How culture, class and care shape the perimenopause experience

For decades, women entering their late 30s and 40s were taught to grin and bear the ‘middle years’—hot flashes, erratic periods, brain fog, anxiety, weight gain, and sleepless nights. The term perimenopause was rarely uttered, let alone understood. But now, a global shift is underway, with women demanding better support, science, and solutions for what is arguably one of the most overlooked health transitions of modern life.

The quiet chaos of perimenopause

Perimenopause—the phase leading up to menopause when oestrogen levels begin fluctuating—can last anywhere from four to ten years. The symptoms are as varied as they are disruptive: mood swings, joint pain, low libido, migraines, digestive issues, and even worsening PMS. According to the North American Menopause Society (NAMS), nearly 75% of women experience moderate to severe symptoms during this phase, yet a staggering number remain undiagnosed or dismissed by their healthcare providers.

Globally, the issue is compounded by cultural taboos and gaps in medical training. In the UK, a 2022 survey by the British Menopause Society found that 45% of women said their symptoms were wrongly attributed to depression or stress. In India, discussions around perimenopause remain hushed, particularly in urban-rural divides, where access to gynaecological care is uneven.

The HRT hesitation—and what’s changing

Hormone Replacement Therapy (HRT) has long been the go-to treatment for menopausal symptoms, but it’s not suitable or desirable for every woman. Some fear risks associated with HRT—especially in countries where medical guidance is inconsistent. That gap is fuelling a wave of innovation.

In the US, femtech companies like Elektra Health, Stella, and My Menopause Centre in the UK are offering digital-first, education-led solutions. These platforms blend virtual consultations, symptom trackers, and tailored wellness plans. 

From wellness podcasts in South Korea to menopause cafes in Canada, women are finally speaking openly—and loudly—about their experiences. Celebrities like Naomi Watts and Gwyneth Paltrow are using their platforms to normalise the conversation, while grassroots campaigns like #OwnYourMenopause are pushing policy change, demanding better training for general practitioners and access to tailored treatments. Yet, access remains uneven. In sub-Saharan Africa, awareness around perimenopause is low, often misattributed to spiritual or emotional disturbances. In Latin America, social stigma prevents many women from seeking help until symptoms become severe.

Perimenopause isn’t a niche issue—it’s a shared biological milestone for nearly half the global population. But until recently, it was shrouded in shame, silence, or pseudoscience. Now, with rising awareness, digital tools, and a chorus of women refusing to suffer in silence, the tide is turning. To truly decode this silent pandemic, what’s needed is not just treatment, but transformation—of how we see, speak about, and support women during one of the most complex stages of their lives.