I had three babies in four years. I worked the overnight shift as a nurse practitioner. I was constantly on edge, trying to hold it all together — at home, at work, and inside my own mind.
Most days, I was fueled by caffeine, cortisol and the pressure to push through.
I remember driving home after a 12-hour night shift, creeping past my children’s bedrooms hoping not to wake them, and collapsing into bed, only to stare at the ceiling, wide awake. Sleep wouldn’t come. My heart pounded. I’d cry in the car for reasons I couldn’t name. And when I finally asked for help, I was told, “Well, that’s motherhood,” or “You’re probably just getting older.” One provider glanced at my labs and said, “Everything looks normal — it’s probably just stress. You have a lot going on. Maybe try slowing down.”
No one, including me, ever considered that I might be in perimenopause.
Like so many women, I had no idea that perimenopause could look like this. My periods hadn’t stopped. But I was moody, anxious, sleepless, bloated, losing handfuls of hair in the shower, waking up drenched in night sweats, and dealing with brain fog so thick I’d repeat conversations or forget why I walked into a room — emotionally disconnected from my own body. I didn’t feel like myself, and no one could explain why.
I started dreading social events and small talk because I couldn’t trust my memory. I felt like a shell of the woman I used to be.
If you’re a woman between 35 and 55 and you’ve ever been told “everything looks normal” while you’re quietly unraveling, you’re not imagining things. And you’re far from alone.
The reality is: Perimenopause is one of the most misunderstood and mismanaged stages of a woman’s life. It’s a complex neuroendocrine shift that impacts nearly every system in the body, but our current health care model still reduces it to a handful of stereotypes. Unless you’re drenched in sweat or your periods have disappeared, the system often ignores what you’re feeling.
And if you’re a woman of color? The system fails you faster.
We face shorter appointment times, more bias and fewer referrals. Our concerns are dismissed. Our pain is questioned. Our stress is normalized. Emotional symptoms like rage, anxiety and exhaustion are often labeled as mental illness rather than viewed through a hormonal or systemic lens. We’re offered advice instead of an investigation.
Even as a nurse practitioner, I didn’t have the language for what I was experiencing. I didn’t learn this in school. I wasn’t prepared for the emotional unraveling that came with midlife. No one told me that declining progesterone could affect sleep, mood, memory, and even how safe I felt in my own skin.
There was no mention of how estrogen changes could impact how my joints ached, how I held onto weight differently, or how easily overstimulated I became. These weren’t just symptoms — they were signals, and I was taught to ignore them.
For me, it took hitting a wall to start questioning the system I was trained in. I ran my own labs. I started researching. I began connecting the dots between chronic stress, hormone imbalances, trauma and the nervous system. And most importantly, I stopped blaming myself.
What I was experiencing wasn’t a lack of resilience. It was a biological transition that demanded attention and care, not shame or silence.
Now, I support others walking this same foggy road. Through Sabrina Ritchie Wellness Consulting, I guide women 35 plus through The Peri Method, my high-touch, six-month program built to support the most painful and overlooked aspects of perimenopause — fatigue, mood swings, brain fog and that gnawing feeling of not being seen or heard.
Because what I hear every day is this:
“No one told me this could happen.”
“I thought I was just losing it.”
“My doctor said I was fine, but I don’t feel fine.”
Women deserve more than a pat on the back and a vague suggestion. They deserve real answers, targeted support and providers who understand that midlife is not a crisis — it’s a turning point.
We need to broaden the narrative. We need to teach women that perimenopause can start in their mid-30s and last for years. We need to include symptoms like insomnia, joint pain, low libido, gut issues and inflammatory changes in the conversation. And we need to train health care providers to stop separating mental health from hormonal health, because in midlife, they’re inseparable.
We also need to make space for cultural nuance and the generational silence around menopause in many communities. These shape how women experience this transition and whether they’re empowered to seek help. Many of us were raised by women who suffered silently, who didn’t talk about their bodies, and who internalized the idea that stress and struggle were just part of womanhood.
But this generation of women is no longer content to suffer quietly.
We are questioning more. Demanding more. And finding each other in the process.
Perimenopause doesn’t have to break us. But the silence around it often does.
It’s time we stop dismissing midlife women at the exact moment they’re holding everyone else together. This isn’t the end of vitality or purpose. For many of us, it’s the beginning of realignment, clarity and unapologetic self-awareness. But we must get honest about what’s happening in our bodies first, and make sure the health care system is listening.
Because when a woman says, “Something’s not right,” we owe it to her to believe her.
Sabrina Ritchie is a dual-certified nurse practitioner and author of Restoring Calm: The Essential Guide to Managing Stress, Anxiety, and Burnout. She is the founder of Thoughtful Therapies, a virtual mental health practice serving adults in Massachusetts with anxiety, burnout, and depression, with integrative, personalized care, and the creator of The Peri Method, a high-touch six-month personalized wellness program for women navigating perimenopause.
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