Chapter 1The Status Quo Experience of PerimenopauseAmy had lived her life with purpose and determination. At forty-three, she was successfully juggling the roles of wife, mother, and career professional, raising her kids with care, and navigating the everyday challenges of life with a sense of accomplishment. Her health had always been steady with no major issues to speak of. Like many other women, she followed the cultural prescription for staying healthy: years of dieting and regular exercise, mostly walking. It was a struggle, but she managed. Additional cardio from her spin class kept her happy, and though she sometimes wished for an easier path, she was proud of her ability to stay disciplined.
But then, seemingly out of nowhere, something changed. She began to feel off, as if she wasn’t herself anymore. At first, it was subtle. Weight started accumulating around her midsection, an area that for her had never been an issue. It was frustrating. Everything she had done in the past to maintain her figure now seemed futile. She doubled down, cutting calories and increasing exercise, but nothing worked. Alongside the weight gain came irritability; she began snapping at her loved ones over minor things. At work, she felt perpetually frustrated. She chalked it up to stress, but deep down, she knew something wasn’t right.
Her first visit to her doctor to try to get to the bottom of things didn’t yield a satisfying answer. “This is just what women go through,” her doctor said. “Work out more and eat less. We can prescribe an antidepressant for your mood.” She left feeling dismissed, unseen. Her irritability worsened, and then her sleep began to falter. She would wake up at 3 a.m., staring at the ceiling, unable to drift back into rest. Exhaustion became her constant companion, and the weight gain continued.
Back at the doctor’s office, she received a prescription for sleeping pills. The physician noted an additional five-pound weight gain and recommended a 1,200-calorie diet and more exercise. She wanted to scream as she was already eating 1,000 calories a day and now attending high-intensity interval training classes three times a week. Her hair began to thin, and her libido vanished. At her next well-woman exam, she hesitantly mentioned her loss of sexual desire. “Just relax more and have some wine,” her doctor advised, looking over her glasses and adding, “If you don’t use it, you’ll lose it.”
Her frustration turned to despair when a nurse called to inform her that her cholesterol levels had risen and she was now prediabetic. The nurse offered her prescriptions for metformin and a statin, with the familiar advice: “Eat low fat and continue with your efforts to lose some weight.” Brain fog at work and her constant exhaustion kept her from applying for the promotion she had worked toward for years. Her husband grew frustrated with her lack of interest in intimacy, which only deepened her feelings of inadequacy and isolation.
Next, her periods became heavy and unpredictable, often waking her in the middle of the night to deal with excessive bleeding. Her gynecologist ordered two tests; a painful in-office biopsy and an ultrasound, but each showed no abnormalities. Still, the recommended solution was a hysterectomy, though they advised that because of her age she should remove only her uterus. Her healthy ovaries would continue to produce important hormones, they explained. Anemic and desperate for relief, she agreed to the major surgery.
Afterward, the bleeding stopped, but new problems emerged. A few months later, she began experiencing severe hot flashes and night sweats, and a worsening sense of exhaustion. It occurred to her that this might be menopause, but when she mentioned it to her physician, she dismissed the idea; she still had her ovaries, after all. “You are too young for that,” she said, again advising weight loss.
Desperation drove her to social media, where ads for “hot flash cures” and “libido boosters” filled her feeds. She ordered herbal supplements, each promising relief, but none delivered. Intercourse, when she managed it, became unbearable. The pain was sharp, like razors cutting into her, leaving her in tears. She braved another doctor’s visit and mentioned the pain, only to be told it might be herpes. Mortified, she waited for test results, which eventually came back negative.
Late one night, scrolling through her phone in yet another bout of sleeplessness, she saw an ad for a telemedicine company specializing in menopause care. Feeling both skeptical and hopeful, she reached out. For the first time, a clinician truly listened. After a thorough evaluation, they diagnosed her with menopause and the genitourinary syndrome of menopause (GSM). They discussed hormone therapy, systemic and local, and together they reviewed the risks and benefits. Finally, she felt seen, heard, and validated. She began treatment, and slowly, her life started to shift.
The unfortunate truth is that it’s not hyperbolic to define this story as status quo; in fact, I would bet that if you don’t identify with parts of it directly, you’ve got to stretch out only one or two degrees to connect with someone who does.
I’m here to deliver a critical message: This doesn’t have to be your story. Together we can rewrite the status quo experience of women in perimenopause and create a movement that changes the trajectory of women’s health. Your task in the push for change is simple: You must no longer be willing to accept the brand of treatment that is defined by dismissive condolences from doctors and other clinicians. Our movement, created for you and with you, is defined instead by active listening and proactive practices that improve quality of life and protect against the effects of inevitable hormone loss.
Perimenopause Symptoms StatsIn 2024, I conducted a community survey to get a clear sense of the most common symptoms reported by women in perimenopause. More than eight hundred women participated. Perhaps you’ll see yourself in this feedback.
How the Status Quo Was BornA standard experience doesn’t come into existence by chance. It’s instead the result of several factors that over time converge and coalesce into this is just how it’s done. In the case of perimenopause, it’s challenging to say for certain which factors, because there are so many, have had the greatest impact on how women have been treated (or more like not treated) during this hormonal stage. It’s challenging but not impossible. Based on history, science, and my own personal and professional experience, I can offer an educated take on how it came to be that a woman in perimenopause would be more likely to win the lottery than hear these words from a doctor: “You may be in perimenopause. Let’s together explore some ways you can proactively support your health and well-being during this transition.”
It’s important first to acknowledge what’s at stake when you aren’t offered a clinical discussion on perimenopause—that is, why is it so critical that we disrupt the status quo? I have a lot to say about this, and I will expand as we move through the book, but ultimately it comes down to your quality of life, now and in the future. Quality of life concerns emotional well-being, physical health, and sexual health. Perimenopause can represent a turning point in any or all of these areas, and not toward the better. Becoming informed will allow you to take actions that can put out the symptomatic fire now and set you up with habits that may prevent heart disease, dementia, osteoporosis, and sarcopenia (age-related muscle loss) later. This isn’t about introducing fear; it’s about establishing generational empowerment. We must disrupt the status quo so that, from now on, perimenopause is defined as a transition invigorated by awareness and actionable knowledge.
Now, let’s get back to some of the factors that have helped create the current status quo.
Copyright © 2026 by Mary Claire Haver, MD. All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.
