Women + Health + Culture: The Perimenopause Years

September is Perimenopause Awareness Month.

We want to talk about something that sits directly at the intersection of women, health, and culture.

Because there is a cultural story here.

The cultural expectation: 

Keep going. Keep producing. Keep caring for everyone. Keep leading.

The cultural silence: 

Many women were never taught what perimenopause was or how profoundly it could affect them.

The cultural shift: 

We finally have language for it. And language gives women the ability to recognize, discuss, and share experiences that previous generations often navigated silently.

Our mothers went through it.

Our grandmothers went through it.

But how many of us actually grew up hearing them talk about perimenopause?

Many of us knew there was something called menopause. We knew about hot flashes. We may have heard older women refer to "the change."

But nobody explained what could happen in the years before menopause.

And that distinction matters.

Perimenopause Is Not Menopause

Menopause is reached after a woman has gone 12 consecutive months without a menstrual period.

Perimenopause is the transition leading to menopause. Hormones fluctuate during this period, menstrual cycles may begin changing, and women can experience physical, cognitive, and emotional symptoms years before their final period.

A woman can be 36, 41, or 49 years old, still having periods and nowhere near what she understands "menopause" to be, and already be experiencing changes associated with the menopause transition.

If nobody ever taught her that, what does she think is happening?

Maybe she thinks she's exhausted.

Maybe she thinks she's burned out.

Maybe she thinks she's depressed.

Maybe she wonders whether she has ADHD.

Maybe she decides she's simply getting older.

Or, perhaps most painfully for a woman who has always been exceptionally capable, she begins wondering whether she is somehow losing the very abilities that made her her.

When Your Brain Has Always Been One of Your Greatest Assets

We need to talk about brain fog.

Not because every woman experiences perimenopause the same way. She doesn't.

But because cognitive changes can be deeply unsettling, particularly when they happen to a woman whose life has been built around her ability to think quickly.

Imagine being the person who remembers everything.

You can walk into a meeting and navigate a complicated conversation without notes. You know your presentation forward and backward. You can retrieve information quickly. You remember the appointment, the deadline, the person's name, and what was said three meetings ago.

Mental agility is part of how you lead.

Then one day, you are in the middle of a sentence and cannot retrieve a word you absolutely know.

You walk into another room and have no idea why you went there.

You begin a thought and lose it before reaching the end.

You know the information. You prepared the presentation. You've said it a dozen times.

Yet suddenly your brain will not retrieve what you need when you need it.

You forget an appointment that you would never have forgotten before.

Concentrating requires more effort.

You feel slower.

For someone who has always taken pride in her mental sharpness, quick wit and ability to navigate complex situations with ease, that experience can be infuriating.

It can also be frightening.

And research increasingly recognizes these experiences. Women report forgetfulness, difficulty concentrating, word-finding problems and slower thinking during perimenopause. Research has particularly identified changes involving verbal learning and memory, with attention, working memory, and processing speed also being studied.

That does not mean every forgotten word is caused by hormones. Cognitive symptoms can have many causes and deserve appropriate medical evaluation.

But it does mean women should know that perimenopause belongs in the conversation.

Fatigue Is Not Always "I Need More Sleep"

Then there is fatigue.

There is ordinary tiredness after a long day.

And then there is the exhaustion women sometimes describe during this transition, the kind that makes something that previously required very little effort suddenly feel disproportionately difficult.

Sleep disruption can compound it. So can hot flashes, night sweats, stress, and mood changes.

Yet what does the high-functioning woman often do when her capacity changes?

She compensates.

She makes another list.

Sets another alarm.

Works later.

Double-checks herself.

Pushes harder.

Drinks another cup of coffee.

She builds systems around whatever suddenly isn't working and keeps going.

From the outside, she may still appear extraordinarily capable.

Nobody sees how much more energy it is taking to produce the same result.

And sometimes, neither does she.

The Culture of the "Strong Woman"

This is where the conversation becomes larger than biology.

Culture influences what women believe strength is supposed to look like.

For generations, many women have been taught, explicitly or implicitly, that a good woman handles things.

She takes care of her family.

She remembers what everybody needs.

She shows up.

She works.

She serves.

She doesn't complain.

She pushes through.

Different communities may express that expectation differently, but the underlying message can be remarkably similar:

Endurance is evidence of strength.

That becomes dangerous when endurance replaces information.

Because there is a difference between resilience and suffering unnecessarily, because nobody told you that what you're experiencing has a name.

Research also tells us that menopause is not experienced or interpreted identically across cultures. Studies have found differences in symptom reporting among racial and ethnic groups, and cultural norms can influence how women understand perimenopause, whether they discuss it and where they seek help.

That is why this belongs in a cultural center.

Health does not happen outside of culture.

We interpret what happens to our bodies through what our families taught us, what our communities discuss, what our workplaces expect, what our faith communities teach and what previous generations were willing, or able, to tell us.

The Women Who Are Leading While This Is Happening

This conversation is particularly relevant in Bartlesville.

Look around our community.

Women are leading nonprofit organizations, businesses, educational institutions, community initiatives, and countless other efforts. Many are doing so during the same stage of life in which perimenopause commonly occurs.

For many women, their late 30s, 40s, and early 50s can also be years when decades of experience are finally converging.

You know your field.

You have developed judgment.

You have relationships.

You have experience.

You have learned how to lead.

And just as you are stepping more fully into that experience, your body may begin changing the way you sleep, concentrate, remember, regulate temperature, manage stress or access the mental sharpness you have always depended upon.

That collision deserves more attention.

Research on working women has found menopause-related symptoms can affect concentration, memory, fatigue, attendance and perceived work performance.

This is not an argument that women become less capable leaders during perimenopause.

Quite the opposite.

It is an argument that capable women should not have to silently compensate for symptoms they were never taught to recognize.

When "Something Is Wrong With Me" Becomes a Mental-Health Issue

We also cannot separate this conversation from mental health.

Research has identified perimenopause as a period of increased vulnerability to depression for some women. In one longitudinal study, women were two to four times more likely to experience a major depressive episode during perimenopause or early postmenopause than while premenopausal.

That does not mean perimenopause inevitably causes depression. It does not.

Nor should women dismiss depression, anxiety, or cognitive changes as "just hormones."

Mental-health symptoms deserve care in their own right, and other medical conditions can produce similar symptoms.

But women deserve to know that hormonal transition may be one part of the picture.

The larger context is sobering. According to the most recent CDC data available, women ages 45–64 had the highest suicide rate among female age groups in the United States in 2024.

That statistic does not establish menopause as the cause.

But when we know midlife can include major biological changes alongside caregiving, career pressure, aging parents, changing relationships, financial responsibilities and other stressors, we should be willing to ask better questions about what women are experiencing during these years.

Therapy can be invaluable.

So can medical care.

So can community.

The goal isn't to choose one explanation. The goal is to stop making women figure this out alone.

Why So Many Women May Not Know to Ask

There is another problem.

If the only word a woman knows is menopause, she may assume she is too young.

She's 38.

She's 44.

She's still menstruating.

Surely this can't be that.

So she may never ask.

Or she asks about individual symptoms without realizing they may be connected.

Even healthcare evaluation can be more nuanced than simply ordering a single hormone panel. Hormone levels fluctuate considerably during perimenopause, and professional guidance notes that clinicians often identify the transition through a woman's age, symptoms, and menstrual changes rather than relying on routine hormone testing alone.

That makes a woman's ability to describe what she is experiencing incredibly important.

We have to give women the language before we can expect them to advocate for themselves.

Advocacy Can Start With a Record

If something feels different, document it.

Track changes in your menstrual cycle.

Write down symptoms, even the ones that seem unrelated.

Track your sleep.

Note when concentration or memory problems began.

Document changes in mood, energy, hot flashes, night sweats, or other symptoms.

Write down how those changes are affecting your ability to work or function.

Then take that information into your healthcare appointment.

Ask directly:

Could I be experiencing perimenopause?

Ask what else should be ruled out.

Ask what treatment or symptom-management options are appropriate for you.

Ask whether your clinician regularly treats women in the menopause transition.

And if you consistently feel that your concerns are not being heard, it is reasonable to seek another qualified healthcare professional, including one with expertise in perimenopause care.

Self-advocacy does not mean diagnosing yourself.

It means refusing to disappear from your own healthcare.

What Did the Women Before Us Know?

This may be the question that interests us most as a cultural organization.

What did the women before us experience without having the language to explain it?

What did your mother call it?

What did your grandmother tell you?

Did women in your family openly discuss “the change”?

Did they joke about it?

Whisper about it?

Pray through it?

Hide it?

Were they expected to simply keep going?

Did cultural traditions help women understand this stage of life, or make it more difficult to talk about?

And what changes when this generation decides not to remain silent?

Those stories matter.

Because women's health is part of women's history.

But there is another cultural question we think deserves attention.

What happens when the expectations placed on previous generations of women don't disappear, but simply get new language?

Every generation teaches women something about what strength is supposed to look like.

Our grandmothers had their language.

Our mothers had theirs.

And our generation certainly has ours.

That's a conversation we're just beginning.