The forgotten midlife: What women in their 40s need to know about perimenopause

New Delhi: In clinical practice, more women in their early to mid-40s are experiencing a variety of nonspecific but persistent issues, including unexplained fatigue, mood swings, difficulties concentrating, and mild abnormalities in their menstrual cycles. These symptoms frequently appear in the absence of a significant lifestyle change or recognised sickness, leaving many people confused of what is causing the shift. In most cases, these early symptoms indicate a natural but often missed hormonal transition: perimenopause, also called as climacteric - the stage preceding menopause in which estrogen and progesterone levels begin to fluctuate.

In an interaction with TV9 english, Dr. Manjula Anagani, Padmashree Awardee, Clinical Director, Robotic Gynaecologist & HOD, Care Vatsalya, Women and Child Institute, CARE Hospitals, Banjara Hills, Hyderabad, decoded perimenopause for women in their 40s.

What Is Perimenopause?

Perimenopause is the time before menopause, in which the ovaries gradually produce less estrogen. It usually starts in the early to mid-40s, but some people experience symptoms much earlier.

What makes this stage tough to navigate is that it is frequently invisible. Women still have periods, however they may become irregular. Blood testing may not reveal anything concerning. Nonetheless, the body is experiencing actual hormonal shifts.

Mood Shifts Are Not "Overreacting"

One of the first indicators of perimenopause is frequently emotional. Many women report feeling more irritated, worried, or depressed without any obvious cause. This is not a personality change, but rather a hormonal fluctuation that affects neurotransmitters such as serotonin and dopamine. Unfortunately, in many Indian households, these mood changes are rejected as overthinking or attributed to external stress. Few women are asked if what they’re feeling could be biological. As a result, many people struggle silently.

Brain fog isn't just in your head.

Another common, but often overlooked, symptom is brain fog. Words arrive slowly. Focus shifts. Memory feels less crisp. For women who are accustomed to juggling numerous roles, this might be upsetting. 

These alterations do not indicate that something is substantially wrong neurologically. In most cases, they are associated with fluctuations in estrogen levels, which affect cognitive sharpness and mental clarity. However, ignoring them might lead to self-doubt and excessive tension.

The Slow Metabolism Surprise

Many women in their forties see abdominal weight gain, even if their diet and activity levels remain constant. This is not a failure of discipline. As estrogen levels drop, insulin sensitivity changes, fat storage patterns vary, and metabolism slows. 

Unfortunately, many women react by undereating or overexercising, both of which can backfire. The body truly needs balanced nutrition, strength training, and, most importantly, gradual acceptance of a changing biology.

Why Indian Women Are Often Missed

In India, there is a cultural emphasis on puberty, fertility, and menopause, while largely ignoring the decades in between. Many women are never informed about perimenopause or urged to monitor their symptoms.

As a result, they frequently visit doctors only after their problems have become unbearable. They may be subjected to unnecessary investigations when what they truly require is information, reassurance, and hormonal support.

What Can Help?

1. Begin the conversation early. Awareness allows women to comprehend what's going on before it becomes overpowering.

2. Keep track of changes. Mood, cycles, sleep, and energy levels—keeping a journal might help you identify patterns.

3. Consider getting blood work, but don't rely on it alone. Perimenopause is diagnosed mostly based on symptoms rather than lab values.

4. Consult your gynaecologist. Treatments range from lifestyle changes to hormone assistance and are tailored to the individual's needs.

Why This Stage Deserves Attention

Perimenopause is not a catastrophe; it is a change. However, without information or help, it may feel like a loss of control. Recognizing the indicators and openly discussing them enables women to traverse this stage with greater confidence and less dread. Midlife is not the start of a downward spiral; rather, it marks a turning point. Every woman deserves to know what her body is telling her.

Reference Link

https://www.tv9english.com/health/the-forgotten-midlife-what-women-in-their-40s-need-to-know-about-perimenopause-article-10867070.ht