I Thought I Was Just Stressed. I Was Actually in Perimenopause, Nobody Told Me.
by
Niamh Coughlan
For about two years, I told myself the same story. I was tired because I was busy. I was anxious because there was a lot going on. I was forgetting things because I had too much on my plate. I was snapping at people because I was under pressure. I was lying awake at 3am because that's just what happens when you have a demanding job and a family and a life that doesn't stop.
Every explanation made sense on its own. Taken together, they added up to one conclusion: I needed to slow down, stress less, and get more sleep. The problem was that no amount of slowing down changed anything. The tiredness didn't lift. The anxiety sat just below the surface no matter what I did. The brain fog rolled in on days when there was nothing particularly stressful happening at all.
It took longer than it should have for someone to say the word perimenopause to me. When they did, something shifted. Not because it solved anything immediately — but because it gave me somewhere honest to start.
If any of that sounds familiar, this is for you.
What perimenopause actually is — and why most women don't recognise it
Perimenopause is the transition period before menopause. Menopause itself is defined as twelve consecutive months without a period. Everything leading up to that point — which can last anywhere from two to twelve years — is perimenopause.
Most women know, in theory, that menopause is coming. What they are not prepared for is how early the transition can begin, how wide the range of symptoms is, and how many of those symptoms have nothing to do with hot flushes.
The average age perimenopause begins is the mid-40s, but it can start in the late 30s. The symptoms most commonly associated with it — hot flushes, night sweats — are real, but they are far from the whole picture. The symptoms that catch most women off guard are the ones that look exactly like stress, burnout, anxiety, or simply the demands of a busy life:
Persistent fatigue that does not resolve with rest
Brain fog — difficulty concentrating, losing words mid-sentence, forgetting things that should be obvious
Anxiety and low mood, sometimes with no clear trigger
Disrupted sleep — difficulty falling asleep, waking at 3am and lying there for hours
Irritability that feels disproportionate to what's actually happening
A feeling of being 'not quite yourself' that is hard to explain to anyone
Changes in how your body stores weight and responds to exercise
Lowered libido and changes in sexual response
Joint aches and a general sense of physical depletion
Any one of these symptoms, in isolation, has a plausible alternative explanation. All of them together, particularly in a woman in her late 30s or 40s, points to one thing. And yet the average time between a woman first experiencing perimenopause symptoms and getting an accurate explanation is — depending on which study you read — between three and seven years.
Three to seven years of being told it's stress. Of being offered antidepressants before anyone mentions hormones. Of being sent away with a blood test that comes back 'normal' because oestrogen levels fluctuate so much during perimenopause that a single test rarely tells the full story.
The average time between a woman first experiencing perimenopause symptoms and getting an accurate explanation is between three and seven years. That is three to seven years of being told it is probably stress.
Why the confusion happens — and why it matters
Perimenopause does not announce itself. It does not arrive with a letter or a clear start date. It creeps in, symptom by symptom, over months or years, in ways that are easy to attribute to other things.
Women in their 40s are also, statistically, at one of the most demanding points of their lives. Careers at a critical stage. Children who still need a lot. Ageing parents who need more. Relationships under strain from the accumulated pressure of all of the above. When you are living that life, exhaustion is a perfectly reasonable thing to feel. Anxiety makes sense. Forgetting things is almost expected.
The problem is that when everything has a plausible explanation, nothing gets properly investigated. You adapt. You manage. You add another coffee and push through. And the symptoms — which were already costing you significantly — start to be treated as just the price of the life you are living.
This is why getting the language matters. Not because perimenopause is the only thing going on — it rarely is. But because it is almost certainly part of what is going on, and treating the stress without addressing the hormonal piece is like putting a plaster over something that needs more than a plaster.
What I wish I had known earlier
I do not say any of this to catastrophise. Perimenopause is not a crisis. It is a transition — a significant one, but a manageable one. What makes it hard is not the transition itself. It is the lack of honest information, the absence of a framework for understanding what is happening, and the very human tendency to keep explaining away symptoms until they become impossible to ignore.
Here is what I wish someone had told me at the beginning:
Your symptoms are real. They are not a sign of weakness, anxiety disorder, or burnout (even if those things might also be present). They deserve to be taken seriously.
A single blood test does not rule out perimenopause. Hormone levels fluctuate dramatically during this transition. If your GP dismisses your symptoms on the basis of one normal result, ask for another test, at a different point in your cycle, or ask for a referral.
You do not need to be having hot flushes to be in perimenopause. The psychological and cognitive symptoms often arrive before the physical ones that most people associate with menopause.
The exhaustion is not a character flaw. Running on depleted hormones while living a full and demanding life is genuinely hard. Recognising that is not an excuse — it is an accurate assessment.
You can feel significantly better. This transition does not have to be endured. There are evidence-based options — from HRT to lifestyle changes to coaching support — that make a real difference. But the first step is understanding what you are dealing with.
What comes after the clarity
Getting clear on what is actually going on with you is, in my experience, the most important first step. Not because it solves everything immediately — it doesn't. But because it gives you something real to work with instead of a fog of explanations that keep you stuck.
In the coaching work I do, this is what I call Shift 1: See Clearly. It is the foundation before everything else. Before you can decide what you want from the next chapter of your life. Before you can make a career decision or a relationship decision or any other decision that is going to be with you for years. Before any of that, you need an honest picture of where you actually are.
Perimenopause is a significant part of that picture for many of the women I work with. Not the whole picture — there is almost always more going on — but a piece of it that, once named, changes everything about how you carry the rest.
If you have been explaining away how you feel for longer than feels comfortable, it might be worth stopping and asking: what if it is not just stress? What if there is something more specific going on that, once understood, could actually be addressed?
That question is a reasonable starting point. It was for me.
A note on getting support
If you think perimenopause might be part of what you are experiencing, the most useful first steps are: speak to your GP and ask specifically about perimenopause (not just stress or low mood); ask for a hormone profile blood test, ideally repeated across different cycle days; and find a source of information you trust — NICE guidelines on menopause are publicly available and readable, and the British Menopause Society has a directory of specialists.
If you are also navigating what it means for your career, your sense of identity, or the general question of what comes next — that is exactly the territory I work in. The link to book a conversation is here.
Niamh Coughlan is the founder of Messy Middle Coaching, a coaching and community business for women navigating perimenopause, career transitions and identity shifts in midlife. themessymiddlecoaching.com
