What I Really Mean When I Say “Perimenopause” and Why It Is So Much More Than a List of Symptoms

“Perimenopause” is suddenly everywhere. Your doctor may have mentioned it. It is in the news, on Instagram, in conversations between friends. After generations of silence, the word is finally out — and that is a good thing.

But have you noticed that almost everyone uses it to mean the same, rather narrow, thing? A list of symptoms. Hot flushes, broken sleep, anxiety, brain fog. Something going wrong with your hormones that needs to be managed.

If that is the only definition you have ever been given, this blog is for you. Because after 25 years of working with women — and after living this transition myself — I have come to understand perimenopause as something much bigger, much deeper, and honestly, much more hopeful than a list of complaints.

So I want to share what I actually mean when I use this word. Because definitions matter. When the only story you are told about this chapter of your life is a story of malfunction and decline, it shapes how you experience it. I would like to offer you a different story, because words are like spells — they create our reality.

Before I begin, an honest word, as always. What follows is my own opinion and my own view. It is not the final word, not an established fact, and not the only truth. I share it to clarify where I currently stand, to enrich a conversation that is — thankfully — growing louder every year, and to gently broaden the narratives we have all inherited.

And one more thing. My view is still evolving, just as I am — as a woman, a human being, a clinician, and a spiritual being. So who knows? Perhaps in a few years I will define perimenopause differently again. That, to me, is not a weakness of my position. It is the most honest thing about it.

The Definition You Have Probably Been Given

In conventional medicine, and in most of society, perimenopause means one thing: the years before menopause when hormone levels begin to fall and symptoms appear. A list of complaints to be measured, managed, and ideally medicated away.

That definition is not wrong. The hormonal changes are real, and so are the symptoms — if you are waking at 3am, losing words mid-sentence, or feeling anxiety you have never had before, I would never dismiss that. Supporting the body through these changes, and reducing your suffering is a big part of my work.

But to me, that definition is incomplete. It describes the surface and misses the depths. So here is what I actually have in mind when I say “perimenopause” — four understandings that, woven together, paint a very different picture.

1. Perimenopause Is Not Just a Set of Symptoms

Here is the first thing I want to gently untangle: perimenopause and its symptoms are not the same thing.

How do I know? Because a lucky minority of women — in my understanding somewhere around 10 to 15 percent — sail through this transition with barely any symptoms at all. They still go through perimenopause. Their hormones still shift. But their experience of it is gentle. If perimenopause were nothing more than its symptoms, these women would not be in perimenopause at all — which makes no sense.

And there is something else I have observed, both in myself and in the women I work with or know as friends: the more balanced and healthy a woman’s body and nervous system are before the natural drop in hormones begins, the fewer and milder her symptoms tend to be. In my opinion, the severity of perimenopausal symptoms is deeply connected to how dysregulated a woman’s body already was before this transition started.

I know how that might land at first. If you are suffering, it can sound like blame. Please hear me: it is not. Most of us arrive in our 40s carrying decades of chronic stress, people-pleasing, over-giving and under-resting — not because we did anything wrong, but because that is what was asked of us, and what we were trained to do. And that was my own personal story too.

And this is where the paradox comes in. Seen this way, the symptoms are a gift. A strange gift, an unwelcome one at first — but a gift (perhaps wrapped in a sand paper!). The symptoms are your body’s honest report on everything it has been carrying. They show you, precisely, where you need support, where you have been running on empty, and what needs your attention now. A body that finally speaks up is not betraying you. It is telling you the truth.

2. Perimenopause Is a Period of Deep Self-Discovery

The second thing I mean by this word: perimenopause is a time of inner evolution. A time when a woman starts to listen more closely to her inner voice, hears and respects her intuition, and develops a deeper trust in herself than she has ever had.

And here is another paradox — one I find quietly remarkable. Very often, the trigger for this growth is the very thing that should never have happened: being dismissed.

So many women come to me after being told by their doctor that everything is fine. That they are too young. That their blood tests are normal. That they should come back in a year. Their real, lived experience — the sleepless nights, the anxiety, the sense that something has shifted — is denied and brushed aside.

It is painful, and it is wrong. And yet, again and again, I watch that dismissal become a turning point. Because when a woman stops being heard, she eventually stops outsourcing her wellbeing. She stops blindly trusting the system to tell her what is right, what is normal, and what she should simply accept and put up with. She begins to research, to question, to seek out solutions. She turns towards the one source of knowing that has been with her all along: herself.

In other words, she leaves behind the role of the patient who waits, and the victim who endures — and steps into the role of the woman who decides. If that has been your journey, I want you to know: that is not stubbornness. That is self-trust being born. And to me it is one of the defining features of perimenopause transition.

4. Reduce Inflammation Through What You Eat

The third layer of my definition reaches beyond psychology, into the spiritual — so take from it what resonates, and leave the rest.

I have already written about Perimenopause as a spiritual journey.  I believe this stage of life is when a woman is, in a sense, meant to wake up Not by accident, and not as a malfunction — but literally by design.

Those who work with astrology point to something fascinating here: between roughly the ages of 38 and 42, every one of us goes through major Uranus and Saturn transits. These are not rare events that happen to a chosen few — they arrive in every woman’s life, around the same age, like clockwork. And they tend to coincide with exactly the changes so many of us feel in those years: a shift in how we see ourselves, in our attitude to life and relationships, in our self-expression, and in our confidence.

You do not need to believe in astrology to recognise the pattern. Around this age, something in us begins to stir. Things that used to fit no longer fit. Roles we played without question begin to chafe. And we start — sometimes gently, sometimes dramatically — letting go of everything that is no longer aligned with who we are becoming.

Or, as I would put it in the language of the soul: letting go of everything that no longer matches the life we chose for ourselves before we came here. But this is more for another discussion. Perimenopause, in this understanding, is not a decline that happens to coincide with midlife. It is the awakening that midlife was always meant to bring.

4. Perimenopause Is Preparation to Become an Elder

And this brings me to the fourth and final layer — perhaps the one closest to my heart.

I believe perimenopause is, ultimately, a preparation. A training ground for the role a woman is meant to grow into: the elder. The wise one. The leader, and role model, in her family, her community, her society.

But to hold that role, she needs new skills — the ones most of us were never taught. She needs to learn how to establish and maintain healthy boundaries. How to be assertive. And for that to happen, she has to let go of the old programme: people-pleasing, and putting everyone else’s needs above her own. Because leaders don’t ask for permission.

Here is the part nobody warns you about. From the outside, this change can be misread. A woman who used to say yes to everything starts saying no. A woman who softened every opinion starts delivering them straight. She can suddenly come across as harder, harsher, even aggressive or uncaring.

But that is only the surface. Underneath, she is as deeply caring and compassionate as she ever was — often more so. What has changed is that her care now includes herself. And what she is actually modelling, to everyone around her, is something quietly revolutionary: taking responsibility for your own health and your own wellbeing.

So, What Do I Mean by “Perimenopause”?

When I use this word, I mean all of it, all at once:

• A real physical transition — whose symptoms are messengers, not malfunctions, and whose severity reflects how much the body was already carrying.
• A period of deep self-discovery — when a woman learns to trust herself, often precisely because no one else would listen.
• An awakening that arrives on schedule — a built-in invitation, around 38 to 42 years, to let go of everything that no longer fits.
• And a preparation — for becoming the elder, the wise one, the woman who shows everyone around her what self-responsibility looks like.

Hormones are part of this story. But they were never the whole story. And if the only definition you have ever been offered is a list of symptoms to manage, I hope this blog has shown you how much bigger — and how much more hopeful — this chapter of your life can be.

As I said at the start: this is where I stand today, and I am still evolving. Take what resonates. Question what doesn’t. And above all, begin listening to what this transition might be trying to tell you.

Want to Explore This With Me?

Wherever you are on this journey, you do not have to do it alone.

If you want to fully understand what is happening in your body, your mind, and your sense of self — not just a surface-level overview, but a real, in-depth understanding of what perimenopause is actually doing, and all the options available to navigate it — join my Finding Joy in Perimenopause Programme.
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If you want the most personalised support — 1:1 Exclusive Mentoring allows us to build a picture of exactly where you are and what is available to you, personally, at this stage.
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And if you simply have a question or two — come along to Ask Dr Kamila, my free monthly Q&A. It runs on the 3rd Wednesday of every month, and you can ask me anything about perimenopause. You don’t even need to be in perimenopause to join — if something feels off and you have questions, you are welcome.
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NOTE: These blogs articles are for information only. They often contain my personal experiences and opinions. They are not a substitute for medical advice. Please consult your GP or a qualified specialist about relevant assessment, medication, or hormone therapy.