The Perimenopause Panic

Two years ago, Ashely Schneider found herself Googling some pretty weird stuff. She kept feeling something brush across her arm, light and tickling, like a hair. But every time, there was nothing there. She typed in “phantom feeling arm,” and added — inevitably, given this was the 2020s and she was in her late 30s — “perimenopause.”

There it was: paresthesia, “a harmless but unsettling sensation like pins-and-needles… caused by fluctuating estrogen affecting the central nervous system and nerve signals.” Did it make Schneider feel more or less insane to know this sensation was legit — and there wasn’t much she could do about it? She laughs: “Look up anything obscure, add perimenopause, and it serves up exactly what, in that moment, you want to read to feel validated.”

When Anne Fulenwider began researching ideas for a potential women’s health startup circa 2018, she wouldn’t have known to Google those terms. She was 48 at the time and had recently left her post as editor-in-chief of Marie Claire, a magazine that regularly covered women’s health. Nevertheless, “I had no idea I was in perimenopause,” Fulenwider says with a laugh. “I didn’t even know it existed.”

Millennials are hitting their mid- to late-30s in an era of not just awareness but, arguably, hyperawareness.

The cultural quantum leap we’ve witnessed around menopause — and, as the standup comedian Amy Miller has put it, “its hot, cool little sister, Peri” — cannot be overstated. Today, midlife female hormonal chaos is everywhere you look — taking top billing in books, articles, movies, celebrity interviews, one-woman shows. It’s been memed, TikTok’d, and endlessly product-pitched. It even made it to SNL.

“Try living one day in my twisted reality, raising two kids, taking care of my aging parents. Life is a nightmare! Vision? Blurry. Nerve? Pinched. Pelvic floor? On the ground. F my life. Also I forgot my Etsy password! God is dead!” screeched Amy Poehler this fall, in the role of “Emo Mom,” a gal who is really going through it.

If this sketch had been written pre-2020, Emo Mom’s family would have found her behavior mystifying. But by late 2025, everybody’s an expert. Emo Mom’s daughter, played by Chloe Fineman, takes a tone one might use to coax a 400-pound silverback back to the zoo. “Mom, we know this is a weird time for you, and your body is changing,” she says. “So we got you this book: When a Period Becomes a Comma: A Guide to Perimenopause.”

Do we even need to point out that raising awareness around women’s health at any stage of life is a good thing? Knowing more about perimenopause gives women the confidence to look for help instead of suffering in silence, or waiting until symptoms peak in their 50s to seek treatment. The tsunami of meno-talk could make millennials the first generation of womankind to largely bypass the worst of menopause’s symptoms altogether. That was previously unthinkable.

Elise resents that what might have been a brief, golden window of not having to think too hard about her reproductive system is now ruled by a new preoccupation: the possibility of its imminent demise.

If boomers and Gen Xers still frequently remark that menopause is something that “nobody ever talks about,” it’s because they cannot quite imagine what millennials are experiencing: coming of age, so to speak, in one’s mid- to late-30s (well before the average age of onset) in an era of not just awareness but, arguably, hyperawareness. For them, it can seem like the opposite is true. Menopause is all anybody talks about.

One 41-year-old mother of two (who asked not to use her name because she was sharing medical information) recalls a girl’s trip to Charleston last fall, during which perimenopause was the chief topic of conversation — as it usually is when she gets together with women her age these days. Comparing notes, she realized her raging PMS and wild periods were “unacceptable.” She came home feeling “very feisty and empowered,” made an appointment with her doctor, and within weeks had started a hormonal birth control patch that made her feel “like a different person.” Now she’s evangelical about getting hormone help early. “I just will not settle or accept feeling sh*tty, if I can do something about it.”

But another 41-year-old I know — I’ll call her Elise — is not so thrilled about her generation’s rush to perimenopause anxiety. She calls it her “golden window theory.” Elise spent her 20s trying not to get pregnant, the first half of her 30s trying hard to get pregnant, and the other half enduring and recovering from two pregnancies and caring for the ensuing children. She emerged from the fog of all that around 38 only to find a whole new and extremely buzzy thing to worry about: the looming perimenopause “cliff,” as All Fours novelist Miranda July famously (and ominously) put it. Elise is pretty sure she’s not in perimenopause. But she resents that what might have been a brief, golden window of not having to think too hard about her reproductive system is now ruled by a new preoccupation: the possibility of its imminent demise.

“It’s very much on my patients’ minds,” says psychiatrist Dr. Pooja Lakshmin, M.D., author of Real Self-Care. “Everybody is like, is this perimenopause? Every single symptom they’re having, whether it’s sleep disturbances, brain fog, any number of things, it could be under that umbrella.” Lakshmin, who is 42 herself, says the millennials she treats tend to approach this less with fear than with a sort of resigned exhaustion. “Its like, ‘Oh, here’s another thing on the list that I now have to educate myself about and figure out,’” she says.

It doesn’t help that at every turn there is a self-appointed expert telling women to pop this supplement and swing that kettlebell to manage a phase that they may or may not be in. Perimenopause is prime influencer territory: a moving target, squirrely by definition, that is seemingly designed to be as confusing as possible. It’s not a health condition or a diagnosis, but rather a life transition, one that lasts an unspecified number of years, begins at no certain age (though around 45 is typical), and is accompanied by 30-plus documented symptoms that are nebulous and vary wildly from one body to the next.

When you’ve got a hammer that vague and all-encompassing, what isn’t a nail? Itchy ears? Crappy sleep? Body odor a little off? Brain a little slow? Invisible non-hairs stroking your wrist? Now we have a one-size-fits-all answer — about which absolutely nothing is one-size-fits-all.

Still, the idea that women might be worrying too much, or too early, about this is somewhat taboo, especially in the wake of a 2024 issue of the respected medical journal The Lancet that questioned whether menopause was being over-medicalized — leading too many women to seek treatment for what is a “natural” and inevitable transition. The issue outraged experts who have been pushing for increased menopause awareness, some of whom called some of its claims misogynistic and tone-deaf. More than 250 of them signed a petition rejecting any suggestion that these symptoms could be “all in her head,” or that women were overreacting by seeking treatment.

The rebuttal effort was led by Dr. Mary Claire Haver, M.D., one of a fresh crop of star menopause experts, and author of The New Perimenopause. When I reached out to Haver, she cautiously agreed that it’s worth considering that we may be prematurely ratcheting up younger women’s anxiety about perimenopause. Still, she insisted that “the greater danger has always been minimizing the symptoms that can profoundly disrupt a woman’s quality of life.” If younger women are pre-worrying about perimenopause, says Haver, it’s “mostly because they are finally hearing about something that has been ignored for decades.”

Indeed, a large 2024 survey done in collaboration between the University of Virginia and the company behind the period app Flo appeared to suggest that, if anything, women aren’t worrying about perimenopause early enough. When 4,400 women self-reported their symptoms on the app, more than half of those aged 30 to 35 said they were already suffering symptoms that the study authors gauged as “moderate to severe.” Physical hallmarks like hot flashes and vaginal dryness were more common in older women aged 50-plus. Younger women tended toward the psychological: anxiety, depression, irritability.

A lot of the signs we’re now quick to chalk up to perimenopause, says Dr. Jennifer Payne, M.D., are just normal symptoms of “being a woman and having a menstrual cycle.”

The study was largely positioned as evidence that perimenopause does, in fact, impact younger women. “I don’t really interpret it as, oh gosh, perimenopause is starting earlier,” says Dr. Jennifer Payne, M.D., a study co-author and an expert in reproductive psychiatry at University of Virginia. “It’s just that these symptoms are common. And when we hit perimenopause, they become extremely common and regularly occurring.”’

Payne cautions against a rush to treatment. A lot of the signs we’re now quick to chalk up to perimenopause, she says, are just normal symptoms of “being a woman and having a menstrual cycle.” Not to mention being a human with a job, a partner, maybe a few kids or an ailing parent, and a menstrual cycle: i.e., being in the thick of one of the most challenging phases of life. Most women in this age bracket do experience mood disruptions, especially during PMS, Payne says. That doesn’t mean they’re necessarily in perimenopause.

In a survey led by Haver, women in the earliest stages of hormonal fluctuation “described irritability, overwhelm, sudden drops in confidence, trouble concentrating, disrupted sleep, and a sense that the emotional ground beneath them was shifting,” she says. “The challenge is that all of this can look a lot like ‘normal life.’”

UVA’s Payne is primarily a researcher now, but in her previous clinical practice she encouraged her patients to look for patterns, rather than isolated bad days. She also says that many of the women who came to her seeking hormone replacement therapy turned out to be candidates for antidepressants and anti-anxiety meds. (Worth noting: In the UVA survey, psych symptoms peaked among women 41 to 45, and dropped again in women ages 56 and up. #itgetsbetter)

Fulenwider, who went on to co-found menopause-focused telehealth company Alloy, says the under-40 set is the company’s fastest-growing demo, more than doubling year over year. Their team of on-demand menopause-trained physicians get the same question all the time: “Is this perimenopause, or is it just that life sucks?”

“The number one tip-off is irregular cycles — too much, too little,” Fulenwider says. “For the most part, that signifies perimenopause, and it can last for a long time.” Hormones can wreak havoc at any age (remember middle school?) and if they do, it may be worth talking to your doctor about something like the pill or an IUD to help get a handle on them. But for most women, until your period gets wonky, you’re likely not technically in perimenopause. (Another wrinkle in this game of hormonal wackamole: those on the pill or other hormonal birth control, of course, have a harder time detecting the cycle irregularity that would tell them they’ve hit perimenopause.)

That hasn’t stopped younger women from wondering if they, too, need to get in on this much-talked-about hormone replacement therapy (or its new “preferred term,” menopausal hormone treatment [MHT] because, lady, there’s nothing wrong with you that needs replacing!). Jodi Neuhauser is a longtime women’s health advocate who has launched multiple startups in the fertility space. Even more than most of her perimenopause-obsessed peers, “I eat, sleep, and breathe this stuff every day,” she says. “It’s in my ear all the time.” Her mother went through menopause early, a possible indicator that she will too. So of course she was not going to passively accept the brain fog, fatigue, and weight gain that began in her late 30s. “I was like, I need to get on this quick.” Through Midi, another online menopause platform, Neuhauser booked a telehealth consult with a nurse practitioner, who said she sounded like a good candidate for HRT. “She’s like, ‘Here you go.’ It was kind of like candy. I don’t know if that’s good or bad.”

For what it’s worth, there are no known health risks associated with going on HRT at a younger age. (Neuhauser was later advised by an integrative medicine doctor that she was too young for HRT, and has since switched to taking progesterone and a list of purportedly cycle-regulating supplements.) For most women, if you’re still having normal periods — indicating that your body is still producing its own estrogen — experts I spoke with say HRT may not do a whole lot for you, because the dose may be too low to move the needle. Hormonal birth control like the pill or an IUD, on the other hand, are built to regulate cycles in bodies that are still producing hormones, and contain a higher dose of estrogen than you’d get in an HRT cream or patch. They also, duh, prevent pregnancy. And we all have that friend who got pregnant when she thought she was “too old.”

The good news is, whether in the form of HRT or hormonal birth control, estrogen is FDA-approved to prevent osteoporosis, which is linked to fatal falls far more often in women than men. Estrogen is also proven to have heart-protective benefits, and emerging research appears to indicate midlife estrogen therapy may lower the risk of dementia, too.

Are there risks? Technically, yes. Both hormonal birth control and hormone replacement therapy carry a small risk of blood clots and elevated blood pressure. Additionally, Haver points to a less-talked-about fact that “combined” oral contraceptives (i.e., those containing both estrogen and progestin) increase levels of sex hormone-binding globulin, which can significantly reduce free testosterone levels. “Lower free testosterone can affect libido, energy, and muscle mass,” she says, “yet many women are never told this is a potential side effect.”

Still, these are dramatically lower health risks than those indicated by the now-infamous and flawed 2002 Women’s Health Initiative trial, which convinced the medical establishment (and a generation of women) that HRT elevated the risk of breast cancer. That study is the reason why millions of menopausal boomers were denied the option of hormone replacement, missing out on both potential relief and the aforementioned protective benefits. It’s also why the rest of us were cheated out of 20-plus years of data about the long-term effects of HRT. And it’s part of the reason why only about 3,000 physicians in the U.S. are certified to treat menopause, and only 20% of OB-GYN residencies offer training on the subject.

“There’s a difference between education and anticipation, and rushing into treatment.”

In November, the FDA officially removed the black box label on HRT. Advocates hope this will lift a hefty psychological barrier that remains in many patients and prescribers, and encourage more physicians to get educated on HRT — so they can recognize the signs of those who need it.

All of which is… something to talk about with your doctor, about your body, to devise a plan that’s tailored to you. There are too many options and variables to even attempt to sum them up here. Given how few menopause-trained experts there are in this country, it’s worth seeking that person out sooner rather than later. “It’s hard to find a provider who feels comfortable with hormones, menopause, and perimenopause, because it’s not something that was taught in OB residency,” Lakshmin says. “So it often takes time to find somebody who is taking new patients, and is affordable, and that you feel comfortable with.”

Checking in, asking questions, and seeing where you’re at, however, is not the same as slapping on a hormone patch ASAP. “There’s a difference between education and anticipation, and rushing into treatment,” says Haver.

“The curiosity is a really good thing,” Fulenwider says. “Get prepared, so that when you're 44 or 47 and you start having more symptoms — you can’t sleep, you’re gaining weight, you have mood issues, your period’s a little wonky — you’ll know exactly what it is, and exactly where to go.” In the meantime, here’s a hot tip from the other side: try to enjoy your “golden window” of relative reproductive ease… while you still can.