What I wish I'd known in my twenties about menopause

I was in my teens when I was first put on synthetic hormones. Not because of anything to do with menopause, I was nowhere near that conversation. I was prescribed them to manage extreme menstrual periods I had been suffering since the age of 11. Later in my twenties I finally got my diagnosis of endometriosis, a condition that had been making my life difficult for years, and that finally had a treatment plan attached to it.

So I took the hormones. And life continued. University, career, commitments, the relentless forward momentum of a woman in her twenties and thirties trying to do everything she was supposed to do, and do it well, and not make too much of the parts that were hard.

What I didn't know then - what I genuinely had no way of knowing - was that those same synthetic hormones were quietly masking something that was beginning to happen underneath all of it. That while I was managing one thing, something else was going on. That my body was trying to tell me something, and the very medication that was helping me function was making it impossible to hear.

I was diagnosed with early menopause at 41. And by the time that diagnosis arrived, I had spent years in a fog I couldn't explain. Anxiety that didn't match my circumstances. Confidence disappearing in ways that felt personal, like a failing, not a symptom. A sense of myself that was getting quieter and harder to locate.

Looking back, the transition had been underway for a long time. I just had no idea.

This post is about what I wish someone had told me when I was younger. Not to frighten me, not to make me spend my twenties worrying about something that felt distant, but because understanding this earlier would have changed so much. For me, and for the many women I now know are living a version of the same story.

The thing nobody tells you about hormones and diagnosis

If you are on the contraceptive pill, the coil, the patch, or any form of synthetic hormone - whether for contraception, for endometriosis, for painful or heavy periods, or for anything else - there is something important you need to know.

A standard blood test cannot give you an accurate picture of your hormonal status while you're on it.

NICE guidance - the clinical standard that GPs in the UK are expected to follow - is explicit on this point: FSH blood tests should not be used to identify menopause or perimenopause in people using combined oestrogen and progestogen contraception or high-dose progestogen. The hormones in contraception suppress FSH levels artificially, which means a blood test can show results that look completely normal when something significant may actually be happening.

In practical terms, this means a woman in her late thirties or early forties who goes to her GP with anxiety she can't explain, sleep that's suddenly difficult, or a confidence that seems to have walked out the door - and who happens to be on the pill - may come away with a normal blood test result and no further conversation. Because the test wasn't able to show what was really going on.

For women managing conditions like endometriosis, this is even more tangled. Endometriosis and perimenopause share overlapping symptoms; hormonal mood shifts, fatigue, pelvic pain, disrupted sleep. Synthetic hormones affect the body differently to natural hormones. And the symptoms of a hormonal transition can be almost impossible to distinguish from the symptoms of a condition you've already been living with for years.

I know this intimately. I spent years not knowing whether what I was experiencing was endometriosis, mental health, hormonal, or some impossible combination of all three. The confusion wasn't in my head, it was intertwined into the situation.

What the clinical guidance makes clear is that for women on hormonal contraception, symptoms and cycle history matter far more than blood test results. If something feels off, the most useful conversation isn't "can you test my hormones", it's "can we talk about what I'm experiencing, my history, and whether perimenopause could be part of this picture?" And if you've been told your bloods are normal, it's worth knowing that those bloods may not have been able to tell the full story.

The culture that kept me from noticing sooner

But here's the thing that I think about as much as the clinical picture.

Even if the tests had been reliable, I'm honestly not sure I would have been paying close enough attention to notice what was changing. Because I was doing what so many women of my generation were taught to do. Keeping going. Managing. Showing up. Not making the hard parts too visible.

There is a story that runs through the culture women navigate; about doing it all, having it all, being capable enough and organised enough and resilient enough to handle whatever comes. And for a long time I believed that story, or at least I lived as though I did. Career, chronic health condition, relationships, the particular exhaustion of pretending everything is fine when it isn't… all of it running simultaneously, all of it requiring me to keep moving.

What I was not doing, somewhere in all of that, was stopping. Genuinely stopping and asking myself what was actually happening in my body, and treating my own signals as worth listening to rather than overriding.

When you live on override for long enough, you lose the ability to distinguish between normal tiredness and something bigger. Between manageable anxiety and a hormonal shift that deserves attention. Between "I'm doing a lot" and "something is happening that I should understand." The signals are there, but the noise of a full life drowns them out, and the synthetic hormones drown out the signals that remain.

This is not a character flaw. It's what happens when you're a woman who has absorbed, over many years, the message that stopping is not really an option. That asking for space to pay attention to your own body is somehow self-indulgent. That the measure of how well you're doing is whether you're still keeping all the plates spinning.

I wish someone had told me, at twenty-five, that that story is not entirely true. And that the cost of living inside it, without questioning it, often only becomes visible later, when your body finally stops being quiet about what it needs.

What I would do differently

So if I could go back to my twenties - knowing what I know now - here is what I would actually do.

I would learn about menopause early. Not because it was imminent, not with any sense of dread, but just as part of understanding my own body over a lifetime. I would know that perimenopause can begin up to a decade before. I would know that early menopause affects around 5% of women and that 1 in 100 experience menopause before the age of 40. I would understand that the transition can unfold gradually over many years, and that if I was on synthetic hormones for any reason, that transition could be happening without me having any clear way to detect it.

I would track my cycle, not obsessively, but with genuine attention. How I feel at different points in the month. My energy, my mood, my sleep, my clarity. Not so that I could fix anything, but so that I would have a baseline. So that when something started to change, I would notice, because I would know what normal felt like for me.

I would have conversations with the women ahead of me in life. My mother, my aunts, older friends. When did their transition start? Did anyone in the family have early menopause? What did it feel like before they knew what it was?

These conversations almost never happen across generations, and they should. The information matters medically and psychologically. And the act of having them matters too. Because it makes the whole thing feel less like something that happens in shameful isolation, and more like something women have always moved through together.

I would also ask different questions of my doctors. I wish I had known earlier that if I was on hormonal contraception or synthetic hormones for endometriosis, a standard FSH test wasn't going to give me a complete picture. I wish I had known to ask specifically about the interaction between my contraception and my ability to get an accurate reading, and to push for a conversation about symptoms rather than just numbers.

And I would take bone health seriously much earlier than felt necessary. Bone density peaks at around thirty. The habits built in your twenties and thirties are mattering in ways that only become visible decades later. I didn't think about any of this in my twenties. And I wish I had.

The part I feel most strongly about

There is one more thing I would tell my younger self, and it's the thing I think matters more than any of the practical advice above.

I would tell her to start paying attention to herself now. Not when things got worse. Not when the diagnosis finally arrived. Now.

Not in a performative wellness way. Not as another thing on the list to optimise. But genuinely, and with real curiosity - who am I? What do I actually need? What is my body telling me right now if I slow down enough to listen?

Because the women I see who navigate the perimenopause transition most positively - including the ones who come through it having been through genuinely difficult years - are almost always the ones who had done some version of this work beforehand. Who had a grounded enough relationship with themselves that when the hormones shifted, the emotional regulation disappeared and the inner critic got louder, they had something to return to. A sense of who they were beneath the performance of it all.

Perimenopause has a way of surfacing everything that hasn't been attended to. Old fears, old wounds, beliefs about our own worth that we thought we'd outgrown. The things that were manageable when life felt stable become much harder to keep quiet when the hormonal stability shifts.

This transition is, in my experience, something close to an invitation; to understand yourself more honestly than the busy years previously allowed.

The earlier you begin that process, and I mean ideally in your twenties, the more anchored you will be when this transition eventually arrives for you.

And it will arrive. For every woman, at some point, it will arrive. The only question is how intense, and whether you meet it with some understanding of yourself already in place, or entirely unprepared.

I met it largely unprepared. I don't want that for you.

If you're navigating perimenopause now, or beginning to wonder whether that might be what's happening, I'd love to connect. I work with women at every stage of this transition, helping them understand what's going on, and find their way back to themselves. You can find out more at jorennie.com, or book a free discovery call.

Jo 🦋