the same for every woman, and the differences are not small.
The most comprehensive research on this comes from the Study of Women’s Health Across the Nation (SWAN) - a landmark 25-year study that followed thousands of women across different ethnic groups through the menopausal transition. The findings are striking.
If you are a Black or Afro-Caribbean woman, the data shows that you are likely to enter perimenopause earlier, experience the most severe and longest-lasting hot flushes of any ethnic group, have higher rates of sleep disruption and depression during the transition, and carry a higher “allostatic load” - the cumulative physiological damage caused by chronic stress, including the chronic stress of navigating racism and discrimination. And yet, despite this greater burden, women of Black African backgrounds in the UK are 79% less likely to be prescribed HRT than White women. That is not a gap. That is a chasm.
If you are a South Asian woman, the science tells us that you may be entering perimenopause as early as your mid-to-late 30s. The average age of natural menopause in India is approximately 46.7 years - nearly five years earlier than the Western average of 51. In Pakistan, it is around 47. This means the clinical benchmarks your GP is using may not apply to you. It also means your risk of osteoporosis, cardiovascular disease, and metabolic syndrome from prolonged low oestrogen is higher - and longer-lasting. Yet only 6.2% of Asian women aged 45-55 in England are prescribed HRT, compared to 23.3% of White women.
If you are East or South-East Asian, you may experience fewer severe hot flushes - partly because traditional diets rich in soy contain natural phytoestrogens that exert a mild oestrogenic effect. But you are more likely to experience joint pain, low libido, and sexual discomfort, and you carry a higher risk of osteoporosis due to lower bone mineral density.
These are not statistics to be filed away. They are a call to action - for women, for clinicians, and for communities.
The silence that is making us sick
I want to speak directly now to my South Asian sisters and my Afro-Caribbean sisters, because this is where the conversation gets personal.
In many of our communities, menopause is not discussed. It is not a topic at the dinner table, at the temple, at the church, or at the beauty salon. Our mothers did not tell us. Their mothers did not tell them. The silence has been passed down like an heirloom nobody wanted.
In Punjabi, there is no direct word for menopause. Without language, there is no framework. Without a framework, there is no conversation. Without conversation, there is no help.
In many Afro-Caribbean communities, women are expected to be strong. Unbreakable. The backbone of the family. To admit that your body is struggling - that you are waking up drenched in sweat, that you cannot remember simple things, that you feel a grief you cannot name - feels like a betrayal of that identity.
And in South Asian communities, there is a myth that has done enormous damage: “Menopause is a white person’s disease.” It is not. It never was. The reason it looks that way is because the women publicly discussing it, the women in the research studies, the women on the magazine covers - they have predominantly been White. Our stories have been absent from the conversation. That absence has been mistaken for absence of the condition itself.
It is not absence. It is silence. And silence is not the same as safety.
A note on getting the right assessment
Before we go further, I want to say something important - because I think it actually makes everything in this post more trustworthy, not less.
While perimenopause can explain many of the symptoms described above, it is important not to self-diagnose. Thyroid disease, anaemia, vitamin deficiencies, autoimmune conditions, and mental health disorders can all present in similar ways. A good clinician will consider all of these possibilities while also asking whether perimenopause may be contributing. The goal is not to replace one missed diagnosis with another - it is to make sure the full picture is seen.
If your symptoms are being dismissed without any investigation at all, that is the problem. You deserve a thorough, open-minded assessment. Not a rushed appointment that ends with “it’s probably just stress.”
You deserve better
If you have been told your symptoms are “just stress,” I want you to know: you deserve better than that.
If you have been given antidepressants for what is actually a hormonal deficiency, you deserve better than that.
If you have been made to feel dramatic, or difficult, or hypochondriac, you deserve better than that.
Perimenopause is a medical transition with real, treatable symptoms and real, serious long-term health implications. Your cardiovascular health, your bone density, your brain health, your metabolic health - all of these are affected by this transition. All of these can be protected with the right support.
You are not too young. You are not imagining it. You are not weak.
You are a woman in perimenopause, and you deserve a healthcare system - and a community - that meets you there.
What comes next
In Part Two of this series, we are going to talk about what you can actually do. We are going to cover the evidence on HRT (and dismantle the fear that has kept too many women away from it), the power of strength training, the science of sleep, the role of mindfulness and spirituality, and - most importantly - how to walk into a GP’s office and advocate for yourself like the informed, empowered woman you are.
Because knowledge is not just power. In perimenopause, knowledge is protection.
The Soulful GP | Mind · Body · Soul
Share this post with a woman in her 40s who needs to read it. You might just change her life.
Coming next: Part Two - “You Have Options. Here Is Everything You Need to Know.”