Medical Gaslighting in Perimenopause: How to Recognize It and Advocate for the Care You Deserve

You Knew Something Was Wrong

You made the appointment because you’d been tracking the changes for months. The brain fog that made you feel stupid in meetings when you’d always been sharp. The sleep disruptions that left you exhausted by noon. The anxiety that arrived out of nowhere. The mood shifts that felt nothing like your usual self.

And the doctor told you it was probably stress. Or anxiety. Or just getting older. Maybe they ordered a single hormone test, got a normal result, and told you everything looked fine.

You left the appointment feeling worse than when you walked in. Not because you didn’t get help, but because your account of your own experience was returned to you as invalid.

If this happened to you, you were not overreacting. You were encountering a systemic pattern that has been documented extensively: the dismissal of perimenopausal symptoms in clinical settings.

Why This Keeps Happening

Medical education has historically underserved women’s hormonal health, particularly the perimenopause transition. A 2019 survey found that ob-gyn residency programs in the United States offered a median of only four hours of menopause education. Many primary care providers receive even less.

The result is a large number of clinicians who genuinely lack the training to recognize and evaluate perimenopause symptoms, and who may default to more familiar diagnoses, anxiety disorder, depression, thyroid disease, or normal aging, when presented with a complex hormonal picture.

This is not always malicious. It’s often a knowledge gap. But the outcome for the person sitting in the exam room is the same: real symptoms being attributed to the wrong cause, real distress being minimized, and real treatment options going undiscussed.

The additional layer is that women’s physical complaints have historically been more likely to be attributed to psychological causes than men’s. That pattern is well-documented in the research and it doesn’t disappear in the exam room.

What Dismissal Can Look Like

Medical gaslighting in perimenopause doesn’t always look dramatic. Sometimes it’s overt: being told your symptoms are in your head, or being talked over when you try to describe what you’re experiencing. But often it’s more subtle.

It looks like a provider who only checks FSH once and declares hormone levels normal without checking estradiol, progesterone, or testosterone. It looks like brain fog and mood changes being attributed to anxiety and treated with an antidepressant rather than investigated hormonally. It looks like heart palpitations being attributed to panic disorder without any discussion of the known cardiovascular effects of estrogen fluctuation.

It also looks like a provider who responds to your symptom list with “what do you expect at your age,” or who moves through the appointment so quickly that you never had the chance to describe the full picture.

Recognizing these patterns helps you understand what happened and gives you a foundation for doing things differently next time.

What Good Perimenopause Care Actually Looks Like

A clinician who is genuinely informed about perimenopause will approach your appointment differently.

They will take a thorough history that includes menstrual cycle changes, sleep, mood, cognition, libido, and physical symptoms. They will understand that hormone levels fluctuate significantly during perimenopause and that a single blood test taken on a random day may not be clinically meaningful. They will be familiar with the range of treatment options, including hormone therapy, non-hormonal medications, lifestyle interventions, and specialist referrals.

They will also listen without rushing you to a conclusion. Your account of your own experience is clinical data. A provider who dismisses it is not fully practicing evidence-based medicine.

Good perimenopause care does not require you to convince anyone that what you’re experiencing is real. It starts from the position that you know your body, and it works from there to understand what’s happening and what might help.

How to Advocate for Yourself in Appointments

Going into an appointment prepared significantly increases your chances of being heard. Here are approaches that can help.

Bring a written symptom log. Track what you’ve been experiencing, when, and how often. Use PeriPlan or a notebook, whichever you’ll actually use. A concrete record is harder to dismiss than a verbal summary of “I’ve just been feeling off.”

Be specific about the impact on your life. “I’m having trouble sleeping” is easy to set aside. “I’ve had broken sleep four to five nights a week for three months and it’s affecting my concentration and my work” is a clinical picture.

Name what you’re there to discuss: “I’m here because I want to talk about whether these symptoms could be perimenopause and what the options are.” Framing the conversation yourself means you’re less likely to spend the entire appointment being steered toward an unrelated conclusion.

Ask direct questions. “Have you considered whether this could be related to perimenopause?” “What hormone tests would you recommend given this picture?” “What are my treatment options if this is hormonal?” Questions put the clinical reasoning on the table where you can examine it.

Scripts for Specific Situations

When a provider says your labs are normal: “I understand the lab values are in the normal range, but my symptoms have been significantly affecting my quality of life for several months. Can we talk about what else might be causing this, or whether there are additional tests that would be useful?”

When you’re offered an antidepressant without a hormonal workup: “Before we go in that direction, I’d like to understand whether my symptoms could be related to hormonal changes. Can we explore that first?”

When you feel rushed: “I have a few more things I need to cover today. Can I take a moment to finish describing what I’ve been experiencing?”

When you feel dismissed: “I want to make sure I understand what you’re saying. Are you saying that these symptoms are not something we should investigate further, or are you saying the next step is something other than what I’ve asked about?” None of these are confrontational. They’re simply specific, which is often all that’s needed to redirect a conversation.

How to Find Providers Who Take You Seriously

There are clinicians who are genuinely knowledgeable about perimenopause and who will approach your care accordingly. Finding them takes some research, but it’s worth the effort.

The Menopause Society (formerly NAMS) maintains a directory of certified menopause practitioners. These are providers who have completed specialized training and passed a certification exam in menopause care. Searching their directory by location is a practical starting point.

You can also ask specifically during an initial appointment: “How do you typically approach perimenopause care?” A provider who can answer that question with substance, who mentions hormone therapy as one tool among several, who understands the difference between perimenopause and menopause, who takes symptoms seriously regardless of lab values, is demonstrating competency you can build on.

Telehealth has significantly expanded access to menopause-informed care. If you’re in a location with limited specialist options, a telehealth provider with menopause expertise may be able to work in conjunction with your local primary care provider. You are allowed to change providers. You are allowed to get a second opinion. You are allowed to walk out of an appointment that isn’t serving you and find someone better.

You Were Right to Trust Yourself

The most important thing to carry out of this article is this: your experience of your own body is valid clinical data. When something changes significantly and persistently, that matters. No single lab test and no brief appointment can override what you know from living inside your own body every day.

The pattern of dismissal you may have encountered is a systemic failure, not evidence that your symptoms are minor or imaginary. You deserve care that begins from a position of belief and works from there.

Better care exists. You deserve to have it.

This content is for informational purposes only and does not replace medical advice. Always consult your healthcare provider about your specific situation.