Perimenopause has entered mainstream conversation thanks to TV doctors and social media influencers. Perimenopause—the years-long transition before menopause, which typically begins around 46 or 47—brings symptoms like hot flashes, irregular periods, and anxiety. Hormones including estrogen, progesterone, luteinizing hormone, and follicle-stimulating hormone fluctuate wildly, making symptoms worst during this phase, says Mary Ann Lumsden, former president of the International Menopause Society. Because hormone levels roller-coaster, there is no reliable test for perimenopause.

Despite this, marketers promote blood tests, apps, supplements, and hormone replacement therapy (HRT). Paula Briggs, former chair of the British Menopause Society, warns that social media pushes a "cult-like" narrative that all women must have HRT. But HRT was trialed for menopausal women, not perimenopausal ones. Standard HRT may be swamped by a woman's own hormone production and can cause abnormal bleeding.

Supplements lack evidence; Lumsden found patients taking testosterone supplements showed no blood-level increase. Nanette Santoro, professor at University of Colorado Anschutz, notes many attributed symptoms—fatigue, brain fog, digestive issues—don't closely link to hormonal changes. The author's pelvic pain turned out to be endometriosis, which HRT can worsen. Midlife stressors like caregiving and career pressures also contribute to exhaustion not explained by hormones alone.