When Hormones Become the Default Diagnosis for Women’s Health

As perimenopause gains attention, many women are asking a difficult question: “Are we becoming too quick to blame everything on hormones? “

She’s 42. She’s exhausted. She snaps at her children over small things. She forgets words mid-sentence in meetings. She wakes at 03:00 and can’t fall back asleep. She feels anxious, sometimes for no obvious reason. When she finally sees a doctor, she’s told gently, almost reassuringly: “It’s probably perimenopause.” Maybe it is, but what if it isn’t?

Perimenopause (the transitional years before menopause) is finally having its moment in the spotlight. Women are talking more openly about mood changes, brain fog, hot flushes, weight shifts and anxiety. Social media is filled with shared experiences. Podcasts, books and specialists are bringing long-overdue awareness to midlife hormonal changes.

Globally, this matters. According to the World Health Organization, most women experience menopause between the ages of 45 and 55, with perimenopause often beginning several years earlier^[i]. Research from institutions such as the Cleveland Clinic notes that perimenopause can start in a woman’s 40s (and for some, even late 30s), lasting up to 10 years^[ii].

The awareness is overdue. For decades, women were told to simply “push through.” But as the conversation grows louder, a quieter concern is emerging. Are we now at risk of blaming everything on hormones?

Fatigue, low mood, weight gain, anxiety, poor concentration, yes, these can be symptoms of perimenopause. However, they can also signal thyroid dysfunction, iron-deficiency anaemia, insulin resistance, depression, chronic stress, burnout and autoimmune conditions

“The danger is not in recognising perimenopause,” says Luvuyo Maloka from digital health care provider, Unu Health. “The danger is in assuming that hormones are the default explanation before we’ve properly investigated what else might be going on.”

The current wave of awareness is empowering, but oversimplification carries its own risks.

For South African women in their 40s and 50s, this stage of life is rarely calm. They are often supporting teenage or university-aged children, assisting ageing parents, managing demanding careers and navigating rising living costs. They are the financial and emotional backbone of their families. When symptoms begin, pushing for further testing can feel like a luxury. Blood tests cost money. Specialist visits cost money. Time off work costs money. So, when told “it’s probably perimenopause,” many women accept the answer — partly out of trust, and partly out of exhaustion.

“There’s a very real economic dimension to midlife women’s health,” Maloka explains. “When healthcare feels expensive or time-consuming, it becomes easier to normalise symptoms than to investigate them. But delayed diagnosis — if something else is going on — can carry a far greater cost later.”

This isn’t about creating fear. It’s about balance. Perimenopause is real. Hormonal shifts are real. But so are thyroid disorders, early metabolic disease and clinical depression.

In South Africa, where chronic diseases such as diabetes and hypertension are rising, often undiagnosed, the overlap in symptoms can blur important warning signs. Brain fog might be hormonal, or it might be unmanaged blood sugar. Fatigue might be hormonal, or it might be anaemia. Anxiety might be hormonal, or it might be burnout in a woman carrying too much for too long. The key is not self-diagnosis and self-dismissal.

What women need now is not less conversation about perimenopause, but a more nuanced conversation. The message is not: challenge every diagnosis. The message is: trust your body enough to ask questions.

For more information, please visit www.unuhealth.org