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I thought I was falling apart. I was in my mid-forties, I work in women's health, I have spent decades reading scientific literature — and I had absolutely no idea that my itchy ears, my chronically dry eyes, my sudden 3am wake-ups and the anxiety that arrived out of nowhere were all connected. Connected to one word nobody said to me: perimenopause.

Three separate doctors. All women. All of them treated each symptom in isolation — a referral to an ophthalmologist for the dry eyes, something topical for the itchy ears, a gentle suggestion that perhaps I was a bit stressed. I sat in one appointment and said outright: "I feel like I'm falling apart. Something is not right." And still, not one of them mentioned the M word.

It wasn't until I visited the UK about four years ago — catching up with a group of friends my age — that it all clicked. They were talking openly and unashamedly about their patches, their testosterone doses, their menopause specialists. And I sat there thinking: we are not having this conversation in New Zealand. I say this as someone who works directly with the very hormone patches we were discussing. I still hadn't put it together for myself.

I thought I was too young and that hot flushes were the thing to look for. Turns out there are hundreds of symptoms — and we are not all alike.

The Gap Between When It Starts and When Anyone Tells You

In New Zealand, the average age of menopause is around 51 to 52 years. But perimenopause — the hormonal shift leading up to that point — can begin a full decade earlier. For most women, it starts somewhere in the mid-to-late forties. The hormonal fluctuation that drives every symptom you're about to read about begins not with the cessation of periods, but with the gradual, erratic shifts in oestrogen and progesterone that precede it by years.

A national survey found that 89% of New Zealand women aged 40 to 60 have experienced new or worsening symptoms associated with menopause. And yet women are routinely leaving their GP appointments with antidepressants, eye drops, and stress management suggestions — their hormones unexamined, the connection unmade.

The Symptoms Nobody Told Me Were Connected

Hot flushes affect around 70–80% of women — meaning 20–30% go through this without the headline symptom while quietly experiencing everything else. These are the symptoms that brought women I know — and myself — to doctors who didn't connect the dots:

Why Your Blood Test Won't Catch It

Oestrogen in perimenopause doesn't decline in a straight line. It swings — up, down, chaotically — sometimes day to day. A blood test taken on one day captures a single data point in a pattern that looks nothing like a straight line. A normal result tells you almost nothing about where you are. This is why the clinical diagnosis of perimenopause in women over 45 is correctly based on symptoms and history, not bloodwork alone.

A normal blood test does not rule out perimenopause. Your symptoms are data. Trust them.

— Sarah, VelaOra

What You Can Do Right Now

Track your symptoms before your appointment. Write down every symptom, when it started, how it fluctuates. "I've been feeling anxious" is easy to dismiss. "I wake between 3 and 4am on 18 of the last 30 days and feel palpitations when I do" is not.

Use the word perimenopause explicitly. Say it in the appointment. Ask directly: "Could this be perimenopause?" Many women report that this single word changed the entire direction of the conversation.

Find a doctor who listens. If you leave an appointment feeling dismissed, you are entitled to seek another opinion. It is not being difficult. It is advocating for your health.

Talk to your friends, your mum, your sister. The UK trip changed my life because women were talking. We are not having enough of this conversation in New Zealand. Start it.