Always Knackered? Why So Many Women Are Missing the Signs of Perimenopause

Exhausted, overwhelmed, forgetting things and wondering why you suddenly don't feel quite like yourself? You're certainly not alone. New research suggests thousands of Australian women may be putting the symptoms of perimenopause down to everyday stress, without realising their hormones could be playing a significant role.

There comes a point in many women's lives when things start to feel a little different. You might find yourself walking into a room and forgetting why you're there, struggling to concentrate during meetings or feeling irrationally irritated by things that wouldn't ordinarily bother you. Perhaps you're waking up at 3am for no apparent reason, feeling exhausted before the day has even begun or wondering why your once-reliable ability to juggle a hundred things at once seems to have disappeared.

Naturally, you put it down to stress. After all, between work, children, relationships, ageing parents and the never-ending mental load of keeping everyone else's lives running smoothly, who wouldn't feel a little overwhelmed?

But what if there's something else going on?

New national research commissioned by Blackmores suggests Australian women, particularly millennials, are struggling to recognise the early signs of perimenopause, with many mistaking hormonal changes for burnout, anxiety or simply the pressures of modern life.

The findings are rather confronting. Some 84 per cent of women experiencing perimenopause say they feel unprepared for this stage of life, while 66 per cent admit they tend to take a 'wait and see' approach to their health rather than seeking professional advice.

Among millennial women, 43 per cent find modern health culture overwhelming, while an extraordinary 89 per cent feel they're left to figure out their health concerns on their own.

Perhaps even more telling is how women explain away their symptoms. According to the research, 43 per cent attribute changes in their health to stress, 35 per cent to burnout and 31 per cent to mental health struggles.

And while any of these explanations could be perfectly valid, they may also be masking something that, despite affecting virtually every woman who reaches midlife, we're still surprisingly poorly educated about.

Belinda Reynolds, Head of Naturopathic Education and Advisory Services at Blackmores, says the confusion is understandable because the symptoms of stress, burnout and perimenopause can be remarkably similar.

"The two are often confused due to how similar the symptoms can be and how intertwined they are as well, often with one contributing in some ways to the other," she explains.

As women approach perimenopause, hormonal fluctuations can affect everything from mood and sleep to concentration and emotional resilience. Suddenly, situations that once seemed manageable can feel disproportionately stressful, while everyday frustrations become harder to shake off.

"The smallest thing may create stress or anger, or they aren't able to deal with or recover from stressful events the way they used to," Reynolds says.

And unfortunately, poor sleep only makes matters worse. When you're already exhausted, struggling to think clearly and feeling emotionally stretched, it's hardly surprising that the possibility of hormonal changes might not be the first thing that springs to mind.

One of the biggest misconceptions surrounding menopause is that it's something women don't need to think about until their 50s. In reality, the transition can begin years earlier.

Perimenopause commonly starts in the mid-to-late 40s, although the timing varies considerably between women, and the transition itself can last for several years.

Reynolds describes it using a particularly helpful analogy: puberty in reverse.

During puberty, our bodies adjust to the arrival of reproductive hormones and menstrual cycles. During perimenopause, those same hormones begin fluctuating as the reproductive years gradually draw to a close.

Unlike the relatively predictable hormonal patterns women may have become accustomed to, these fluctuations can be erratic, which helps explain why symptoms can appear seemingly out of nowhere.

And it's not simply a matter of experiencing the occasional hot flush.

While hot flushes and irregular periods remain among the most widely recognised signs, Reynolds says there are plenty of other symptoms women may never have associated with menopause.

Sleep disturbances, night sweats, anxiety, low mood, headaches, changes in libido, vaginal dryness, joint pain and weight gain around the middle can all occur during the transition.

Then there's brain fog, which can be particularly unsettling for women who have spent their careers relying on their ability to think quickly, communicate confidently and manage competing demands.

"For some women, this can mean losing confidence in different scenarios at work, forgetting names, losing their train of thought in conversations or having difficulty articulating themselves," Reynolds explains.

It's easy to see how these changes could leave someone questioning their professional abilities or wondering whether they're simply no longer coping as well as they used to.

The hormonal explanation is more complicated than simply having too little oestrogen. During perimenopause, levels of oestrogen and progesterone can fluctuate considerably, influencing brain systems involved in mood, memory, motivation and sleep.

Of course, hormones aren't responsible for every headache, sleepless night or moment of forgetfulness. Stress, genetics, nutrition, lifestyle and other health conditions can all play a part, which is precisely why Reynolds believes women shouldn't automatically assume their symptoms are hormonal either.

If changes are affecting your ability to function at work, manage everyday responsibilities or maintain relationships, it's worth having a conversation with your GP.

Heavy menstrual bleeding also deserves medical attention, particularly because it can contribute to iron deficiency and worsen fatigue.

Reynolds recommends women make regular health checks a priority as they approach midlife, including monitoring blood pressure, iron levels, cholesterol, blood sugar and other relevant health markers, alongside keeping up to date with recommended cancer screening.

What makes the research particularly interesting is that so many women are experiencing these changes while already managing extraordinarily demanding lives.

According to the Blackmores findings, 72 per cent of perimenopausal women are employed, 75 per cent are raising children and 69 per cent report simultaneously managing a mental health condition.

It's a combination that hardly leaves much room for prioritising your own wellbeing, particularly when you're not entirely sure what's happening to your body in the first place.

Reynolds believes education is a significant part of the problem.

We're taught about puberty at school, and there's no shortage of information available about pregnancy and childbirth. Yet menopause, another major biological transition, has historically received comparatively little attention.

"We're taught about puberty in school while we're going through it, we seek out information about pregnancy while we're planning it and during, then later suddenly perimenopause creeps up on us and we're taken by surprise!" she says.

Thankfully, that conversation is beginning to change, with women increasingly sharing their experiences and challenging the idea that menopause is something to be endured quietly.

But with greater awareness comes another problem: the sheer volume of information, advice and miracle solutions now competing for women's attention.

Spend five minutes scrolling through social media and you'll likely encounter everything from hormone-balancing diets and expensive supplement regimes to influencers promising to transform your menopause experience practically overnight.

Reynolds encourages women to approach these claims with a healthy degree of scepticism.

"I would always say to be wary of overseas products, or those that aren't regulated by the TGA, which is Australia's regulatory body for therapeutic goods," she says.

She also cautions against anything promising extraordinary results or presenting itself as the answer for everyone.

While some supplements and herbal ingredients may have a role in managing particular symptoms or addressing nutritional deficiencies, their effectiveness varies, and they aren't a substitute for individual medical advice. It's also important to consider potential interactions with prescription medications.

For women wondering where to begin, Reynolds believes the most useful changes are often the least complicated.

Eating a varied diet with plenty of vegetables, good-quality protein, healthy fats and fibre, staying hydrated, moving regularly and prioritising sleep can all help support physical and emotional wellbeing during the menopause transition.

She particularly encourages women to incorporate resistance training, whether that's lifting weights or other forms of strength-based exercise, to help maintain muscle mass and support long-term bone health.

Nutrients including omega-3 fatty acids, vitamin D and magnesium also play important roles in overall health, although supplementation should depend on individual needs rather than the latest wellness trend.

And importantly, she doesn't believe women need to overhaul their entire lives to start feeling better.

"Even small baby steps towards a healthier diet and lifestyle can make a huge difference to how you feel," she says.

It's a refreshingly achievable approach, particularly for women who are already feeling overwhelmed by everything they're supposed to be doing.

In response to its research, Blackmores has launched a digital Women's Health Hub, alongside new products targeting different stages of the menopause transition. The company says the initiative is designed to help women access more reliable health information and better understand the changes they're experiencing.

But perhaps the more important conversation is why so many women have reached midlife without feeling adequately informed about something that is a normal part of ageing.

For generations, women have navigated menopause with limited discussion, inconsistent information and, at times, little understanding of how profoundly hormonal changes can affect their everyday lives.

And while awareness is improving, the latest findings suggest there's still considerable work to be done.

For Reynolds, the message to women who are exhausted, overwhelmed or wondering why they no longer feel quite like themselves is reassuringly simple.

"Seek out support and find a practitioner who truly listens," she advises.

And perhaps that's the most important takeaway of all. You don't have to accept feeling miserable as an inevitable part of getting older, nor should you assume every symptom is simply the price of having a busy life.

Sometimes stress really is stress. Sometimes it's burnout. Sometimes hormonal changes are contributing to both.

The important thing is recognising that your health deserves the same attention you've probably spent years giving to everyone else's.

And if that means finally putting yourself at the top of the priority list, perhaps that's one midlife change worth embracing.