A Visit That Made Me Feel Seen and Understood About Perimenopause

So I have written about something many women quietly experience – the moment when burnout does not quite feel like burnout anymore. If you missed it, you can read it here: "The Subtle Changes of Your Forties: When Burnout Might Actually Be Perimenopause".

Taking the Next Step

After recognising that some of the changes I was experiencing could be linked to perimenopause, I decided to do something about it. So I went for a consultation with Dr. Premitha Damodaran, a menopause specialist at Pantai Hospital Kuala Lumpur.

I went in with a list of symptoms: mood swings, sleep disruptions, brain fog, cholesterol shifts, etc., but I also went in with a quiet question: is this really what I think it is?

A Consultation That Looked at the Whole Picture

What I appreciated most about the session was how the consultation itself was not rushed. Instead, it felt like a thoughtful conversation. 

She asked about different aspects of my health, not just one isolated symptom. We spoke about my cholesterol levels; menstrual cycle – how regular or irregular it has been; and weight changes. She also asked about my Mirena IUD and why I chose to have it.

But the conversation did not stop there. Beyond that, she explored things that are often easy to dismiss, such as my sleep patterns, mood changes, memory, and even whether I had any joint pain or bowel changes. These things are usually ignored or dismissed, but they are actually part of the bigger picture.

Our body does not work in isolation. Everything is connected. Hence, it makes total sense to also look at all these different aspects of health.

Understanding What My Body Is Already Doing

One of the most reassuring parts of the consultation was realising that my body is not "falling apart". Without going into too much detail, what I wanted to say is that the narrative was changed from "something is wrong" to "something needs to be balanced".

Starting with the Foundation: Sleep

Interestingly, we are not trying to fix everything at once. The first focus is sleep. She explained that improving sleep can influence many other areas such as energy levels, mood, and even the ability to stay consistent with lifestyle habits.

Start with the foundation, and let the rest build from there.

We also spoke about exercise. Not as something I need to force immediately, but as something to build into gradually, especially weight training, once my sleep and energy improve.

There is a time to push, and there is a time to restore. Not as a pressure to immediately "do more", but as a next step when my body is ready. This perspective stayed with me.

Rather than trying to fix everything at once, we start with something that supports the body more holistically. And sometimes, restoration needs to come first.

Walking Away Feeling Supported

If my previous article was about awareness, this experience was about reassurance.

There is something deeply comforting about being heard, understood, and guided with clarity. It reminded me that navigating perimenopause does not have to be confusing or isolating. With the right support, it becomes something we can understand, manage, and even learn from.

I am still at the beginning of this journey. There will likely be adjustments along the way, like new observations, new questions, and perhaps new insights.

But for now, I feel more grounded. Not because everything is solved, but because I understand a little more about what my body is going through. And I truly believe that understanding is the most important first step.

Watch Dr. Premitha's short video about perimenopause.

The Subtle Changes of Your Forties: When Burnout Might Actually Be Perimenopause

A Personal Observation

I have begun noticing changes in myself that I could not immediately explain for the past 4-5 years, but they have intensified since last year.

My sleep feels different. I couldn't fall asleep fast enough. I need a moment longer to recall a word. Situations that I would normally handle without much thought feel a little more draining than before. My brain feels like it's in the drain. Lots of things could trigger an onslaught of emotions. I feel challenged in many ways, and I dislike the feeling of not being in control.

At first, I assumed it was simply the result of a busy season of life. Like many women in their forties, I am balancing work, studies, family, and the usual responsibilities that come with adulthood.

But as I started paying closer attention, I realised these changes were not random. They seemed to follow a pattern that many women eventually encounter: the stage of perimenopause, which is the hormonal transition before menopause.

Perimenopause can begin several years before menopause itself, and hormonal fluctuations during this time can affect sleep, mood, metabolism, and cognitive function. Ouch!

Five Signs You May Be Entering Perimenopause

Here are five signs that are often mistaken for burnout but may actually be related to perimenopause.

1. You Notice More "Brain Fog" Than Before

Many women begin to notice changes in memory or concentration during perimenopause. You might take longer to recall certain words, forget why you entered a room, or feel that your thinking is slightly slower than before. For women like me who rely heavily on mental sharpness at work or in daily life, this can feel worrying.

Research shows that cognitive symptoms such as brain fog, slower recall, and reduced focus are common during perimenopause and are linked to hormonal fluctuations affecting brain function. The brain contains many receptors for oestrogen, and fluctuations in this hormone can influence memory and processing speed.

2. Your Tolerance for Stress Feels Lower

Another common experience during perimenopause is a change in how the body responds to stress. Hormonal fluctuations can affect the body's stress-response system, including how the nervous system regulates cortisol and emotional responses.

Situations that once felt manageable may now feel more draining. You may find yourself feeling overwhelmed more easily, especially when juggling multiple responsibilities at work or at home. This is so true.

3. You Have Difficulty Falling Asleep

Sleep disruption is one of the earliest and most overlooked signs of perimenopause. As Dr. Mary Claire Haver highlights, many women experience a "hidden sleep crisis" during this stage, often mistaking it for stress rather than a hormonal shift.

Some women find that they feel tired but have difficulty falling asleep. Others may notice that their sleep schedule shifts or that they wake earlier than usual. For me, I couldn't fall asleep as fast as I wanted it to be. Sometimes I could lie in bed for two hours before being able to fall asleep. One reason for this is that progesterone, a hormone that has calming and sleep-supporting effects, may fluctuate or decline during this stage of life.

4. Your Body Stores Weight Differently

Many women are surprised to notice weight changes during their forties, even when their diet and activity levels remain the same. Experts note that visceral fat increases even without lifestyle changes due to hormonal shifts.

Hormonal decline can lead to weight changes and fat redistribution, particularly abdominal fat. Oestrogen plays a role in how the body distributes fat. Changes in oestrogen levels can influence how the body stores fat, which is why many women notice increased weight around the abdomen during the perimenopause stage. Clothes may fit differently even if overall weight has not changed dramatically.

5. Your Emotions Feel More Sensitive at Times

Many women report feeling "not quite themselves" emotionally during early stages. Mood swings, irritability, and emotional changes are common symptoms of perimenopause. You might feel more irritable than usual or react more strongly to situations that previously felt minor.

These emotional shifts can come and go as hormone levels fluctuate throughout the cycle. This fluctuation affects the brain chemicals that regulate mood, including serotonin and GABA. When hormone levels fluctuate, mood regulation can become more sensitive.

Why High-Performing Women Often Notice These Changes More

Interestingly, many women who notice these changes most clearly are those who are used to functioning at a high mental and emotional capacity.

Women in their forties are often balancing demanding careers, family responsibilities, and multiple commitments. They are accustomed to being organised, efficient, and mentally sharp. Because of this, even small shifts in sleep, memory, stress tolerance, or energy can become noticeable.

When these changes appear, it's easy to assume that something is wrong or that burnout is setting in. However, hormonal fluctuations during perimenopause can affect several systems in the body at the same time, including sleep regulation, cognitive processing, mood stability, and metabolism.

For women who have spent years managing complex schedules and responsibilities, these subtle changes may feel especially surprising.

To be very honest, I was taken aback by these changes, particularly the feeling that they were no longer entirely within my control.

Taking Action

Because of that, I began reading and researching to better understand what was happening in my body. I needed this knowledge not just for information, but to reduce unnecessary self-criticism and self-doubt.

I'm not labelling myself or limiting what I can do. I'm creating awareness. And with awareness, we can begin to adapt our routines, priorities, and self-care in ways that support our well-being more sustainably.

It also made me reflect on something else. For many years, women's health experiences were not openly discussed. Conversations around hormonal changes were often minimised or simply not prioritised.

But times are changing. More women today are beginning to speak, share, and seek understanding, not just for themselves but for those who come after them. In many ways, we are part of a generation that is learning to listen to our bodies more closely and to give language to experiences that were once kept quiet.

That realisation led me to take the next step: to speak with a menopause specialist and better understand what my body needs.

In this next post, I share what that consultation was like and why it made me feel more supported than I expected.

References

Menopause symptoms that may surprise you: What to watch for during perimenopause

Menopause and stress

The Girls Aren't Sleeping

Menopause Masterclass: Hormones, Brain Fog, Weight & Mental Health with Dr. Mary Claire Haver

How symptoms of perimenopause and menopause can impact mental health

In Another Universe, I Have Four Animals

Sometimes I imagine a slightly different version of my life. Well, I believe we all carry small alternate universes in our minds, like the café we never opened, the house by the lake we never bought, and the pets we never adopted.

In one of mine, four animals share my home: Sherlock, Sheldon, Shelby, and Shiloh. Each of them carries a distinct personality, and if I'm honest, I suspect each of them represents a different part of me.

Sherlock, the Curious One

Sherlock is always investigating something: a rustle in the garden, a new bag brought into the house, a sound that most people would ignore. Nothing escapes his attention. He moves through the world with quiet curiosity, piecing together clues that others might miss.

If I look closely, Sherlock reminds me of the curious part of me; the part that looks at trends, behaviour, and patterns and wonders, "Why does this happen? What does it mean?" Sherlock notices everything. And perhaps that is why I understand him best.

Sheldon, the Keeper of Order

Sheldon prefers structure. His world runs on quiet precision. The warmth of the terrarium lamp turns on at the same hour each day. Feeding time follows a familiar rhythm. Even the small cave he retreats to remains perfectly positioned where he expects it to be.

If something changes, like a shifted rock or a slightly different light, Sheldon notices and quietly evaluates the disturbance. There is something comforting about that predictability. While the rest of the household moves with noise and energy, Sheldon lives by steady patterns. Day after day, the same gentle routines create a small, controlled universe within glass walls.

If I look closely, Sheldon reminds me of the part of me who needs structure. Structure is not the enemy of creativity. To me, structure is what allows everything else to function.

Shelby, the One Who Understands People

Shelby has a quiet gift for reading the room. He notices when someone arrives tired from a long day, when a visitor lingers a little longer by the door, and when the energy in the house shifts in subtle ways. His welcome is warm but never overwhelming. A gentle wag of the tail, a soft presence beside whoever needs it.

If I look closely, Shelby reminds me of the part of me who views genuine connection as not having to be loud or obvious. Sometimes it is simply the ability to notice people, to recognise when someone needs comfort, conversation, or just quiet companionship.

Shiloh, the Quiet Observer

Shiloh spends a lot of time by the window. He watches the street, the trees, and the changing light of the afternoon. While the others move around the house with energy and purpose, Shiloh seems content simply to observe.

In the evenings, he walks beside me slowly, matching my pace without pulling ahead. There is something peaceful about his presence.

If I look closely, Shiloh reminds me of the part of me who values quiet downtime. Not every moment needs to be filled with activity. Some moments are meant simply for reflection.

A Small Ecosystem of Personalities

When I imagine this household, I realise something interesting. Each of these animals reflects a different way of moving through the world.

Sherlock, curious and analytical.

Sheldon, structured and dependable.

Shelby, warm and generous.

Shiloh, calm and reflective.

Together, they form a kind of balance. Perhaps that is why the image feels so comforting. Because somewhere in that imagined home, all those parts coexist peacefully.

The Universe That Exists Only in Imagination

In reality, I do not have these animals. Life sometimes takes us down paths where certain things, even lovely things, are simply not part of the journey.

But every now and then, I visit this alternate universe in my mind.

A place where mornings begin with the sound of paws on the floor. Where Sherlock investigates the garden, Sheldon rests quietly beneath the warmth of his lamp, Shelby greets the day with enthusiasm, and Shiloh watches the sunrise beside me.

It is not a grand life. Just a quiet one, filled with companionship and small, warm moments. And perhaps that is enough.

Preparing for the Care We Rarely Talk About

I registered for the "The First Step in Caregiving: Chaperone & Companionship" course at Care Concierge Academy with no particular expectations. I assumed it would be practical and instructional. I thought I would simply learn some guidelines on caring for elderly family members and understanding when something constitutes a medical emergency.

What I did not expect was how personal the experience would feel.

More Than Just Technical Skills

The course was not limited to caring for older adults. It covered anyone who might be bedridden or dependent on others for daily needs, including stroke patients.

We learnt the basics of handwashing; how to wear surgical masks and gloves properly; how to perform perineal care, change urine bags, and change adult nappies; and how to safely transfer someone from a bed to a wheelchair and into a car. We were taught how to use a gait belt during mobility transfers and what it means to chaperone someone during hospital visits and medical appointments.

These were technical skills. Necessary ones.

But somewhere in between the demonstrations and instructions, something shifted in me.

The Moment It Became Personal

During the session on perineal care, I felt an unexpected sense of helplessness. It was not because the procedure was difficult to understand. It was because I suddenly imagined myself in that position one day.

If I were old and bedridden, how would I allow myself to be cleaned and handled by someone else? How would I accept being touched by strangers? How far could I hold on to my dignity without feeling shitty?

I realised how much I dislike asking for help from strangers. The thought of depending entirely on someone else for basic hygiene unsettled me more than I expected. It made me confront a version of vulnerability that I had not fully considered before.

Understanding Dementia Differently

The course also touched on dementia. We learned that patients may refuse to eat, may behave unpredictably, and can deteriorate in ways that are painful to witness. They are not difficult because they choose to be. Dementia is a disease that gradually eats away at the brain. The behaviour is not personality; it is pathology.

That reframing matters. It shifts frustration into compassion. It shifts judgement into understanding.

Why I Signed Up in the First Place

I attended this course because I wanted to be the first in my family to know what to look out for. I wanted to be able to recognise when something is a medical emergency and when it is not. I wanted to understand how to care for my loved ones before immediately turning to external professional caregivers. I wanted to feel prepared.

A geriatric specialist once told me that in an emergency, I should just go to the hospital. That advice is correct. Hospitals are for emergencies.

The Part No One Talks About: After the Hospital

But what happens after the hospital is what concerns me most.

The discharge summary is handed over. The medication list is explained. The follow-up appointment is scheduled. Then the patient goes home.

Home is where the real care begins.

Who helps with toileting?

Who ensures proper hygiene?

Who notices subtle changes?

Who handles mobility transfers?

Who sits through the waiting at medical appointments?

Who understands when agitation is part of dementia and not defiance?

That "after" is rarely discussed openly.

Yet it is the reality many families quietly navigate.

Working closely with hospitals over the years has given me insight into patient journeys, discharge processes, and continuity of care from a systems perspective.

But sitting in this caregiving class made me feel the emotional weight of what those transitions actually mean at home. It moved the concept of "post-discharge care" from professional understanding to personal responsibility.

What Shifted in Me

What shifted in me was not fear, although there was some of that. It was a deeper awareness of responsibility.

When the time comes, how ready will I be for my family? How ready will I be for myself?

Caregiving is not only about physical tasks. It is about preserving dignity when independence is no longer possible. It is about balancing clinical necessity with emotional sensitivity. It is about being steady when someone else feels vulnerable.

Preparedness is not only medical knowledge. It is emotional readiness. It is the willingness to step into uncomfortable spaces. It is acknowledging that one day, roles may reverse.

Midlife, Readiness, and Contribution

Perhaps this is also what midlife begins to look like. It is not only about career growth or personal ambition. It is about contribution. It is about quietly preparing for responsibilities that may not yet have arrived but eventually will.

We often prepare for promotions, investments, and milestones. We rarely prepare for frailty, dependency, or decline. Yet these are just as much a part of life.

I do not know what the future holds for my parents, my loved ones, or myself. But I know this: when the time comes, I want to contribute meaningfully. I want to respond with knowledge instead of panic. I want to act with steadiness instead of avoidance.

The hospital may handle the emergency.

But the care after that, the quiet, daily, intimate care, is what truly sustains a person.

And that is what I am learning to take seriously.

Part of the #CareAndCalling series

#CareAndCalling is a series about preparing for the responsibilities we rarely talk about, and recognising that care is not a detour but a calling.

– Finding My Way Back to Healthcare

– Learning to Care, Before We Have To

– This Was Never a Detour

– What Healthcare Has Quietly Taught Me