Why So Many Women Don’t Realize They’re Already in Perimenopause
For many women, perimenopause doesn’t begin with hot flashes. It starts with exhaustion, anxiety, brain fog, disrupted sleep, and the unsettling feeling that something has changed. New data suggests those symptoms may be more connected than we realize.
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For decades, most women thought they knew what menopause looked like. It was hot flashes. Night sweats. Not getting your period anymore. What received far less attention was everything that could happen beforehand.
Exhaustion that seemed to come out of nowhere. Anxiety that suddenly felt harder to explain. Brain fog that has you forgetting how to articulate your thoughts. Libido changes you can’t understand. For many women, those experiences never felt connected. But according to a new report from women’s health company Joylux, that fragmented way of thinking about symptoms may be one reason so many women fail to recognize the earliest stages of perimenopause.
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Early Perimenopause Symptoms You Might Not Recognize
The image most women carry of menopause is the one passed down from mothers and aunts and every pharmaceutical ad of a woman fanning herself. Something that happens, clearly and unmistakably, after 50. But actually, perimenopause can begin in the late 30s or early 40s, and its earliest symptoms look almost nothing like the stereotype.
A new analysis from Joylux drew on symptom data from more than twenty thousand women collected through the company’s digital health platform and found that many of the symptoms women experience during perimenopause appear as part of an interconnected network rather than isolated complaints. Fatigue, cognitive symptoms, mood changes, sleep disruption, and sexual health concerns frequently appeared together across the dataset. The report was funded by Joylux and analyzed data from its own platform.
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Colette Courtion, founder and CEO of Joylux, came to the work personally. “After becoming a mom, I experienced changes in my own body that nobody had really prepared me for,” she says. “When I talked to my girlfriends, almost every one of them had a version of the same story. The message women were getting was that these symptoms were simply something to endure.” But according to Courtion, they can also obscure a much larger pattern. “Here were millions of women experiencing symptoms that affected confidence, relationships, sexuality, and daily quality of life, yet the medical system had largely normalized their suffering instead of addressing it. It was a major women’s health gap hiding in plain sight.”
Discover the new insights in perimenopause and menopause
The report she built around that gap found that many women are experiencing meaningful symptoms long before they would identify themselves as being in menopause, which helps explain why so many aren’t getting diagnosed or even having these conversations with their doctors.
The findings echo what menopause specialists have observed in clinical practice for years. New research is now putting numbers to it. Dr. Sarah de la Torre, OB-GYN and chief medical officer at Joylux, says much of the confusion starts with when women have been taught to look. “Most women still think menopause starts when their periods stop, but clinically, symptoms often begin years before periods become irregular,” she says. “Women can experience fatigue, anxiety, sleep disruption, brain fog, joint pain, frozen shoulder, vaginal dryness, mood changes, and loss of libido long before obvious cycle changes appear.”
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If women are missing the signs, it isn’t because they aren’t paying attention. It may be because they’ve been taught to look for menopause at the end of the process, while many of its earliest symptoms begin years earlier and often look like something else entirely.
Why Perimenopause Fatigue Is the Most Overlooked Symptom
Hot flashes. It’s what people have come to associate with menopause. They’re easy to identify, easy to describe, easy to recognize as hormonal. Fatigue, by contrast, rarely gets the same attention. Why? Because most women are tired. They are balancing work, family, caregiving, relationships, and the countless invisible responsibilities that accumulate in midlife. Exhaustion often feels less like a medical symptom than a reflection of modern life. That assumption may be one reason fatigue has been overlooked for so long.
According to the Joylux report, fatigue emerged as the most centrally connected symptom in the entire dataset. Not simply another complaint, but a key connector between cognitive, emotional, sexual, and physical symptoms. “When people think about menopause, they immediately think about hot flashes,” Courtion says. “But the data showed that fatigue was one of the most connected symptoms affecting women’s daily lives. It affects mood, focus, libido, motivation, sleep quality, work performance, and relationships. Women often describe feeling like they are no longer themselves, and exhaustion is frequently at the center of that experience.”
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A woman who feels exhausted may also be sleeping poorly, struggling to concentrate, feeling more anxious than usual, and less interested in sex. Because those symptoms tend to be discussed separately, they can feel like separate problems rather than different expressions of the same transition. “Fatigue is often the symptom that connects everything else,” de la Torre says. “During perimenopause and menopause, women may experience disrupted sleep, night sweats, mood changes, increased stress sensitivity, hormonal fluctuations, and cognitive changes. All of those can feed into fatigue.”
De la Torre says fatigue has also been historically hard to take seriously in clinical settings. “It has been underrecognized because women are often conditioned to push through exhaustion. In medicine, fatigue can be difficult to quantify, so it may get minimized.” The result is that exhaustion becomes background noise rather than useful information.
That growing sense of “I don’t care anymore” isn’t random. It’s rooted in real neurological changes that come with perimenopause and midlife.
Menopause Brain Fog and Trouble Concentrating
Women describe forgetting names, losing words mid-conversation, struggling to focus during meetings, finding it harder to process information that once came easily. For women who have spent decades building careers, managing households, and carrying enormous responsibility, those changes can feel unsettling in ways that are hard to explain to anyone who hasn’t experienced them.
According to this new research, brain fog and focus-difficulty shared the strongest relationship of any symptom pair. Experts say that’s not a coincidence. “Estrogen has important effects on the brain, including areas involved in memory, attention, sleep regulation, and mood,” says de la Torre. “During perimenopause, estrogen levels fluctuate unpredictably, and that fluctuation can affect neurotransmitters, sleep quality, and cognitive processing.”
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Cognitive symptoms tend to arrive during the years when women are carrying peak professional and personal responsibility. De la Torre says it often reflects a misunderstanding of what’s actually happening. “One of the biggest misconceptions is that women are somehow losing their intelligence or becoming less capable, and that is simply not true.” She’s also direct about the cost of not addressing it. “Companies risk losing some of their most experienced and valuable employees simply because women are struggling silently without support or flexibility.” The encouraging news, per de la Torre: cognitive symptoms are often manageable. “For many women, these cognitive symptoms improve over time, especially when sleep, stress, mood, and hormonal health are addressed. Brain fog is real, it is biologically plausible, and in many cases, it is manageable and reversible.”
Low Libido and Hormonal Changes in Midlife
Of all the symptoms associated with menopause, libido may be the most misread. Changes in sexual desire are almost always interpreted through the lens of relationships. The conversation immediately becomes emotional before anyone has asked whether the underlying cause might be physical.
According to the Joylux report, libido functioned as a “bridge symptom,” connecting vaginal dryness and other genitourinary symptoms outward to fatigue and mood. The findings suggest libido may reflect broader physiological changes occurring throughout the body rather than sitting in isolation as a purely relational concern.
“Libido is not a relationship failure or a sign that something is wrong with you as a person,” says de la Torre. “Libido is influenced by hormones, blood flow, vaginal comfort, sleep, stress, mood, medications, relationship dynamics, and overall health.” Partners often assume a woman is no longer attracted to them when she may be navigating pain, exhaustion, or an anxiety around intimacy she hasn’t fully understood herself yet. “Women are often silently pulling away from intimacy because sex is painful, not because they do not love their partner or want closeness.” When women understand libido as a health symptom rather than a personal failing, de la Torre says, they can seek help without shame.
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Why Modern Healthcare Fails Menopause Patients
One of the more telling findings in the Joylux report wasn’t which symptoms appeared together; it was how consistently those symptoms appeared as part of the same network, regardless of where a woman was in the transition. Modern medicine excels at specialization. That’s often a strength until a condition refuses to stay neatly inside one specialty. “Menopause should not be viewed as a checklist of isolated complaints,” says de la Torre.
“Hormonal changes influence multiple systems at once, including the brain, sleep, mood, metabolism, musculoskeletal system, vaginal tissue, skin, bladder, and cardiovascular and bone health.” Most women learn about estrogen primarily as a reproductive hormone, but its role extends much further. “Estrogen plays a role in brain function, collagen production, inflammation, blood vessels, bone health, muscle and joint function, and even how the body regulates temperature and energy.” Because estrogen receptors exist throughout the body, fluctuating levels during perimenopause can affect multiple systems simultaneously… which is part of why symptoms, viewed one at a time, can look like so many other things.
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De la Torre points to examples that many women would never connect to hormonal changes: a frozen shoulder treated in isolation, fatigue and anxiety sent home with an antidepressant. “Instead of asking, ‘How do we treat this one complaint?’ physicians should also be asking, ‘Could these symptoms be connected through hormonal transition?’”
Courtion says she hears versions of the same story from women constantly. “I cannot tell you how many women, including many on the Joylux team, have shared stories of going to their doctors and being told their symptoms were stress, aging, anxiety, or simply something they had to live with. Many were not getting the conversations, education, or treatment options they deserved.”
Click here to read the full study.
