Why Perimenopause Often Gets Missed

Understanding perimenopause, and why it’s often missed

Dr. Katherine Lambert

Dr. Kate works in women’s health with a focus on perimenopause and menopause.

Her pathway into medicine wasn’t linear. She began in medical school, transitioned into nursing, and later returned to complete her medical training. That experience shaped a more grounded, patient-focused approach to care.

Her interest in menopause was influenced early on by her mother, a GP who established a women’s health menopause clinic. Since then, she has continued to develop her expertise through clinical work, mentorship, and ongoing research.

Her approach is holistic and patient-centred, with a focus on improving quality of life and long-term health outcomes.

What is actually happening during perimenopause?

Perimenopause is the phase leading up to menopause where hormone levels begin to decline.

It can start 7–10 years before a woman’s final period.

Menopause itself is only diagnosed retrospectively - once someone has gone 12 months without a period, typically after the age of 50.

Both stages are driven by the same underlying change: hormone deficiency.
This is why the symptoms can look similar, even though they may appear years before menopause is officially diagnosed.

Why so many women don’t realise it’s perimenopause

One of the biggest challenges with perimenopause is that it doesn’t always present in obvious ways.

For many women, it doesn’t start with hot flushes.

It starts with a general sense that something feels off.

Energy levels change.
Concentration becomes harder.
Mood shifts feel less predictable.
Sleep may become disrupted.
Cycles can change - in timing, flow, or symptoms.

For women in their 30s and 40s, these changes are often attributed to stress, burnout, or lifestyle.

And in many cases, that’s what they’re told.

Why standard testing often doesn’t help

Blood tests are not a reliable way to diagnose perimenopause.

Hormone levels fluctuate significantly - even within the same day.
A result that appears “normal” doesn’t rule it out.

This creates a gap where symptoms are real, but difficult to confirm through standard testing.

Without the right context, it’s easy for both patients and clinicians to look elsewhere for explanations.

The result: symptoms are treated, not understood

When perimenopause isn’t recognised, care often becomes fragmented.

Symptoms are addressed individually - sleep, mood, energy, cycle changes - without connecting them back to an underlying hormonal shift.

This can lead to ongoing frustration, trial-and-error treatment, and a sense that nothing is quite working.

A different way of looking at it

Perimenopause isn’t a single symptom or a single moment in time.

It’s a gradual, complex transition that affects multiple systems at once.

Understanding that changes the way it’s approached.

It allows symptoms to be viewed as part of a broader pattern, rather than isolated issues.
And it creates a clearer pathway toward appropriate support and management.

Closing

For many women, the turning point is simply recognising what’s actually happening.

Not everything is stress.
Not everything is burnout.

And if something feels off, it’s worth looking at it more closely.