Episode 35: Am I Crazy, or Is This Perimenopause?
Am I Crazy, or Is This Perimenopause?
The Modern Midlife Collective Podcast
Episode Overview
Have you been told your labs are normal -- but you still don't feel like yourself? Are you waking up at 3 a.m., snapping at people you love, forgetting words mid-sentence, and wondering what is happening to your body? Before you assume the worst, there's something you need to hear: you are not crazy. You may be in perimenopause.
In this foundational episode, Dr. Jillian Woodruff, MD, FACOG, MSCP, and Dr. Ade Akindipe, DNP, break down everything women need to know about the menopausal transition -- what it actually is, why it begins earlier than most women expect, and why the symptom list goes so far beyond hot flashes. They explain why perimenopause is a clinical diagnosis rather than a laboratory one, what the research actually shows about hormones and brain health, and what to do if you have already been dismissed by a provider who told you your numbers look fine.
This episode also addresses why so many perimenopausal symptoms are misattributed to anxiety, stress, or aging -- and what the full, evidence-based picture actually looks like. If you have been searching for someone to finally connect the dots, this is that conversation.
Key Takeaways
• Perimenopause can begin in the late 30s and lasts an average of four to ten years -- and women can be fully symptomatic while still having regular menstrual cycles.
• Hormone levels fluctuate dramatically during this transition. A single blood draw is a snapshot, not the full film. Perimenopause is a clinical diagnosis based on symptoms, history, and patterns over time.
• Estrogen receptors are found in the brain, bones, heart, blood vessels, bladder, skin, and muscles. When estrogen fluctuates, women feel it throughout their entire body -- which explains why the symptom list seems so disconnected.
• The SWAN Study (Study of Women's Health Across the Nation), one of the largest long-term studies of the menopausal transition, confirmed that sleep disruption, mood changes, cognitive complaints, and hot flashes commonly emerge during perimenopause -- often well before the final menstrual period.
• Cognitive changes -- word-finding difficulties, brain fog, and memory lapses -- are common during perimenopause and are typically temporary and hormone-related. They are not early dementia.
• Tracking your symptoms over four to six weeks -- including sleep, mood, energy, cycle changes, hot flashes, brain fog, and joint pain -- gives your clinician critical information that a single lab result cannot provide.
• Evidence-based treatment options exist. There is no clinical or moral virtue in suffering through this transition without support.
Topics Discussed
What perimenopause is and how it differs from menopause, why perimenopause can begin in the late 30s, the hormone fluctuation pattern during perimenopause and why it is not a steady decline, the full symptom spectrum of perimenopause including neurological, cardiovascular, musculoskeletal, urogenital, and metabolic symptoms, the SWAN Study and what it tells us about the menopausal transition, estrogen and the brain including research from Harvard Medical School and Brigham and Women's Hospital, the ACOG position on perimenopause symptom onset, why perimenopause is a clinical diagnosis and not a laboratory diagnosis, the limitations of hormone testing and what labs actually tell us, conditions that mimic perimenopause including thyroid disease, iron deficiency, and insulin resistance, why perimenopausal anxiety is frequently misattributed to stress, the cognitive changes of perimenopause and why they are temporary, building your midlife foundation using the CARESS framework, how to find a Menopause Society certified practitioner, listener questions addressing the most common perimenopause misconceptions
Your Five-Step Perimenopause Action Plan
1. Track your symptoms for four to six weeks. Include sleep, mood, energy, hot flashes, brain fog, cycle changes, joint pain, and libido. Patterns are data your clinician needs.
2. Know your family history. Ask when your mother or sisters reached menopause and whether they experienced osteoporosis, heart disease, or cognitive changes.
3. Build your midlife foundation. Prioritize protein at every meal, resistance training two to three times per week, daily movement, stress management, and sleep. The CARESS framework is a place to start.
4. Find a clinician with menopause-specific training. The Menopause Society maintains a certified practitioner directory at menopause.org.
5. Give yourself grace. You are not weak. You are not lazy. You are moving through a transition -- and you deserve support during it.
Resources Mentioned
The Menopause Society certified practitioner directory: menopause.org
ACOG (American College of Obstetricians and Gynecologists): acog.org
SWAN Study (Study of Women's Health Across the Nation): swanstudy.org
Modern Gynecology and Skin: moderngynalaska.com
Rejuvenate Health and Wellness: rejuvenatehealthak.com
The Modern Midlife Collective: modernmidlifecollective.com
Contact us: connect@modernmidlifecollective.com
**Watch on YouTube:** @drjillianwoodruff -- video available one week after audio release
**Connect with Dr. Ade:** @dr.adeakindipednp
Scientific References
1. Sowers MF, Crawford SL, Sternfeld B, et al. SWAN: A multicenter, multiethnic, community-based cohort study of women and the menopausal transition. In: Lobo RA, Kelsey J, Marcus R, eds. *Menopause: Biology and Pathobiology.* San Diego, CA: Academic Press; 2000:175-188.
2. Bromberger JT, Matthews KA, Schott LL, et al. Depressive symptoms during the menopausal transition: the Study of Women's Health Across the Nation (SWAN). *J Affect Disord.* 2007;103(1-3):267-272. doi:10.1016/j.jad.2007.01.034
3. Avis NE, Crawford SL, Greendale G, et al; Study of Women's Health Across the Nation. Duration of menopausal vasomotor symptoms over the menopause transition. *JAMA Intern Med.* 2015;175(4):531-539. doi:10.1001/jamainternmed.2014.8063
4. Harlow SD, Gass M, Hall JE, et al; STRAW + 10 Collaborative Group. Executive summary of the Stages of Reproductive Aging Workshop + 10: addressing the unfinished agenda of staging reproductive aging. *Menopause.* 2012;19(4):387-395. doi:10.1097/gme.0b013e31824d8f40
5. Brinton RD, Yao J, Yin F, Mack WJ, Cadenas E. Perimenopause as a neurological transition state. *Nat Rev Endocrinol.* 2015;11(7):393-405. doi:10.1038/nrendo.2015.82
6. Maki PM, Henderson VW. Hormone therapy and cognition: where do we go from here? *Menopause.* 2016;23(7):733-735. doi:10.1097/GME.0000000000000678
7. Weber MT, Maki PM, McDermott MP. Cognition and mood in perimenopause: a systematic review and meta-analysis. *J Steroid Biochem Mol Biol.* 2014;142:90-98. doi:10.1016/j.jsbmb.2013.06.001
8. American College of Obstetricians and Gynecologists. ACOG Practice Bulletin No. 141: Management of menopausal symptoms. *Obstet Gynecol.* 2014;123(1):202-216. doi:10.1097/01.AOG.0000441353.20693.78
About Dr. Jillian Woodruff, MD
Dr. Jillian Woodruff, MD, is a board-certified OB-GYN, gynecologic surgeon, and Menopause Society Certified Practitioner. She is the founder of Modern Gynecology...
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