Symptoms and what women usually think is happening

Common symptom clusters we see (often overlapping):
 

Sleep + nervous system

• Waking at 2–4am, restless sleep, night sweats

• Racing thoughts, a “wired but tired” feeling

• Increased sensitivity to noise, stress, alcohol, or sugar
   

Mood + cognition

• Irritability, anxiety spikes, low mood, loss of confidence

• Brain fog, word-finding issues, reduced focus

• Feeling emotionally “thin-skinned” or more reactive than before
   

Cycles + bleeding changes

• Shorter cycles, longer cycles, heavier bleeding, spotting

• PMS that feels worse than your 20s/30s

• A sense that your body is no longer predictable
   

Body changes

• Increased belly fat or a body shape shift

• Reduced muscle tone despite effort

• Lower energy recovery after exercise
   

Sexual and urogenital changes

• Low libido, less sensation, more effort to get aroused

• Vaginal dryness, recurrent irritation, pain with sex, UTIs
   

What women are often told (and why it’s incomplete):

• “Your labs are normal.” (Often only a partial panel was checked, at the wrong time, without symptom context.)

• “It’s stress.” (Stress matters, but it is not the whole story.)

• “Try an antidepressant.” (Sometimes appropriate, often used as a shortcut when hormones and metabolic factors weren’t assessed properly.)

• “This is ageing.” (Age is not a diagnosis.)

What is really going on hormonally

Perimenopause is commonly misunderstood because it’s not simply “low estrogen.”
 

It’s often hormonal volatility:
 

• Progesterone declines first (more anovulatory cycles), which can worsen sleep quality, anxiety, and cycle disruption.
   

• Estrogen can swing high and low, which affects temperature regulation (hot flushes), mood stability, migraine patterns, and sleep.
   

• Over time, after menopause, estrogen settles lower, and symptoms can shift toward genitourinary discomfort, bone changes, and metabolic risk.
   

On top of that:
 

• Thyroid function can mimic or amplify menopausal symptoms.
   

• Iron deficiency (often from heavier bleeding) can drive fatigue, hair shedding, breathlessness, and low resilience.
   

• Insulin resistance and stress physiology often increase in midlife and can worsen brain fog, sleep, and weight gain.
   

WHI’s job is to connect the dots: your stage, your symptoms, your labs, and your risk profile.
 

Why conventional care often fails women here

We commonly see failure points like these:
 

1. Symptom-by-symptom prescribing
   A sleeping tablet for sleep, an SSRI for mood, a cream for dryness, a “diet plan” for weight, without stepping back to ask: what transition is her body in, and what is the primary driver?
    

2. Inadequate testing or poor timing
   Many women get minimal labs (or none), or results are interpreted without context.
    

3. No structured follow-up
   Even good HRT can fail if there’s no review, no titration by symptoms, and no plan for side effects or bleeding changes.
    

4. Over-correction or under-treatment
   Some women are started too aggressively and feel worse. Others are under-dosed, told to wait, and give up.
    

5. Sexual health is ignored
   Low libido and vaginal dryness are often treated as “secondary.” For many women, they are central to quality of life and relationships.