Perimenopause symptoms often misidentified as stress or aging

New data from the Bonafide 2026 State of Menopause Survey indicates that 71% of women fail to recognize their first perimenopausal symptom as hormonal. This lack of recognition is largely because early symptoms often manifest as emotional and cognitive changes—such as anxiety, depression, sleep disruption, and brain fog—rather than the more commonly recognized vasomotor symptoms like hot flashes.

Many women attribute these shifts to stress or aging. The survey found that 77% of respondents reported cognitive changes, including brain fog, while 60% noted impacts on emotional or mental health. These symptoms can create a self-reinforcing cycle where poor sleep and anxiety exacerbate one another.

Research from Harvard Health Publishing suggests that perimenopause depression can occur 40% more often than in pre- or postmenopausal stages. Experts recommend that women track symptoms and their connection to menstrual cycles to distinguish hormonal transitions from other conditions like autoimmune diseases or clinical depression. Healthcare disparities may also cause symptoms to intensify for Black women if medical intervention is lacking.