Perimenopause

Perimenopause can begin in the early to mid 40s, while cycles are still happening. Hormone levels do not decline in a straight line during this stage. They oscillate, sometimes within a single cycle, which is why the experience is inconsistent and why it is so often dismissed. The symptoms most women actually arrive with are fatigue, memory lapses, difficulty concentrating, irritability and sleep that stopped working. Hot flashes rank far lower in reported prevalence. That gap matters because it shapes what women are told. A 2025 national survey of more than 1,000 working women found 39% felt they had been misdiagnosed when seeking care for perimenopause symptoms. Among them, 33% were diagnosed and treated for anxiety, 27% for depression, and 25% for mood swings. There is a structural reason for that. Seven of the eight items on the PHQ-8 depression screening scale, including sleep disruption, appetite changes, fatigue and trouble concentrating, can be produced by perimenopause rather than clinical depression. A screening tool cannot distinguish between them. Research from The Menopause Society also found that fewer than one in five medical students receive any formal menopause education. Some women in midlife do have clinical depression, and some have both. The point is not that one answer is always right. It is that both possibilities deserve an evaluation, and at T Clinics USA in Naples, Fort Myers, and Coral Springs that evaluation happens in person. Results vary by individual.