Whose Knowledge Counts? Perimenopause, Power, and the NHS

We've Been Stitched Up: Women’s Bodies and Medical Power Mixed media collage, 2026

Last week I found myself on the phone, voice cracking, describing my own body to a specialist, and within four minutes I was being offered antidepressants.

Four minutes.

In four minutes, a lifetime of embodied knowledge, years of clinical training, careful cycle tracking, and a clear, coherent description of what I was experiencing were reduced to: "perhaps you are depressed".

I am furious about this. And I am not interested in making my fury polite.

I have a long history with the NHS and its narrow, medicalised way of seeing human beings. I left the NHS because of this. Because of the routine pathologising of normal human emotion. Because of the way professionals so often position themselves as the experts of you, while subtly, or not so subtly, dismissing your own knowledge of your body. Because of the default slide toward medication, particularly antidepressants, rather than curiosity, dialogue, or respect for lived experience.

I avoid going to the GP when I probably should, because too many times I have left appointments feeling smaller, more anxious, and more powerless than when I arrived.

There had been one exception: the pharmacist at my practice who specialised in HRT. For years, she felt different, more collaborative, more human. I trusted her.

So, when I asked for an early review of my HRT last week, I did so in good faith. I went prepared. I know my body. I track my cycle. I have language for my hormonal landscape. I have written about mental health and menstrual cycle awareness. My closest friend is a menstrual cycle coach. I am not floating in ignorance here. I am also on the cusp of turning 50.

I laid out, clearly and calmly, what I was noticing. On days 5–8 of my cycle my body felt as though it had turned against me:

· a sudden, sharp drop in mood,

· rising irritation, itching, breathlessness, and sleeplessness,

· senses so heightened that ordinary noise, light, and touch felt unbearable,

· a deep, bone-level ache in my joints,

· and a kind of crushing, depleted fatigue that left me barely functional.

At its worst, I found myself saying to my husband, “my body feels so horrendous that I feel like I’m going to die.” That is not metaphorical drama, it is how it viscerally feels to inhabit this phase of my cycle.

I explained that this pattern tapered off after a few days, as would be expected, but that something had shifted. A harder hit. A different quality. I told her I thought I was no longer ovulating regularly, that my libido had disappeared. Paradoxically, just before my bleed, I had lots of energy, a kind of wired-tired. I mentioned that I had read about histamine sensitivity in perimenopause, which maps closely onto what I was describing.

I felt overwhelmed saying all of this aloud, because it is overwhelming to live inside a changing body, and my voice cracked. I paused briefly to steady my voice and wipe the tear that had escaped down my cheek.

Before I had even finished that moment, she cut in to suggest that I should book an appointment with my GP to discuss antidepressants.

In that instant, her dismissal felt almost violent in its speed and certainty.

I told her plainly: “I am a clinical psychologist. I am self-aware. I am not anxious or depressed. This is hormonal, and I will absolutely not take an antidepressant.” I want to be clear that being a psychologist does not make me immune to anxiety or depression, nor would I hesitate to seek help or take medication if I needed it. But in this situation I knew that was not what was happening. I asked if she could explain what she thought was happening to me from a hormonal perspective.

She said she didn’t know the tracking model I was referring to and outlined two options:

1.    increase my oestrogen, or

2.    If that didn’t help, spread my progesterone across the whole cycle instead of taking it only in the second half.

What struck me was not just the content of these options, but how little they engaged with what I had described. There was no discussion of histamine sensitivity, no curiosity about my loss of libido, and no exploration of whether my symptoms might reflect an imbalance rather than a simple “need more oestrogen.” It felt like moving down a protocol rather than thinking with me about my body. By the end of the call, it was clear that her expertise lay in administering HRT, not in understanding women’s cyclical physiology in a nuanced way.

And here is something that has stayed with me: she was a woman herself. How is it that a woman working in this field did not have a richer understanding of the female hormonal landscape? How many women have been flattened into symptoms rather than understood as complex, cyclical beings, even by other women inside this system?

Later, I spoke to my menstrual cycle coach friend. She immediately recognised my pattern as likely being linked to an overproduction of oestrogen in the early follicular phase, meaning that increasing it could be exactly the wrong move.

She guided me toward Lara Briden’s Period Repair Manual. Briden argues that symptoms like mine often point to oestrogen dominance and histamine sensitivity, particularly in perimenopause, and that simply “adding more oestrogen” can be a blunt instrument that worsens symptoms rather than alleviating them.

Maisie Hill makes a similar point in Perimenopause Power. She describes how, during perimenopause, oestrogen levels often become erratic and can remain elevated relative to progesterone. This imbalance, commonly called oestrogen dominance, is not a fringe idea, but a well-recognised pattern that can produce mood swings, fatigue, and heightened sensitivity to the world. Crucially, Hill emphasises that these experiences are physiological, not psychological: they are rooted in real hormonal shifts, not in a woman’s failure to cope.

Both Briden and Hill are saying something that should be obvious, but rarely is, in mainstream medicine: women’s symptoms in perimenopause often make sense when you actually look at the hormonal terrain of their bodies.

Yet this kind of knowledge is frequently dismissed by medical professionals as “not evidence-based.” What is rarely named is that what counts as “evidence” in mainstream medicine is overwhelmingly shaped by pharmaceutical funding, male bodies as the default in research, and clinical trials that routinely under-represent women. An “evidence base” built on these foundations is not neutral, it is a politics of knowledge dressed up as objectivity.

We are only just on the cusp of women in their 40s and 50s openly talking about perimenopause as the profound life transition it is, every bit as seismic as puberty. And already, the backlash is here. A friend recently told her (female) GP that she felt she was entering perimenopause. The response? “It’s quite fashionable to think you’re perimenopausal at the moment”.  

Fashionable. As if this is a trend rather than a biological reality that half the population will experience to some degree.

If this is how I am treated, someone informed, articulate, confident, and professionally trained in listening to bodies and minds, what happens to women who don’t have that language? Who don’t have that confidence? Who simply nod and swallow whatever they are told?

I did not leave that consultation only angry. I left shamed, shamed for having emotions, shamed for trusting, shamed for needing care, and shamed for expecting to be met as a knowledgeable person rather than a problem to be managed.

Last week wasn’t just a bad appointment. It was a rupture of trust with one of the few people in that system I had believed in. And that loss of trust stings more than I expected it to.

But it also fuels something in me, a refusal to stay silent.

This experience has reminded me that the question at the heart of all of this is not really about hormones, or HRT, or even the NHS. It is about whose knowledge counts? Whose experience is taken seriously? Whose body is treated as intelligible?

My body made sense. My description made sense. My tears made sense. What did not make sense was the speed with which that was overwritten by a medical script.

Women’s bodies are not problems to be managed. Our emotions are not pathologies to be suppressed. Our knowledge of our own lived experience matters, whether medicine is ready to hear it or not.

References / Further Reading

Briden, L. (2015). Period Repair Manual: Natural Treatment for Better Hormones and Better Periods.

Hill, M. (2021). Perimenopause Power: Navigating Your Hormonal Transition with Knowledge and Confidence.