At 46, No One Mentioned Perimenopause

I was talking to a friend recently.

She’s 46, and she mentioned she’d spoken to her doctor and had recently started HRT. She said it’s been a real help, and there was a lightness in the way she spoke about it, a sense of things beginning to make more sense.

I felt genuinely pleased for her.

And then, almost immediately, I found myself thinking…

At 46, I was already struggling.

What I was experiencing, but couldn’t name

I can’t remember every detail clearly, but I do remember how I felt.

The brain fog that made simple things feel harder than they should. The low mood that didn’t quite lift. The broken sleep. The exhaustion that sat underneath everything.

I was going to the doctor, having blood tests, trying to explain what felt off. But perimenopause was never mentioned. Not once.

So I carried on, trying to function, trying to keep up, trying to make sense of something that didn’t seem to have a name.

Looking back now with a later ADHD self diagnosis, I can also see how much that may have been heightening things. The overwhelm, the inconsistency in energy and focus, the way everything could feel just a bit harder to hold together. At the time, I didn’t have that awareness either, so everything blurred into one experience that I couldn’t quite explain.

With more understanding now

It’s only now that I can see it more clearly.

And if I’m honest, there’s a part of me that feels a quiet kind of grief. I remember the sense of despair and hopelessness, that there was no change coming, that I simply had to continue like this. A sense of wishing I’d known, of wondering how things might have felt if someone had joined the dots earlier, of recognising how much effort went into just getting through those days.

I realise now that feeling was grief. I grieve for myself at 46.

Awareness is growing, but not evenly

At the same time, I can see that things are shifting.

Conversations around perimenopause are more visible now. More women are sharing their experiences, and more of us are beginning to recognise the signs in ourselves and each other.

My friend’s experience is part of that. The fact that HRT was discussed, offered, and has helped her, that matters. It’s progress.

But then I saw a clip shared by Dr Louise Newson from a recent storyline on EastEnders.

It highlighted something that still feels all too familiar. How difficult it can be for women to be prescribed body identical hormone treatments. How often symptoms are overlooked or redirected. How inconsistent the support still is.

It made me think about how often antidepressants are prescribed instead, something I’ve experienced myself.

I was prescribed them more than once over the years. The last time was when things felt at their worst, panic attacks, anxiety, waking early, and feeling close to not wanting to leave the house. At the time, it was treated as anxiety.

Looking back now, I can see that it may well have been perimenopause.

And it made me realise that alongside the progress, there’s still a gap.

Why does it still feel this hard?

It made me wonder why change still feels slow.

Why, when awareness is clearly growing, access doesn’t always follow. Why so many women are still having to push to be heard, to be taken seriously, to be offered options that could genuinely help.

What actually helped me

For me, HRT has been part of my journey now.

But it hasn’t been the whole answer.

What’s helped just as much, if not more at times, has been everything around it. Slowing down, paying attention to how I actually feel day to day, getting outside more, walking more slowly and intentionally, and sleeping better where I can.

I’ve also become more aware of the basics in a way I hadn’t before. Eating more regularly, choosing foods that support my energy rather than spike and drop it, and simply drinking more water. Small things, but not always easy to stay consistent with, especially when everything already feels a bit off.

And none of it has been an overnight shift.

It’s been gradual, often messy, and at times overwhelming, realising how many areas of life might need to change at once. Not in a complete overhaul, but in small, ongoing adjustments.

Letting go of the idea that I can keep going at the same pace I always have has probably been the biggest shift of all.

Because the truth is, we can’t just carry on as if nothing has changed.

We might feel like we’re still in our thirties in some ways, but our bodies are going through something real. Ignoring that doesn’t seem to work.

I think that’s the part I didn’t understand then. I kept trying to push through, to function in the same way, to expect the same energy and focus, instead of stepping back and asking what I might need differently.

Where this leaves us now

Things are improving, slowly.

There’s more conversation, more awareness, more women recognising themselves in what they’re hearing. But there’s still more to be done, in how we’re supported, in how seriously symptoms are taken, and in how easily we can access the right help at the right time.

And if you’re in that space now, where something feels off, where you’re not quite yourself, where things feel harder than they used to…

You’re not imagining it.
This comes from my own experience, but I know I’m not the only one.