Lately I keep hearing the same sentence from women in their early and mid thirties: I think I'm in perimenopause. It comes up in sessions, in comments, in conversations over tea. Each time, something in me wants to slow the moment down and ask a few more questions before that word settles in.
Perimenopause is real, and for some women it does arrive earlier than expected. My concern is how quickly it has become the catch-all explanation for a body that is struggling. Many of the symptoms we attribute to this transition are shared by a whole constellation of other states, and some of those states are far more reversible than we have been led to believe.
What my own body showed me
I am 37, and on paper my recent history reads like a textbook case. For three moon cycles in a row, my bleed came three weeks apart. My hormones felt erratic and unfamiliar. I have lived with insomnia for close to a year. If I had walked into a clinic and listed those symptoms, perimenopause would almost certainly have been raised with a question mark.
Knowing my own system as I do, I read the picture differently. I had been carrying chronic stress for a long time. I also had unresolved viral load from COVID still moving through me, asking to be cleared at a systemic level. My body was speaking the language of depletion and stagnation.
So I went to work on that. I saw a traditional Chinese medicine practitioner every fortnight for three months with one aim: to reset my menstrual cycle. This cycle, my bleed returned to what I know as my normal. Four weeks apart, with blood that looks healthy and feels like mine again. My body had been asking for support, and once it received it, the rhythm came home.
The many faces that look like perimenopause
Chronic stress. The menstrual cycle is governed by a conversation between the brain and the ovaries, and stress hormones interrupt that conversation directly. Prolonged stress can shorten or lengthen cycles, change the quality of the bleed, and erode sleep. A nervous system that has been on high alert for months will show it in the womb.
Long COVID and post-viral load. Changes to menstrual cycles after COVID infection have now been documented, and long COVID brings its own fatigue, sleeplessness, brain fog and temperature swings. In the language of Chinese medicine, I see this as blood stagnation: a system where circulation and flow have been compromised and the body cannot clear what it is holding.
Collective stress. We are living through a period of intense collective strain. Women are often finely attuned to the emotional field around them, and in my experience that attunement registers in the body. Grief and fear moving through the world can land in our sleep, our cycles and our hormones.
The relationships we hold. In my work I often see women acting as a surrogate for the unhealthy dynamics in their relationships, metabolising what others will not. That weight is physical as well as emotional, and the reproductive system frequently carries it.
Electromagnetic exposure. Many of us now live wrapped in screens, devices and wireless signals from waking to sleep. The research here is still unsettled, yet I see enough in my practice to believe our exposure deserves attention, especially for anyone whose sleep has fallen apart.
A life that runs against our feminine biology. The female body moves in cycles. When we live in a linear, always-on rhythm, ignoring rest, seasons and the phases of our own month, the body eventually protests. Those protests can look remarkably like hormonal decline.