"I just don't feel like myself."
I hear it all the time, almost word for word.
You're sleeping worse than you used to. Your periods are doing something new. You feel more anxious or short-tempered than the person you know yourself to be. You walk into a room and forget why you're there. And when you try to explain it, it comes out as one sentence: I just don't feel like myself.
Here's what I want you to know, woman to woman: that statement matters. It's often the very first sign of a hormonal change, and there's research that backs that up. You're not imagining it, and you're not alone.
Why perimenopause is so confusing
Perimenopause is the transition leading up to menopause, when your ovaries gradually change how they make hormones. It often begins in your 40s, though it can start earlier, and it can last several years.
The tricky part is that your hormones don't drop in a straight line. They rise and fall, sometimes from one month to the next. So your symptoms can come and go, change, or seem to have nothing to do with each other.
Some of the signs women expect:
- Periods that become irregular, heavier, lighter, closer together or further apart
- Hot flashes and night sweats
And some that tend to surprise people:
- Trouble falling or staying asleep
- Anxiety, irritability or low mood that feels new
- Brain fog and trouble finding words
- Joint aches
- Heart palpitations
- Itchy skin, and yes, even itchy ears
- Vaginal dryness or a lower sex drive
- Feeling exhausted no matter how much you rest
I get asked about that itchy-ears one a lot: "Is that really a perimenopause symptom?" The answer is yes.
Because these symptoms are spread across sleep, mood, memory, skin and your cycle, a lot of women experience them one at a time. A sleep problem here. Stress there. It's easy for nobody, including you, to connect the dots.
The belief I wish women would let go of
"I'm not old enough for this to be hormones."
So many women think perimenopause is driven by age alone, and that they have to hit a certain birthday before it's worth asking about. In reality, the focus should be on your symptoms. If something has changed and you don't feel like yourself, that's worth a conversation, whatever your age.
You deserve a real conversation
I'm Katie Carstens, a physician assistant in western Wisconsin. When a woman sits down with me and says she doesn't feel like herself, I don't rush past it. My first response is simple: Tell me more about that.
I want you to feel heard, seen and taken care of. And I want you to leave feeling like you're in control of your plan, not like a plan just happened to you.
Three steps to your first perimenopause appointment
1. Know your history
Your gynecologic history is one of the most helpful things you can bring. Before your visit, think through:
- Your periods. When they started, what they've been like over the years, and how they've changed recently (timing, length, heaviness).
- Pregnancies and births, and any complications.
- Birth control, past and present, including IUDs.
- Gynecologic procedures or diagnoses, like fibroids, endometriosis or abnormal Pap results.
- Your family history, especially any bleeding disorders or cancers.
- Your symptoms. What they are, when they started, and how much they affect your day.
2. Ask the questions, including about testing
A first visit with me is going to feel very thorough. I'll ask a lot of questions: about your symptoms, your gynecologic history and your family history. I want to make sure there's no history of bleeding disorders or cancers that we need to keep in mind.
Then there's hormone testing, which is one of the most common things women ask me about.
Here's what surprises a lot of people: when you test matters as much as whether you test. Your hormones change throughout your cycle, so checking them blindly on whatever day your appointment happens to fall often doesn't give us the best information. If you're still having periods, it's best to test during the luteal phase, the second half of your cycle after ovulation. We're happy to talk you through the timing so your results actually mean something.
3. Leave with a plan
You should walk out understanding what's likely going on and what comes next.
Depending on your symptoms and your history, your plan might start with sleep, nutrition, movement or stress. It might include hormone support, such as progesterone, estrogen or testosterone. We'll talk honestly about what fits your life, and we'll start with one simple goal instead of trying to change everything at once.
When not to wait
Perimenopause can change your periods, but some bleeding changes deserve a prompt visit. Make an appointment soon if you have:
- Very heavy bleeding, such as soaking through a pad or tampon every hour or two
- Bleeding between periods or after sex
- Periods that come much closer together than usual, like every three weeks or less
- Any bleeding after you've gone 12 months without a period
And if you're feeling hopeless or having thoughts of harming yourself, please reach out right away. You can call or text 988, any time.
You don't have to just push through
When perimenopause goes unnamed, women can spend years thinking they're just stressed, failing at sleep, or "not themselves anymore." That's a lot of time spent feeling worn down while still taking care of everyone else.
It doesn't have to be that way. Imagine sleeping through the night again. Imagine understanding why your body has been changing, and having a plan that actually works for your life. Imagine feeling like yourself again.
Your next step
If there's one thing I want you to know before your first perimenopause appointment, it's this: your symptoms matter more than your age. If you don't feel like yourself, that's reason enough to ask.
Know your history. Ask the questions. Leave with a plan.
Feeling tired too? Read Why Am I So Tired? You Deserve More Than "It's Just Normal".
I do this because I care. — Katie
Contact the clinic to arrange care with Katie, or call the Roberts office at 715-760-3770.
