Saul: If Your Brain Feels Like 47 Open Browser Tabs, It Might Not Just Be Stress

By Dr. Lisa Saul

You're awake at 3 a.m. for no obvious reason. Your patience is gone by 9 a.m. You walk into a room and forget why. You reread the same email three times and still don't get it.

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So you blame stress. Work. Kids. Life.

And sure, life is doing a lot right now. But for many women in their late 30s through early 50s, there may be another explanation hiding in plain sight: perimenopause. It's the transition leading up to menopause, when hormone levels begin to shift.

The tricky part is that perimenopause doesn't always start with the symptoms people expect. Before hot flashes or noticeable period changes, women may experience sleep problems, fatigue, mood changes, trouble focusing or a general sense that something feels off. Night sweats, anxiety, headaches, joint aches and vaginal dryness can also be part of the picture.

Why women don't always connect the dots

Perimenopause can be easy to miss because, for some women, it looks a lot like modern life. Exhaustion, brain fog and irritability are easy to attribute to packed schedules, caregiving responsibilities, work pressures or lack of sleep.

As a result, women may spend months, or even years, pushing through symptoms before realizing they could be connected. That can be frustrating because perimenopause rarely shows up as a single issue. It often affects multiple aspects of daily life at the same time.

When it follows you to work

Brain fog is one thing when you forget why you opened the refrigerator. It feels different when you lose your train of thought in a meeting or find that tasks that once took minutes now take hours.

Many women also report feeling more anxious or emotionally depleted. That can be especially challenging because this stage of life often arrives when women are balancing careers, households, children, aging parents or all of the above. When sleep suffers, concentration slips or anxiety increases, those effects can show up at work, too.

Nearly 3 in 4 women say menopause symptoms have negatively affected some aspect of their work life, and 1 in 5 say those symptoms have affected their income. That highlights how disruptive this transition can be when it overlaps with everything else women are already managing.

Why it doesn't look the same for everyone

One reason perimenopause can be confusing is that there is no single experience.

Some women have mild symptoms, while others experience changes severe enough to disrupt daily life. Women of color often face additional challenges, including earlier onset, longer symptom duration and more severe symptoms. If your experience feels harder than what you've heard described, you're not alone.

Why answers can be hard to get

One of the most frustrating aspects of perimenopause is that symptoms are often treated individually instead of as part of a larger pattern.

Sleep problems may be treated as sleep problems. Anxiety may be treated as anxiety. Difficulty concentrating may be dismissed as stress. When those pieces are not viewed together, the bigger picture can be missed.

How to advocate for yourself

If changes in sleep, mood, focus, periods or energy are affecting your daily life, it's worth talking with a clinician. A few ways to make that conversation more productive include:

• Track symptoms and look for patterns.
• Describe the specific impact on your daily life.
• Ask directly whether perimenopause could be contributing.
• Discuss available treatment and support options.
• Keep asking questions if you don't feel heard.

A good time to put yourself back on the list

Open enrollment is often the only time of year to review your health coverage and decide whether it still fits your needs. The coverage that worked for you a few years ago may not be the best match for the stage of life you're in now, and that's okay. Your health needs are allowed to change.

As you compare plans, consider whether you have access to the providers, treatments, mental health support and women's health resources that fit your needs today. UnitedHealthcare, for example, helps connect eligible members with information, care resources, and treatment options that may help them better understand and manage these symptoms.

Perimenopause is a natural transition, but that doesn't mean you have to simply push through it. Pay attention to what your body is telling you, ask questions and seek support. Taking care of yourself helps you keep showing up for everyone else.

Dr. Lisa Saul is the chief medical officer of Women's Health for UnitedHealth Group