Is This Perimenopause or Just Stress?

If you’re over 35 and feeling tired, moody, anxious, forgetful, or like your body has changed without warning… you might be wondering: Is this just stress? Or could it be perimenopause?

You’re not alone in asking that question — and you’re not imagining things. The symptoms of perimenopause and chronic stress often look nearly identical, which leads to confusion, misdiagnosis, and a lot of women being dismissed.

Let’s break down what’s really going on, what to look for, and how to support your midlife health no matter where you are in the transition.

What Is Perimenopause, Really?

Perimenopause is the hormonal transition period leading up to menopause. It can start as early as your late 30s or early 40s, and it lasts, on average, 4 to 8 years.

This is the time when your estrogen and progesterone levels fluctuate wildly, often before any real change to your period happens.

You may still be having “regular” cycles and still be in full perimenopause — this is one of the reasons it’s so often missed.

Symptoms of Perimenopause That Mimic Stress

Here’s the tricky part: many perimenopause symptoms overlap with what we typically attribute to stress, burnout, or anxiety.

Shared symptoms include:

• Sleep disturbances

• Irritability and mood swings

• Anxiety or heart palpitations

• Brain fog and forgetfulness

• Fatigue and low motivation

• Weight gain (especially around the middle)

• Low libido

• Increased sensitivity or emotional reactivity

These are real biological symptoms, often caused by fluctuating estrogen and progesterone. The adrenal system (which handles stress) is also affected during perimenopause, making everything feel more intense.

How to Tell the Difference: Stress vs. Perimenopause

While stress and perimenopause can feel similar, there are clues that point more toward hormonal shifts:

• Symptom Stress Perimenopause

• Cycle Changes No Yes

• Hot Flashes / Night Sweats Rare Common

• Waking up at 3 a.m. Occasionally Frequently

• Breast Tenderness Rare Common

• Vaginal Dryness No Yes

• Sleep Aids Help Often Sometimes ineffective

Still not sure? Track your symptoms across a few weeks. If they rise and fall in cycles — even with a “regular” period — hormones may be playing a big role.

The Problem with Dismissing Perimenopause as “Just Stress”

Many women are handed an antidepressant or anti-anxiety medication without any conversation about hormone shifts.

While medication can be helpful for some, ignoring the root cause means many women don’t get the full support they need — and continue struggling with undiagnosed perimenopause.

This is a major gap in women’s midlife health care — and one we need to close.

Supporting Your Body Through Perimenopause (Even If It Is Stress Too)

Whether your symptoms are hormonally driven, stress-related, or both, support matters. Here are evidence-based strategies to improve both:

1. Regulate Sleep and Cortisol

• Prioritize consistent bedtimes and morning light

• Reduce caffeine and alcohol

• Try magnesium glycinate at night

2. Track Your Symptoms

• Use a simple journal or symptom tracker app. [Here's a downloadable PDF symptom tracker (coming soon).]

3. Assess Hormone Therapy Options

• For many women, hormone therapy (estrogen, progesterone, or both) can dramatically reduce symptoms.

• Learn more in: How Long Does Hormone Therapy Take to Work?

4. Nourish Your Body

• Eat enough protein

• Hydrate your body

• Eat enough fiber

• Eat enough fruits and veggies

• Support blood sugar balance

• Incorporate strength training (helps with muscle, metabolism, and mood)

When to Talk to a Menopause Specialist

You don’t need to wait until you’ve missed periods for 12 months to get support. If you’re 35+ and noticing changes in mood, sleep, cycles, or overall well-being, it’s time to check in.

At Osteopathic Midlife Health, we take your symptoms seriously and walk you through your options — from hormone therapy to non-hormonal or lifestyle-based care.

Summary: It’s Not All in Your Head

Stress is real. Perimenopause is real. And you are not broken.

If you’ve been feeling “off” and your labs are normal, don’t let anyone tell you it’s just in your head. This is a critical window to address your midlife health and advocate for the support you deserve.

Not sure what’s behind your symptoms? Let's find out together.

Visit us at www.osteopathicmidlifehealth.com