Perimenopause Chaos: Why Your Doctor Says ‘It’s Normal’ But You Feel Like You’re Losing Your Mind

Author: Rohan Smith | Functional Medicine Practitioner | Adelaide, SA

Quick Answer

Perimenopause symptoms emotional chaos can feel overwhelming, as your body’s hormonal shifts impact mood, sleep, energy and cognition even when lab results look “normal.” Many women are told their symptoms are expected or “just aging,” but the intricate interplay of estrogen, progesterone, stress hormones and neurotransmitters often drives the discomfort they experience. In this article, we break down why perimenopause symptoms can feel so disruptive, why conventional testing may not capture the full picture, and what underlying factors may be contributing to the chaos you’re feeling.

Perimenopause is a prolonged hormonal transition—often lasting 5–10 years—during which fluctuating oestrogen, progesterone, and stress hormones can affect mood, sleep, cognition, and metabolism. Standard blood tests may appear “normal” because hormone levels fluctuate rapidly during this phase. Perimenopause is typically identified clinically (based on symptoms and cycle changes), rather than confirmed by a single hormone result. More comprehensive assessment approaches, including symptom tracking and advanced hormone testing interpreted in clinical context, may help explain persistent symptoms when routine tests do not.

You wake up at 3:00am again. Heart racing. Mind spinning. No obvious reason why.

By breakfast, your brain feels like it’s been stuffed with cotton wool. You lose your train of thought mid-sentence. Later, you snap at your partner because the dishwasher is full. Then you’re teary because someone on television hugged their dog.

You think, What on earth is going on?

You book an appointment with your GP. They run a few blood tests—perhaps iron studies, thyroid markers, maybe a basic hormone panel. Then they smile kindly and say, “Everything looks normal. Probably just stress or anxiety.”

You leave feeling frustrated. Not crazy exactly… but definitely unheard.

Welcome to perimenopause—the often-overlooked hormonal transition before menopause that many women are never warned about.

The Hidden Hormone Havoc of Perimenopause

Perimenopause refers to the years leading up to menopause, marked by increasing variability in reproductive hormones rather than a smooth, predictable decline (1–3). This phase can begin in the late 30s or early 40s and may last five to ten years or more.

During this time, hormones such as oestrogen, progesterone, testosterone, and cortisol may fluctuate significantly (2,4). These changes are rarely gentle. Levels can spike and crash unpredictably, contributing to symptoms that feel sudden, intense, or confusing.

Research shows that oestrogen variability—not just low levels—is strongly associated with mood symptoms, cognitive changes, sleep disruption, and anxiety during perimenopause (5–7). For some women, these hormonal shifts may also exacerbate pre-existing conditions such as ADHD, migraine, or anxiety disorders (8).

Why Conventional Medicine Often Misses the Mark

Conventional medical testing is primarily designed to detect disease—not hormonal variability or functional dysregulation.

In perimenopause:

• Hormone levels may change day to day or week to week (3).
• A single serum blood test captures only a moment in time.
• Results may fall within broad population-based “normal” ranges that don’t reflect an individual’s optimal hormonal balance (9).

Clinical guidelines acknowledge that hormone testing during perimenopause is often limited in diagnostic value, particularly when menstrual cycles are still occurring (1). As a result, many women are told they are “fine” despite ongoing, disruptive symptoms.

This mismatch leaves many women feeling dismissed, untreated, and unsure whether they should trust their bodies or their test results.

“Is This Just Me Losing the Plot?”

Short answer: No.

Perimenopause has been associated with a wide range of physical, cognitive, and emotional symptoms, including (4–7,10):

• Mood swings or emotional volatility
• Anxiety or panic symptoms
• Insomnia, especially early-morning waking
• Brain fog, memory lapses, and word-finding difficulty
• Weight gain, particularly around the abdomen
• Heavy or irregular menstrual cycles
• Reduced libido or discomfort with intimacy
• Joint pain or unexplained body aches
• PMS that feels stronger or more intense than before

Because these symptoms don’t always appear “hormonal” on the surface, many women are treated for anxiety or depression alone—sometimes with limited benefit—while the underlying hormonal transition remains unaddressed (6,11).

The Changing Understanding of Perimenopause

For decades, menopause received most of the medical attention. More recently, research has begun to recognise perimenopause as a distinct neuroendocrine transition with measurable effects on the brain and body (5,6).

Large cohort studies show that the perimenopausal phase is associated with:

• Increased risk of new-onset anxiety and depressive symptoms
• Sleep disruption linked to hormonal and cortisol rhythm changes
• Cognitive complaints that cannot be explained by ageing alone (5–7,12)

This evolving understanding has shifted the focus toward earlier identification and personalised support, rather than waiting until menopause is complete.

Functional Hormone Testing: Seeing Patterns, Not Just Snapshots

When interpreted carefully and in clinical context, functional hormone testing may offer additional insight into symptom patterns during perimenopause.

One example is DUTCH testing (Dried Urine Test for Comprehensive Hormones). Unlike single serum measurements, this approach assesses hormone metabolites over time and can provide information about:

• Oestrogen and progesterone patterns
• Daily cortisol rhythm
• Androgen levels and metabolism (13–15)

This type of testing is not a replacement for medical care or diagnosis. However, when combined with symptoms, history, and standard pathology, it may help identify patterns or imbalances that are not visible on isolated blood tests alone.

For example:

• Relative progesterone insufficiency alongside fluctuating oestrogen has been associated with heavy bleeding, anxiety, and sleep disturbance (4,6).
• Disrupted cortisol rhythms have been associated with insomnia and heightened stress reactivity (16,17).
• Low androgen levels may contribute to reduced energy, motivation, and libido (18).

Interpretation remains critical, and results should always be viewed within the broader clinical picture.

You’re Not “Just Getting Older”

While perimenopause is a normal biological transition, persistent or debilitating symptoms are not something you simply have to endure.

Just like puberty or the postpartum period, perimenopause represents a major hormonal shift. It deserves informed assessment and appropriate support.

Suppressing symptoms may provide short-term relief, but understanding why they are occurring allows for more targeted, personalised strategies that support long-term wellbeing.

What You Can Do Right Now

1. Track Your Symptoms

Document sleep patterns, mood changes, cycle irregularities, stress levels, and triggers. Over time, clear patterns often emerge.

2. Rethink “Normal”

Normal lab ranges do not always equal optimal function. Ongoing symptoms are a signal worth exploring further.

3. Seek Individualised Assessment

There is no one-size-fits-all approach to perimenopause. Personalised evaluation—considering hormones, stress physiology, nutrition, and lifestyle—can help guide more effective support.

Listening to Your Body Matters

Perimenopause does not mean you are broken or failing. It means your body is navigating a complex hormonal transition.

When hormone rhythms fall out of sync, the effects can ripple through the brain, nervous system, and metabolism. With the right insight and support, many women regain clarity, stability, and confidence during this phase.

Ready to Understand What’s Really Going On?

If you’re tired of being told you’re “fine” when you don’t feel fine, support is available.

We offer comprehensive hormone assessment, including DUTCH testing where appropriate, alongside personalised interpretation and guidance tailored to your perimenopause journey.

It begins with a relaxed, obligation-free discovery call—no pressure, no hype—just an honest conversation about what you’re experiencing and whether a deeper approach may be helpful.

You’re not losing your mind. You’re navigating perimenopause—and you don’t have to do it alone.

1. Harlow SD et al. Executive summary of the Stages of Reproductive Aging Workshop +10. Menopause. 2012.
2. Santoro N, Randolph JF. Reproductive hormones and the menopause transition. Obstet Gynecol Clin North Am. 2011.
3. Hale GE, Burger HG. Hormonal changes and symptoms in the menopause transition. Best Pract Res Clin Obstet Gynaecol. 2009.
4. Prior JC. Progesterone for symptomatic perimenopause. Climacteric. 2018.
5. Gordon JL et al. Mood and anxiety disorders during the menopausal transition. Am J Psychiatry. 2015.
6. Freeman EW. Associations of hormones and menopausal transition symptoms. Menopause. 2010.
7. Schmidt PJ et al. Estrogen fluctuation and affective symptoms. Arch Gen Psychiatry. 2015.
8. Quinn PO, Madhoo M. ADHD and hormonal influences. Curr Psychiatry Rep. 2014.
9. Rosner W et al. Utility of laboratory hormone testing. J Clin Endocrinol Metab. 2007.
10. Avis NE et al. Symptom clusters in perimenopause. Menopause. 2015.
11. Soares CN. Depression and menopause. J Clin Psychiatry. 2014.
12. Greendale GA et al. Cognition in the menopausal transition. Neurology. 2010.
13. Newman MS, Brandon TR. Urinary hormone metabolite testing. Steroids. 2019.
14. Zava DT et al. Estrogen metabolism and hormone balance. Exp Biol Med. 2013.
15. Stanczyk FZ. Urinary steroid hormone measurement. Steroids. 2006.
16. Vgontzas AN et al. Cortisol and sleep disturbance. J Clin Endocrinol Metab. 2004.
17. Meerlo P et al. Stress, sleep, and the HPA axis. Physiol Behav. 2008.
18. Davis SR et al. Androgen deficiency in women. J Clin Endocrinol Metab. 2015.