“Is This Burnout, Fibro… or Perimenopause? Rethinking Your Midlife Symptoms”

Brain fog, low patience, new aches, sleep that doesn’t restore you, a nervous system that feels closer to the edge than it used to… for many women, this is the reality of midlife. It’s easy to file all of this under “stress” or “just getting older”, especially if you are someone who is used to coping and carrying a lot. But for many, these are signs that hormones are shifting – and that perimenopause or menopause may be part of the picture, even if classic hot flushes or night sweats never show up. 

This is where the conversation about hormone replacement therapy (HRT) can become important. Not because HRT is the only answer, or the “correct” answer, but because it is one evidence based tool that some women find genuinely lifechanging. It deserves a place on the table alongside lifestyle changes, nonhormonal medicines, and supportive therapies – not in the shadows, and not as something you can only consider when your symptoms are extreme. 

When midlife doesn’t feel like “you” anymore

Perimenopause can start years before periods finally stop. During this time, hormones fluctuate rather than simply “drop”, and that upanddown pattern can show up in ways that don’t look like the stereotypical picture of menopause. 

You might notice, for example:

• A shorter fuse or sudden waves of irritability.

• Brain fog, wordfinding difficulties, or feeling scattered in ways that are new.

• A shift in sleep – waking at 3am, lighter sleep, or feeling unrefreshed.

• New or worsening joint and muscle aches, even if you’re otherwise well. 

• A general sense of not feeling like yourself, without being able to point to one clear cause.

On top of that, many women have other health conditions in the mix – chronic pain, migraine, gut issues, autoimmune conditions, fibromyalgia – which already bring fatigue, pain, and cognitive load. When hormonal change is layered on top of all this, it can be hard to see that midlife hormones are part of the story at all. 

So where does HRT fit in?

HRT is a medical treatment that replaces some of the hormones (mainly oestrogen and progesterone, and sometimes testosterone) that naturally decline during menopause. For many women, it can help: 

• Reduce hot “surges” and internal heat.

• Ease nighttime disturbances linked to vasomotor changes.

• Improve sleep quality by calming some of those hormonedriven wakings.

• Support mood and overall sense of wellbeing in some cases. 

It is not a magic wand, and it will not address every symptom you have, especially if you’re also living with conditions such as Fibromyalgia or other longterm health issues. A recent clinical case highlighted a woman whose hot flushes and night sweats improved significantly on HRT, but whose pain, fatigue and brain fog remained driven mainly by fibromyalgia and other comorbidities. That example is a useful reminder: HRT can remove a hormonal “layer” of difficulty, but life and health are often more complex than one prescription. 

The empowering piece is this: HRT does not have to be allornothing, yesorno forever. For many women, it is a conversation, an option to explore, and a treatment that can be trialled, reviewed and adjusted over time. 

Questions you are allowed to ask about HRT

Talking about HRT with a clinician can feel intimidating if you’re not sure where to start. You don’t need to arrive with a decision made; instead, you can arrive with questions.

Here are some you might find helpful:

• “Which of my symptoms might be related to hormone changes?”

  
  

  Ask your clinician to look at the whole picture: mood, sleep, cognition, energy, changes in body temperature, joint pain, cycle changes (if you still have periods), and any conditions you already live with, such as chronic pain or fibromyalgia. 

• “Given my health history, could HRT be appropriate for me?”

  
  

  This includes discussions about benefits and risks in your specific situation – for example, your age, how long it has been since your last period (if applicable), other medical conditions, and any previous treatments you’ve tried. 

• “If I try HRT, how will we review whether it’s helping?”

  
  

  You can ask how long to wait before assessing benefit, which symptoms you’re hoping to see change, and how to monitor side effects. This makes HRT a shared experiment rather than a fixed commitment.

• “If HRT is not suitable for me, what else can we consider?”

  
  

  Nonhormonal medications and lifestyle approaches can also support vasomotor symptoms, mood, and sleep; asking about alternatives keeps the conversation from becoming a closed door. 

These questions are not demands; they are invitations to partnership. They signal that you are willing to engage and that you respect both your own experience and your clinician’s expertise.

What if you already live with Fibromyalgia or another longterm condition?

If you’re living with Fibromyalgia or another chronic condition, you might be used to everything being labelled under that one diagnosis. Worsening pain, extra fatigue, poor sleep, cognitive fog – it can all easily be dismissed as “just Fibro” or “just your condition”. 

If this resonates, it might be worth asking: “Could hormonal changes be amplifying what I’m feeling? And if so, would HRT be something to discuss as one part of my support, alongside pain management, pacing, movement, and emotional support?” 

An invitation to explore

If this blog has stirred questions about where you are in your own midlife story, that is a good sign – not that something is wrong, but that you are paying attention. You are allowed to ask, to explore, and to take your time.

The aim here is not to push HRT, or any single solution, but to make sure you know that perimenopause and menopause might be part of what you’re experiencing – and that you have options to discuss if you want to feel more like yourself again.