Women’s health around perimenopause is having a moment in the spotlight, and I couldn’t be more thrilled. Women’s health NEEDS further research, and both women and healthcare providers NEED to share openly and honestly about alllllll the details so every woman can feel empowered to make decisions for her own personal healthcare based on her own body’s unique needs.

But as a family doctor with a fellowship in women’s health, I’m concerned that many women (and even healthcare providers) have inadvertently developed “tunnel vision” when it comes to health in midlife. What exactly does that mean? Well, tunnel vision is the tendency to focus exclusively on a single diagnosis rather than consider a full differential of possibilities based on all the relevant information. In the middle of a tunnel, we tend to keep our eyes focused on the light at the end, right? And when we have tunnel vision in medicine as it pertains to women’s health, we often focus on the signs and symptoms most consistent with our viewpoint while filtering out anything that might not fit.

Tunnel vision not only limits our thinking on a broader scope but also:

1.  Misses important warning signals

2.  Excludes relevant information and contextual details

3.  Limits our perception and problem-solving capabilities

4.  Creates an illusion of control

5.  Stunts our ability to seek, find, or accept appropriate treatment and support

We MUST remember that not every problem in midlife can be chalked up to hormonal imbalance, and women’s health during the midlife years is about so much more than perimenopause.

Tunnel vision isn’t anyone’s fault, except for maybe marketers. Every day women are inundated with social media advertisements, beauty & wellness podcasts, billboards or TV commercials, and personal celebrity endorsements or “expert” recommendations all promoting “hormone balance” with some new “all-natural” product. And while only a few years ago it seemed like most women had never heard of perimenopause, today perimenopause is a trending term!

It's true that symptoms related to perimenopause ARE quite common. Perimenopause is technically “the time around” menopause that begins during the 4-10 years before a woman’s final menstrual period and is known for unpredictable fluctuations in estrogen and progesterone that can lead to a whole host of symptoms affecting almost every part of a woman’s body. And yes, many common symptoms in midlife COULD be attributed to perimenopause.

Perimenopause symptoms include[i]:

• Abnormal menstrual bleeding in the form of heavy or irregular periods, skipped periods, or bleeding between periods

• Hot flashes and night sweats which may come along with heart palpitations

• Changes in sleep including difficulty falling asleep or frequent nighttime waking

• Cognitive changes (i.e. the dreaded brain fog)

• Hair loss or changes in hair texture

• Weight gain, especially in the abdominal region

• Thinning of vaginal mucosa causing vaginal dryness and pain with sex

• Decreased libido and/or a decreased ability to achieve orgasm

• Frequent urinary tract infection

• Joint pain and stiffness

Not every woman will experience every possible symptom of the hormonal changes associated with the menopausal transition. Plus, other medical illnesses can present with similar symptoms including but not limited to thyroid disease, iron deficiency anemia, metabolic disease, carcinoid syndrome, addiction or mental illness, certain cancers, heart arrythmias, and many more.

So, how can women and their healthcare providers avoid tunnel vision in midlife?

Here are FIVE vital tips:

1.  Become an expert in observation.

2.  Write everything down with as much description as possible.

3.  Challenge any initial conclusions by asking, What else could it be? What diagnosis can’t be missed?

4.  Continually reassess the signs and symptoms and be willing to change course.

5.  Widen your point of view.

The range of symptoms many women experience in midlife could be due to perimenopause, but other factors are important to consider and rule out. We can’t rely on social media or product marketing as a reliable source of medical information. And let’s not fall prey to trending terms. Remember, women’s health during the midlife years is about so much more than perimenopause!

Talk with your personal healthcare provider to discuss your symptoms and discover a diagnosis, then decide together which treatment options work best…for YOU.

Read More About Hormones and Women’s Health:

Hormone Imbalance: What Does It Really Mean?

Perimenopause is a “Diagnosis of Exclusion", so What Does That Mean?

Bioidentical Hormones Explained

Marketing Tactics Geared Toward Women: What They Are, How They Work, and What We Can Do

During Perimenopause We’ve Got To Keep It Simple

[i] Symptoms of perimenopause. Santoro N, Roeca C, Peters BA, Neal-Perry G. The Menopause Transition: Signs, Symptoms, and Management Options. J Clin Endocrinol Metab. 2021 Jan 1;106(1): 1-15. Doi: 10.1210/clinem/dgaa764. PMID: 33095879.