Explore your symptoms

Describe the pattern, not just the symptom

“Dizziness” can mean spinning, lightheadedness on standing, unsteadiness or a feeling of disconnection — four different evaluations. “Memory problems” usually turn out to be attention problems. The single most useful thing you can do before an appointment is characterise five features of each symptom:

• Onset. Sudden over seconds, over days, or a gradual creep over months?
• Course. Fluctuating with good and bad days, or steadily progressive?
• Distribution. One side of the body, both sides, or generalized?
• Company. What travels with it — night sweats, poor sleep, headache, low mood, a new medication?
• Function. What can you no longer do at work, while driving, or at home?

Fluctuating, bilateral, generalized symptoms accompanied by vasomotor symptoms and disrupted sleep are a common perimenopausal picture. Sudden, one-sided, or steadily progressive symptoms are a neurologic picture that needs its own workup regardless of menopausal status.

Common contributors that get missed

In midlife, these are frequent and treatable, and each can produce symptoms that look like “menopause brain”:

• Obstructive sleep apnea, which becomes markedly more common after menopause
• Iron deficiency, with or without anemia, and heavy perimenopausal bleeding
• Thyroid dysfunction
• Vitamin B12 deficiency, especially with metformin or acid-suppressing medication
• Depression and anxiety, which impair attention and processing speed
• Medication effects — sedating antihistamines, some sleep aids, anticholinergics, muscle relaxants, certain migraine preventives, alcohol as a sleep aid
• Undertreated migraine, which produces cognitive symptoms between attacks
• New or worsening hypertension and glucose intolerance

None of this argues that your symptoms are “not really menopause.” It argues that the transition often unmasks or amplifies other things, and those things are usually the most modifiable part of the picture.