By Kara Kennedy

If you’re a woman who speaks English, it sometimes feels like you can’t spend time on the internet without being bombarded with all the ways in which your body or your mind could be just a little broken. A few years ago, Instagram was full of women talking about attention deficit disorder, and lo and behold: From 2020 to 2022, the percentage of women (between the ages of 23 and 49) newly diagnosed with it nearly doubled. Not long ago, premenstrual syndrome was all the rage, with the algorithm pushing videos that explained why it’s okay to fly off the handle once a month. These days, the word perimenopause is everywhere.

Perhaps you’ve seen the headlines. “Perimenopause is having a millennial moment. Here are 7 ways to cope,”. Or perhaps you’ve seen Apple TV’s glossy drama Your Friends & Neighbors, which is back for its second season; the female protagonist Mel is explicitly perimenopausal, and in the first season, she keyed a car for no apparent reason. She’s played by Amanda Peet, who talks about being perimenopausal in real life (“God knows I’ve wanted to key a lot of cars in the last three years,” she’s said.) In fact, it sometimes feels like every celebrity interview with a forty- or fiftysomething woman requires her to open up about what’s going on with her hormones. Drew Barrymore joked on CBS Mornings that when she found out how long perimenopause can last, she thought she’d “never make it 10 years like this.” Katherine Heigl said that “whoever designed it so that women would be going through perimenopause while raising teenagers should be sent a strongly worded letter.”

At the same time, influencers who talk about perimenopause seem to have cropped up out of nowhere with something to sell you, causing people online to wonder where this all came from. It’s trickled down from Instagram to tchotchke shops, which sell fridge magnets that say “Perimenopause Is Hot.” You can buy a T-shirt that proclaims “Perimenopause Made Me Do It!” My mom, who is 48, started uncontrollably shaking her leg at night a few years ago. “It’s perimenopause,” she told me when I complained about how annoying it was.

But what exactly is perimenopause—and why are we all talking about it all of a sudden?

Put simply, perimenopause is the long hormonal transition leading up to menopause (which is the point at which a woman hasn’t had a period for twelve months). It can last seven to 10 years, beginning as early as a woman’s mid-thirties, and is marked not by a steady decline but by increasingly erratic hormonal signals as the ovaries run low on eggs, throwing previously predictable cycles into chaos. Symptoms may first be felt in the brain, through mood changes, anxiety, and cognitive fog, before showing up elsewhere in the body.

When you search the internet for stories of perimenopause, what you’ll find will terrify you. “I’m having insane mood swings, completely out of control, brain fog is so intense I am making a ton of mistakes at work,” one poster writes on the Reddit thread r/Perimenopause, which has 192,000 weekly visitors. “I keep coming home after work and reading ‘Perimenopause for Dummies’ and rage-crying,” she says. “This 300-page book . . . makes it sound like this is going to be the worst experience of my life.” The commentators, thankfully, told the original poster to put the book down, and chill out.

But many perimenopausal women talk of an extreme rage that bubbles up out of nowhere. “I feel like I could kill a bear with my bare hands,” one writes. Another says: “My husband and I have been together for 10 years and married for one. Him simply existing pisses me off. . . . I feel so bad for him because he truly isn’t doing anything out of the ordinary.”

There’s nothing wrong with women sharing their experiences online. For decades, “the change” happened in private, and women who struggled with it were often dismissed by a medical system that is notoriously bad at helping women if hormones are at the heart of their struggles. Polycystic ovary syndrome affects about one in every 10 women of reproductive age in the world, yet up until recently it was thought of as an orphan disease—something rare enough to justify the fact there is little to no research or treatment available. But in the case of perimenopause, a hormonal change that almost every woman goes through, it’s worth asking: When does awareness-raising tip into fearmongering?

Dr. Mary Claire Haver, founder of The ‘Pause Life, a “tool kit” for menopausal women, and author of The New Perimenopause—which came out in April—is glad that social media allows women to compare notes about perimenopause in real time. “Women are telling their stories, and women are reading those stories and being like, ‘Wait a minute. That’s me too,’” she said. They’re spotting patterns that don’t exist in the formal medical literature. “This is patient-led. Women are realizing, ‘I’m not crazy. This is happening. It’s happening to 10,000 of my new friends I met online. We’re all in a chat room with the same symptoms.’”

Medicine has been slow to understand perimenopause, according to Dr. Haver, who told me that many of its symptoms can be mistaken for other conditions. In a lot of patients, she said, “what we think is fibromyalgia is probably musculoskeletal syndrome of menopause” (a cluster of symptoms like joint pain, stiffness, decreased bone density, and muscle loss). “Instead of interstitial cystitis,” she added, “a patient might have genitourinary syndrome of menopause” (a condition due to decreased estrogen that can cause symptoms like urinary urgency, vaginal dryness, and painful sex).

What else can perimenopause do to you? “We also see muscle pain, joint pain, a lot of hip pain, back pain,” Dr. Haver said. “The cutaneous nerves under your skin can become inflamed, so we see some people feeling like ants are crawling on them.” But the most commonly reported symptom of perimenopause, she said, is “not feeling like yourself.”

Dr. Haver says that a perimenopausal woman can easily be diagnosed with, and treated for, the wrong thing. For example, if hormone fluctuation causes sleep disruption, she’ll be given Ambien; if it causes anxiety, she’ll be prescribed an antidepressant; if it causes brain fog, she might get Adderall; if it’s joint pain, maybe pain meds. But that’s treating the symptom, not the root cause, which is dwindling estrogen and progesterone.

Personally, Dr. Haver swears by hormone therapy, which she describes on her Substack as “replacing what I had lost.”

But there are those who question whether so many symptoms can be totally explained by perimenopause. Patricia Bencivenga and Dr. Adriane Fugh-Berman work at PharmedOut at Georgetown University Medical Center, which “advances evidence-based prescribing” and raises awareness of marketing practices in the pharmaceutical industry. In a co-authored article, they argue that perimenopause as a term has swollen into a sprawling, catchall explanation. They call out the recent PBS film about perimenopause, The M Factor 2: Before the Pause, writing that “this movie, along with recent articles on perimenopause and seemingly endless social media chatter, attributes every possible symptom associated with stress, parenthood, burnout, depression, and normal aging to perimenopause.”

This is “not only wrong,” they write; “it’s dangerous.” Both women point to a case published in February, in which writer Jessica Toonkel went to 11 doctors over a two-year period for a stubborn itch and was told it was a standard sign of perimenopause, as “dropping estrogen levels can thin and dry skin.” She was advised to put lotion on before bed. Toonkel writes that she was eventually diagnosed with stage 2 Hodgkin’s lymphoma, “a blood cancer for which a common symptom is a persistent itch.”

Speaking to Bencivenga and Dr. Fugh-Berman on the phone, I mentioned that “not feeling like yourself” is a symptom of perimenopause—and they both laughed. Dr. Fugh-Berman said, “That’s not a symptom. Maybe that’s an existential crisis.” A lot of the things attributed to perimenopause might be more accurately described as the perfectly natural process of getting older. “You know, people complaining about having thinning hair or weight gain,” said Dr. Fugh-Berman. “Sorry, bud. You’re not 20 anymore.”

They’re skeptical about Dr. Haver’s belief that this new awareness of perimenopause is an organic patient-led movement. “This isn’t an uprising from newly mobilized perimenopausal women,” said Dr. Fugh-Berman. “This is engineered by a group of pharmaceutical companies.” For example, Pfizer sponsors “Let’s Talk Menopause,” an advocacy group that raises awareness about menopause and perimenopause. “There are companies who are making a profit off of medicalization and even just the narratives around perimenopause right now,” said Bencivenga. “It’s a perfect way to make money, to make perfectly well people think they’re sick and that there’s a cure.”

Pfizer was once known as Wyeth, and in 2010, Dr. Fugh-Berman was an expert witness in civil litigation against Wyeth, in which some 1,500 unsealed documents revealed that the company “used ghostwritten articles to mitigate the perceived risks of breast cancer associated with HT [hormone therapy] . . . and to promote off-label, unproven uses of HT such as the prevention of dementia, Parkinson’s disease, vision problems, and wrinkles.” A spokesman for Wyeth said that the articles were scientifically accurate and that pharmaceutical companies routinely hired medical writing companies to assist authors in drafting manuscripts.” The company lost multiple lawsuits and settled thousands more.

Countless women swear by hormone replacement therapy (HRT), including Gwyneth Paltrow, 53, who has publicly said of the treatment: “I tried to take other routes, but it wasn’t worth the suffering.” But according to Dr. Fugh-Berman, fluctuating hormones are not a straightforward deficiency to be corrected but a volatile system that does not always respond predictably to intervention. “Your hormones during perimenopause are going not just down, but up,” said Dr. Fugh-Berman. “They’re bouncing around,” meaning that adding more hormones “may make some symptoms better and some symptoms worse.”

Both Bencivenga and Dr. Fugh-Berman are worried that HRT is increasingly being presented as benign and even preventative, in ways that downplay well-established findings. “We know that menopausal hormone therapy increases the risk of breast cancer, ovarian cancer, gallbladder disease, strokes, dementia, and a host of other things,” said Dr. Fugh-Berman. And yet, she said, “There’s a bunch of influencers out there saying, ‘Oh, don’t worry about the breast cancer risk. It’s not real, that’s just been misinterpreted’ or ‘all of these scary numbers are from the Women’s Health Initiative, which is an old, outdated study’—which is simply not true. It is a robust, government-funded, long-term, huge study that is completely reliable.”

It’s easy to forget that some of the women who speak confidently about perimenopause on the internet are making money when they make certain suggestions. Melani Sanders, who has 2.3 million followers on Instagram and 1.5 million followers on TikTok, is founder of the We Do Not Care Club—which is for women in “perimenopause, menopause, and post-menopause”—and the author of The Official We Do Not Care Club Handbook. Sanders often uses her platform to do paid product promotion for her perimenopausal fans—including TheraTears eye drops and Replens Long-Lasting Vaginal Moisturizer. She also sells a coloring book. And she promotes the telehealth company Midi Health, which has been praised online by Amy Schumer, 44. Schumer says she used the service to go on “estrogen and progesterone because I realized I was in perimenopause” and claims that since then, “my symptoms from being perimenopause have disappeared.” It is worth noting that Schumer is a partner and investor in Midi Health.

The influencers, the celebrities, the doctors, the drug companies: They say a lot of the same things, some of them with the best of intentions, some of them because they want to make money. And with so much information about perimenopause out there, the message is getting through. Sometimes it makes women feel seen, and sometimes it scares them; sometimes it misleads them, and sometimes it leads them to something that will help.

Picture this: A 35-year-old woman comes across the headline “I’m a Hot Sleeper in Perimenopause—These Cooling Sheets and Pajamas Helped Calm My Night Sweats from $14.” She does a quick Google search on perimenopause, finds out that she could be in the right age bracket, finds the hysterical Reddit posts and an influencer posting about a must-have lubricant, and all of a sudden, she’s buying the entire list of products in the article because sometimes she runs hot at night too. Because she’s just started to realize that she’s older now, and her fertility won’t last forever, and her body won’t keep bouncing back. She’s scared, and she wants to feel better.

And now picture this: The fortysomething woman can’t sleep and feels sad all the time, like she’s coming undone, even though her marriage is good and the kids are the light of her life. Her back hurts when it never did before, and sex hurts too. She wants an explanation, and she listens to a celebrity interview, and there it is, a woman saying there’s a pill that will stop all of this and make her feel young again. She gets a prescription, and it helps. The feeling is relief. And relief, as it turns out, is an intoxicating thing, whether it comes in the form of medicine, merch, or just the reassurance that you are not, in fact, losing your mind.