This past spring, a small group of women gathered at the Beaverbrook estate in Surrey, England, a 470-acre country idyll outside London that once received guests including Elizabeth Taylor and Ian Fleming. The sprawling property, which has become a destination for wellness programs featuring everything from lectures on traditional Chinese massage to Wim Hof’s cold plunges, had lured attendees for a women’s health retreat. The topics included abdominal massage therapy and guided talks on depleted estrogen. “This is the first time there have been so many of us,” gut-health expert Amanda Porter relayed to the group, adding the staggering statistic that nearly 1 billion women are projected to experience the onset of symptoms including hot flashes and brain fog by 2025. They are the many, the confused, the perimenopausal.
“Think of it like puberty,” says Jen Gunter, MD, a Canadian American gynecologist and the author of The Menopause Manifesto. “There isn’t really a hard start date, and you don’t know that you’re in it until you’re really in it.” She goes on to describe an often undiagnosed panoply of symptoms associated with perimenopause, which precedes menopause (when you’ve gone 12 consecutive months without menstruating) and can start as early as our mid-30s: cycle irregularities, increased anxiety and depression, insomnia, night sweats, weight gain, a decimated sex drive. A lack of visibility doesn’t help. When I turned 43, feeling wholly unequipped for my own experience with mood swings and spontaneously heavy periods—and with no guidance from my doctor—I found myself googling “flash periods” after an episode of And Just Like That… (the one where Charlotte memorably bleeds through a white jumpsuit at a charity paint party). “There was just this lack of information and support,” agrees the actor Naomi Watts when we spoke about the topic earlier this year. “I’d had enough.” This September, Watts will join an increasingly vocal group of entrepreneurs, celebrities, and medical providers determined to change that dynamic when she launches a new perimenopause- and menopause-focused wellness brand with Bay Area biotech company Amyris.
It’s true that hormones—their unpredictability, and their ripple effect on how we look and feel—are increasingly part of the beauty conversation. “The first part of perimenopause is typically characterized by estrogen levels that fluctuate, but are still pretty high, and decreasing progesterone levels. And then the second part has to do with very rapidly declining estrogen,” explains Anna Barbieri, MD, an ob-gyn at New York’s Mount Sinai Hospital. Hormone replacement therapy (HRT), in which synthetic versions of these hormones can bolster dwindling supplies, remains a tried-and-true course of treatment. “Every single one of us who’s entering this transition or going through it should know about the option of hormone therapy and its risks and benefits,” says Barbieri, who is also the founding physician of Elektra Health, a digital women’s health platform offering virtual one-on-one menopause care with accredited providers and accountability counselors known as “menopause doulas.” But now there are also products such as Kindra’s hot flash– and night sweat–mitigating Cool Down Mist; Wile’s Drinking Your Feelings, a stress-reducing adaptogen powder that can be mixed into your daily matcha; and the skin-calming Meditation Gel Cream from Knours, an entire skin-care range tailored to fluctuating cycles. Veracity, a six-piece skin-care line formulated to support tangential issues, including excess oil production and thinning skin, recently inspired a Hormone Balancing Facial at The Well, Manhattan’s buzzy destination for mindful beauty. A 60-minute treatment left my skin far less inflamed than usual, and my soul soothed.
Despite an uptick in home diagnostic tests from Thriva and Everlywell, there is no clinically proven way to test for perimenopause. “Somebody who tells you we can just measure your estrogen and progesterone is bullshitting you,” says Alicia Jackson, PhD, the founder of Evernow, a telehealth company that aims to provide patients with 24/7 online perimenopause support as well as virtual hormone therapy plans. That’s because our hormone levels during this transition vary wildly from day to day, so testing them to get a quantifiable diagnosis isn’t reliable. “There’s no established value for them,” agrees Barbieri. What hormone testing can help with, she says, is to rule out other conditions (like thyroid abnormalities, for instance) that can often pose as perimenopause. Somi Javaid, MD, a Cincinnati-based ob-gyn, uses hormone tests at HerMD, the medical practice she runs in Ohio and Kentucky, for a different reason: “If women see that their FSH [follicle-stimulating hormone], which is responsible for controlling our menstrual cycles, is going up and their estrogen and testosterone are going down, I may not be able to tell them they’re perimenopausal, but it helps them understand that something’s going on,” says Javaid, adding that this kind of validation is extremely important: “So many women who complain about perimenopause symptoms are being dismissed.”
According to a recent report published in The New York Times, female patients—and particularly women of color—are far more likely than men to experience a kind of medical gaslighting (in which legitimate symptoms are invalidated by doctors); when it comes to perimenopause, that brush-off may be even more widespread. Stacy London experienced this firsthand. The longtime fashion stylist’s hormonal transition at age 46 had a number of typical markers. “I started to feel anxiety all the time, my skin got worse, my joints felt sore, I had insomnia and terrible brain fog,” says London. “I thought my brain was short-circuiting, because I couldn’t remember words.” London’s doctor recognized her symptoms but provided little recourse for treatment. “She said, ‘It’s just menopause, you’ll get through it,’ ” London recalls. The experience compelled her to join State Of, a skin- and body-care line that she became the CEO of in 2021, which aims to give the menopause transition a makeover, one cheerily packaged tube of joint cream at a time.