I Thought I Was Becoming Less Capable: What New Perimenopause Research Tells Us About Our Symptoms and Looking After Ourselves Earlier
There's something I hear from women all the time, and increasingly I find myself wondering why we've accepted it as normal.
They tell me they're exhausted, sleeping badly, feeling anxious for no obvious reason, putting on weight around their middle, struggling with their digestion or simply not feeling quite like themselves anymore. They just can't cope.
But when I ask how long they've been feeling this way, the answer is often the same.
Oh, a few years probably.
A few years! And yet they've carried on. Looking after their families, working, exercising, trying another supplement, blaming stress or wondering whether they're simply getting older.
And it's not just clients. I hear the same things from friends and women around me.
They talk about losing their patience, flying off the handle over things that never used to bother them, feeling flat and unmotivated, struggling with relationships or finding it increasingly difficult to manage the emotional ups and downs of teenagers. One woman described how even opening her mail had become overwhelming, and I don't mean emails because that's entirely normal. :o)
Some feel constantly run down, seem to pick up every illness going or have developed aches and pains they never used to have. And so often, the explanation is simply, "Well, I suppose I'm getting old."
Really? At 40-something?
I find that quite depressing, actually. Not because ageing is something to fear, but because we've become so accepting of feeling progressively worse without asking what might be contributing to it.
Often, it hasn't even occurred to these women that their hormones might be playing a part. After all, they're still having periods, they haven't had a hot flush and they don't think they're anywhere near menopause. And I wonder how many of these women are experiencing perimenopause symptoms without even realising it.
This is something I feel quite strongly about, both as a practitioner working with midlife women and as a woman navigating this stage of life myself.
Why are we waiting until we feel absolutely dreadful before we start taking our changing physiology seriously?
And why do we seem to need a dramatic symptom or a diagnosis before we give ourselves permission to prioritise our health?
Two pieces of research I've come across recently have made me think about this even more. One looks at how our physiology changes around menopause, potentially much earlier than many women realise. The other looks at something rather different: why life satisfaction often appears to reach its lowest point in midlife before improving again. And together, I think they raise some fascinating questions about how we look after ourselves during these years.
Could perimenopause symptoms begin earlier than we think?
A fascinating study published in Nature Medicine in October 2026 analysed more than 300 million laboratory tests from over one million women. That's an enormous amount of data!
What the researchers found was particularly interesting. Changes in certain reproductive hormone patterns were detectable more than a decade before the final menstrual period. They also identified surprisingly abrupt changes in several other physiological systems around menopause, including those involved in bone health, metabolism and cardiovascular risk.
What I find so interesting about this is that it challenges the way many of us think about menopause.
We tend to imagine it as something that happens when our periods become irregular, hot flushes begin or we reach our early fifties. But the hormonal story is more complicated than that.
The years leading up to menopause can involve significant hormonal fluctuations, and these changes affect different women in very different ways.
Sleep can become less predictable. Mood and stress tolerance may change. Some women notice differences in their menstrual cycles, while others experience symptoms they would never immediately associate with reproductive hormones.
And importantly, some of these experiences may begin before a woman identifies herself as perimenopausal.
An early change in a hormone marker doesn't mean every woman in her thirties is clinically perimenopausal. Nor does it mean every symptom is caused by hormones.
But I do think this research challenges the idea that menopause suddenly arrives one day, entirely out of the blue.
Our bodies don't wait for us to recognise perimenopause before they begin changing.
And perhaps we need to become better at recognising those changes ourselves.
Why do we assume we're simply getting older?
This is something I see constantly in practice. A woman tells me she hasn't slept properly for three years. She's increasingly anxious, struggling to recover from exercise, perhaps noticing that foods she used to tolerate now leave her bloated.
But when we start exploring her health history, she hasn't necessarily connected any of these things. They're separate problems in her mind:
The sleep is because she's stressed.
The anxiety is because life is busy or tricky.
The weight gain is because she's getting older or can't control that sweet tooth;
"-must blame ourselves!"
The digestive problems must be something she's eating.
And of course, sometimes those explanations are correct. There may be several contributing factors. But what interests me is the bigger picture.
Could changing hormones be affecting her sleep and ability to cope with stress? Could years of poor sleep be influencing appetite, metabolic health and recovery? Could gut health, thyroid function, nutritional deficiencies or other factors be adding to the picture?
This is where my background in functional medicine, naturopathy and herbal medicine becomes particularly useful. I'm not interested in simply putting every symptom into a menopause box. I'm interested in understanding why that particular woman is feeling the way she does. Because what I find especially interesting is that many of these women aren't necessarily doing anything dramatically different. They're still working, parenting, managing households and doing everything they've always done. But suddenly it all feels so much harder.
And I think we need to start asking why.
I thought I was doing everything right. So why did I feel so awful?
Here's the thing. I'm a functional medicine practitioner, a medical herbalist and a nutritionist. Looking after health is literally what I do. I exercise, I pay attention to nutrition, I understand the importance of sleep and I have a very good understanding of how hormones work.
And yet, perimenopause has still managed to knock me sideways. Looking back, I can see that things were changing long before I recognised what was happening.
My sleep problems began after the birth of my second daughter, when I was 35. At the time, I put it down to having a young child who didn't sleep particularly well. Which, of course, was part of it.
But now I wonder whether hormonal changes were contributing too. I was also juggling children, working and studying for my master's degree and then after that a rigorous postgraduate medical certification. I was constantly pushing myself, trying to do everything I had always done to a massively unrealistic standard and rarely giving myself much of a break. And gradually, things became harder.
There was a period when exercise, something I'd always tried to prioritise, became increasingly difficult to maintain. I felt achy, my mobility deteriorated and I remember my knees hurting simply walking downstairs. I assumed it was tiredness, weight gain after having children or perhaps just getting older. What I somehow still didn't understand, despite seeing it all the time in others was that hormonal changes might also have been contributing to how I felt.
It wasn't until later, when my menstrual cycle began changing, that I really started to appreciate the possible role of progesterone and the wider hormonal picture.
And the frustrating thing is that I spent so much time wondering what was wrong with me.
Why couldn't I cope better? Why was exercise suddenly so difficult? Why was I struggling when I was already doing so much to look after myself? I wish I'd understood earlier that this wasn't necessarily about a lack of effort or discipline.
There were genuine physiological questions worth investigating, alongside the enormous demands I was placing on myself. And if I'd recognised that sooner, I think I would have approached those years very differently.
I might have been kinder to myself. I might have adjusted my exercise rather than letting it fall away. I would certainly have paid more attention to my sleep and hormonal health instead of assuming I simply needed to try harder.
I thought I was becoming less capable. What I didn't understand was how much my physiology might be changing at exactly the same time as life was demanding more of me.
And I think this is where so many women find themselves. It's not just about hormones. It's the combination of changing hormones, disrupted sleep, children who need you in entirely different ways as they get older, work, relationships, responsibilities and the expectations we place on ourselves. You can be a perfectly capable, knowledgeable and resilient woman and still find that combination completely overwhelming.
Yet instead of recognising what's happening, we often turn the frustration inwards. We tell ourselves we need to be more organised, more patient, more disciplined. That we should somehow be coping better.
Perhaps the problem isn't that we've suddenly become less capable. Perhaps we're expecting the same things from ourselves when the conditions we're operating under have fundamentally changed.
Why does life satisfaction sometimes dip in midlife?
Image shared by Dr Marie Claire on Instagram.
I recently came across a graph showing the familiar U-shaped pattern of life satisfaction, with a dip somewhere around our late forties and an upward curve afterwards.
As someone who's 47, I found it absolutely fascinating.
But more than that, I found it strangely reassuring. Because sometimes midlife feels like an endless list of things to deal with.
There are the children, their friendships, their worries, school expectations, homework, activities and the constant running around. There's work, running a home, relationships, responsibilities and trying to find five minutes for yourself somewhere in the middle. And if you're anything like me, you're probably making it even harder by expecting yourself to do everything properly. I'm definitely guilty of that.
I can be incredibly hard on myself when things aren't going as well as I'd like. And when everything starts feeling overwhelming, it's easy to wonder why I can't simply cope better.
I've even been told that perhaps I find things more difficult than other women - why can they cope so well and I can't? But looking at that graph made me question that assumption.
What if this is simply a particularly demanding stage of life for many women? What if our changing physiology, disrupted sleep and the sheer accumulation of responsibilities are all contributing to how we feel?
The research doesn't tell us that every woman is at her unhappiest at 47, and it doesn't establish that hormones are responsible for the dip. But seeing that midlife can be a difficult period for many people gave me a real sense of validation. Perhaps I wasn't uniquely bad at coping with life. Perhaps this stage of life really is challenging. And then I looked at the other side of the graph.
Life satisfaction rises again.
That was the part that gave me hope. Not because I think we should simply wait until we're 55 or 60 for life to improve, but because it reminded me that how we feel now doesn't necessarily predict how we'll feel for the rest of our lives.
And I think that's a message worth sharing.
We may not be able to change every responsibility or challenge that midlife brings, but we can become better at understanding our bodies, recognising when we need support and making our own health more of a priority. I'd rather start doing that now than spend the next decade waiting to feel better.
Why do we wait until we're at breaking point?
This is the question I keep coming back to.
Why does a woman have to feel completely exhausted before she decides her sleep matters?
Why does she have to become thoroughly miserable before she starts asking questions about her hormones?
And why do so many women put their own health at the bottom of the list until something forces them to move it to the top?
I don't think it's simply because women don't care about their health. Quite the opposite. Many of the women I meet are doing an extraordinary amount to keep everybody else healthy and happy. They're organising their children's lives, supporting their partners, managing work and family commitments, thinking about what everyone is eating and remembering everything that needs doing.
Somewhere along the way, their own health becomes something they'll deal with later.
When life calms down.
When the children are older.
When work is less demanding.
Except that moment doesn't always arrive. And by the time they finally seek help, they may have spent years feeling considerably worse than they needed to. I find that incredibly frustrating.
Not because women should be doing more, but because I think they deserve better information, better support and permission to take their own wellbeing seriously before reaching that point.
What would I tell my 35-year-old self?
Quite a lot, actually!
Firstly, I'd tell her to stop being quite so hard on herself. I'd just had my second daughter, I was juggling family life, work and studying for a master's degree, and I was determined to do everything well. And while I'm enormously proud of what I achieved during those years, I look back now and wonder why I expected quite so much of myself.
Having a baby is a huge physiological and emotional adjustment. Yet we seem to expect women to recover, get back into shape, return to work, look after everyone else and somehow carry on as though nothing particularly significant has happened.
I'd tell myself to slow down a little. To stop seeing rest as something I had to earn.
I'd also tell myself to pay much closer attention to my thyroid and seek advice from someone willing to look beyond a single blood test result and consider the whole clinical picture.
When you're exhausted, struggling with your weight, feeling low or generally not yourself, being told your thyroid results are normal doesn't always mean the conversation should end there. Reference ranges are useful (or in the case of the NHS perhaps not), but so are symptoms, medical history and the wider clinical picture.
I wish I'd asked more questions and explored what was happening rather than simply accepting that everything must be fine. And I'd take my nervous system much more seriously.
Not in the sense of adding another complicated wellness routine to an already overflowing day, but recognising how much pressure I was under and finding realistic and simple ways to reduce it.
Whether that's appropriate herbal support, making more room for sleep, getting outside, breathing, asking somebody else to take something off my plate or simply not trying to achieve quite so much at once.
I'd also tell myself not to abandon movement when exercise starts feeling difficult.
There were times when I couldn't face the workouts I'd previously enjoyed, so I ended up doing much less. Looking back, I wish I'd understood that I could have changed the type of exercise rather than feeling I had to choose between doing everything and doing nothing.
Walking, mobility work, gentle strength training, getting outdoors. It all counts.
But perhaps the biggest thing I'd tell myself is this:
Get support. As much as you can. And stop thinking you should be able to work everything out on your own.
Because one of the strangest things about being a health practitioner is that you can know an enormous amount about looking after yourself and still struggle to put that knowledge into practice.
Knowing and doing are not the same thing. Sometimes you need somebody who can look at your situation objectively, understand your personality type and recognise the patterns you can't necessarily see yourself.
If you're somebody who constantly pushes herself, sets impossibly high standards or feels responsible for everybody else's happiness, being told to 'reduce stress' is hardly going to transform your life.
You need somebody who understands why you're finding it difficult, what you're dealing with and which changes are genuinely realistic. And I think we've lost some of that support in modern life.
We've lost the communities where women shared their experiences, helped one another and talked openly about the difficult parts of motherhood and ageing.
Instead, so many of us are trying to manage everything independently, quietly wondering why everybody else seems to be coping better.
I'd love to see that change. Because needing support isn't a sign that you're failing. It's part of being human.
And finally, I'd tell my 35-year-old self that things can get better. That she'll learn an enormous amount about herself over the next decade, become more confident in who she is and gradually understand her body in ways she never did before.
I just wish she'd been a little kinder to herself along the way.
What could we be doing differently in our thirties and forties?
I don't believe the answer is to start taking an enormous collection of supplements or to assume that every woman needs the same menopause protocol.
In fact, that's almost the opposite of how I practice.
I think we need to start paying attention earlier, recognising possible perimenopause symptoms rather than dismissing changes in how we feel as simply getting older.
That means taking changes in sleep, energy, mood, digestion and recovery seriously rather than automatically dismissing them.
It means understanding that nutrition and adequate protein matter, particularly as we age. That maintaining muscle and bone strength becomes increasingly important. That our gut health and metabolic health deserve attention.
It means recognising that sleep isn't a luxury, and that chronic stress can have consequences beyond simply making us feel overwhelmed.
And it means being willing to explore hormonal changes, thyroid health, gut health, nutritional deficiencies and other possible contributors when symptoms begin to appear. For some women, appropriate hormone treatment may be an important part of that conversation. For others, there may be several areas to address together.
My approach combines functional medicine, nutritional support, herbal medicine and realistic lifestyle changes. But above all, through the coaching and education in my programs I want women to understand what's happening in their bodies and feel that they have some influence over how they experience these years.
Not everything can be prevented or controlled. But there is a great deal we can do to support our health, function and quality of life. And I would much rather we started having those conversations before women were thoroughly exhausted.
The best years are definitely not behind us
I keep thinking about that life-satisfaction graph. The fact that the curve rises again is such a hopeful image. Of course, it doesn't mean we can guarantee happiness by eating well, sleeping properly or addressing our hormones. Life is much more complicated than that. But it reminds me that the way we feel at 45 or 47 or 50 doesn't have to define the decades ahead. And I think that's something women need to hear.
We don't have to accept feeling increasingly tired, anxious or disconnected from ourselves without asking why. We don't have to wait for a hot flush or a missed period before considering whether hormonal changes might be playing a part.
And we certainly shouldn't have to reach breaking point before we feel entitled to prioritise our health.
I don't want women to spend the best part of a decade feeling progressively less like themselves before somebody finally tells them that their hormones might be involved.
I want us to start looking after ourselves earlier, with more understanding, more curiosity and a little less acceptance that feeling awful is simply part of getting older.
When I saw that life-satisfaction curve rising again after midlife, I felt something I hadn't expected: relief. Not because a graph could explain everything I'd experienced, but because it reminded me that this stage of life isn't the whole story. We can learn to understand our bodies better. We can change how much we expect of ourselves. We can ask for help.
And perhaps, rather than waiting until we feel awful before looking after ourselves, we can start believing that we deserve to feel well in the first place.
If you're recognising yourself in this article and would like to understand what's contributing to how you're feeling, my Feel Like Yourself Again programme brings together functional medicine, gut health, nutrition, herbal medicine and personalised support to help you make sense of your symptoms and take practical steps forward.
Comments