Michigan Just Named September Perimenopause Awareness Month. Here Is What I Wish Someone Had Told Me at 38.

On September 1, 2026, Governor Gretchen Whitmer and Lieutenant Governor Garlin Gilchrist II signed a proclamation naming September 2026 Perimenopause Awareness Month in Michigan.

I live in Michigan. I went through perimenopause here. And when I read that proclamation, I got genuinely excited, which is not a word I use often about a piece of state paperwork.

I am excited because awareness is the whole problem. Not treatment. Not research, though we need more of that too. The problem is that hundreds of thousands of women in this state are living through something right now and have no idea what it is. I was one of them for fifteen years. My hope is that a proclamation like this one helps women understand their own bodies and what is actually happening to them, sooner than I did.

So in the spirit of the month, here is the honest version of my story. What was actually happening to me at 38. What I told myself it was. And the full list of symptoms I wish someone had handed me back then, because I would have recognized myself in it years earlier.

What Michigan actually proclaimed

The proclamation is short, and it is worth reading the actual language rather than a summary of it. A few lines stood out to me.

It notes that “approximately 602,326 women between the ages of 35 and 45 are in the state of Michigan.” That is the age band where this usually starts. Six hundred thousand women in one state, in the window, most of them with no framework for what they are feeling.

It states plainly that “perimenopause and the symptoms associated with this phase of life are a normal part aging for women, but women and healthcare professionals don’t know enough about it.” I appreciated that it named healthcare professionals and not just women. That is the part usually left out.

And this line, which is the one I would put on a billboard:

Five to ten years. That is the thing almost nobody tells you. Menopause is a single day, the day that marks twelve months since your last period. Perimenopause is the decade leading up to it. The symptoms do not start when your periods stop. They start years before, while your cycle is still perfectly regular and nothing looks wrong on paper.

The proclamation closes by saying awareness matters because the lack of information and the stigma around this stage “often leaves women suffering in silence.” I did that for fifteen years, and I was not being brave about it. I just did not know there was anything to say.

Michigan has been building toward this. In March 2026, the Michigan Women’s Commission released the Menopause Memorandum, built on thirteen community conversations across the state and more than 2,500 women. One finding from their 2024 survey data has stayed with me: 60 percent of respondents had little to no knowledge of perimenopause or menopause, and many had never discussed it with their doctor.

Sixty percent. That is not a small gap. That is most of us.

What I was doing at 38 (and what I told myself)

Here is what my first symptom actually was. It was not a hot flash. It was not a missed period. It was math.

I have always been good with numbers. I could hold fairly complex calculations in my head and work them through without writing anything down. It was a thing I quietly liked about myself. Then, sometime around 38, I noticed I was counting on my fingers to add two single digit numbers.

Not once. Regularly. Seven plus five, and my hand would come up.

I want to be clear about how small that sounds and how large it felt. Nobody watching me would have seen anything wrong. I was working, running things, holding conversations. But I knew what my own mind used to do, and it was not doing it anymore.

The problem did not arrive all at once. It progressed slowly over the next ten years. By the end of that stretch, I was making mistakes every single day with tasks I had done daily for decades without a second thought. Simple things. Routine things. The kind of work that had been automatic since my twenties.

I want to name the emotional part of this, because the symptom lists never do. It was depressing. Deeply. Not because any single mistake mattered, but because of the trajectory. If this is what 38 to 48 looks like, I thought, what does 58 look like? What does 68 look like? I genuinely believed I was watching the beginning of a permanent decline, and that I would spend the rest of my life like this, slowly losing the thing I had always counted on.

And the whole time, I told myself the same thing every woman I have talked to since has told herself: this is just what getting older is.

It was not. It was estrogen.

Then the joints. Then the hair.

The second thing I noticed was my joints. My knees and my elbows started aching. Not injury pain. A dull, persistent, this-is-just-how-my-body-is-now ache.

I assumed it was arthritis developing. That is a reasonable assumption. It is what most people would assume. Joint pain in your forties reads as wear and tear, and no one had ever mentioned to me that falling estrogen affects joints, so there was no other explanation available to me.

Joint pain and stiffness is a documented and common symptom of the menopause transition. I did not know that. I spent years quietly filing it under arthritis.

Then, in my mid-forties, my hair started thinning.

I was completely unprepared for that one. Nobody had ever said the word “hair” to me in connection with menopause. Not a doctor, not an article, not a friend. Hot flashes, yes. Everybody knows about hot flashes. But watching your hair thin in your forties, with no warning that it might be coming and no framework for why, is its own particular kind of awful.

So there were three signals, spread across roughly fifteen years, and I read every one of them as a separate problem: cognitive decline, arthritis, and bad luck with hair. Three unrelated things happening to one unlucky woman.

They were one thing. I just did not have the list.

The full list of perimenopause and menopause symptoms

This is the part I most want you to have, because this list is what would have changed things for me. Most women can name three or four symptoms. There are dozens. Reading them all in one place is very often the moment the whole picture snaps into focus.

Two things to know before you read it. First, you will not have all of these. Nobody does. Second, symptoms vary enormously from woman to woman, and the ones that hit you hardest may not be the famous ones at all.

Hot flashes and night sweats are the most commonly reported, affecting up to 80 percent of women at some point in the transition. Cognitive symptoms like the ones that scared me are reported by roughly 40 to 60 percent of midlife women, which means my experience was not rare. It was ordinary. Nobody just happened to tell me.

If you recognize yourself in more than a few of these, that is worth taking seriously. I have written about my own experience with a lot of these in more depth in Peacefully Through Menopause: A Real Woman’s Guide.

Why nobody connects the dots

There are three reasons this goes unrecognized for so long, and none of them is that women are not paying attention.

The timing hides it. Symptoms start while your periods are still regular. If your mental model of menopause is “periods stop, hot flashes start,” then a 38-year-old with normal cycles and a math problem does not fit the model. You do not go looking for a hormonal explanation because nothing in the picture says hormones.

The symptoms are individually unremarkable. Tired, achy, forgetful, moody, and thinning hair are each explainable on their own. It is only when you see them stacked in one list that the pattern appears. Separately, they are just life. Together, they are a diagnosis.

Most doctors were not taught this. This is the part that made me angry when I learned it. In a national survey of ob-gyn residency programs, only 31.3 percent reported having a menopause curriculum, while 92.9 percent of participants agreed residents nationwide should have standardized menopause training. In a separate survey of residents, 20.3 percent said they received no menopause lectures at all during residency, and only 6.8 percent felt adequately prepared to care for women going through it.

Read that number again. Fewer than seven in a hundred felt ready.

So when your doctor does not raise perimenopause, it is usually not indifference. It is that nobody taught them either. Which is exactly why the Michigan report recommends that lawmakers “create policies for menopause physician education,” and why an awareness month is more than a nice gesture.

What to say to your doctor

This is the practical part. If something in the list above landed, here is how to make the appointment count.

Track before you go. Two weeks of notes is enough. Write down the symptom, the date, and how much it interfered with your day. Vague reports get vague answers. “I have been tired” is easy to wave off. “I have woken up at 3 a.m. eleven of the last fourteen nights and I am exhausted by 2 p.m. every afternoon” is not.

Include your cycle, even if it seems normal. Note your period dates, flow changes, and cycle length alongside the symptoms. The relationship between the two is information your doctor needs.

Say the word. Do not describe symptoms and hope your doctor gets there. Say it directly: “I think this might be perimenopause. Can we talk about that?” Naming it changes the whole shape of the visit.

Bring your list, in writing. Hand it over. Do not rely on remembering everything in a fifteen-minute appointment, particularly if brain fog is one of the things you came in about.

Ask these specific questions.

• Could these symptoms be related to perimenopause?
• What else could be causing them, and how do we rule those out?
• What blood work would you recommend, including thyroid, iron, and B12?
• Am I a candidate for hormone therapy? If not, what specifically rules me out?
• What are the non-hormonal options, and what does the evidence say about them?
• If we try something, when should I expect to feel a difference, and when should I come back?

Do not accept “you are too young.” I was 38. The proclamation names 35 to 45 as the relevant age band. Perimenopause in your late thirties is not unusual and it is not a stretch.

What to do if your doctor brushes you off

Sometimes you do everything right and still get told it is stress, or that you should try sleeping more, or that you are just at that age.

Here is what I want you to know: you are allowed to leave.

Finding a different doctor is not being difficult or dramatic. It is not a personal betrayal of the one you have. Given that fewer than seven percent of residents felt prepared to manage menopause, the odds that a randomly assigned doctor is well versed in this are genuinely not good. That is a training gap, not a reflection on you.

Some things that help:

• Look for a menopause-certified practitioner. The Menopause Society certifies clinicians who have demonstrated competence in this area specifically, and lists them. This is the single highest-yield thing you can do.
• Ask for the reasoning in writing. If you are told you cannot have hormone therapy, ask for the specific reason to be noted in your chart. This is a reasonable request, and it tends to sharpen a vague answer into a real one.
• Get a second opinion without guilt. You would get one for a surgical decision. This deserves the same.
• Do not stop at one no. I have talked to women who accepted the first dismissal and lost years to it. I was one of them.

What I do now

I am on hormone replacement therapy, and it is the single most important thing I have done. The brain fog, the thing that frightened me most, lifted. Not partially. It came back. My night sweats resolved, my hot flashes are down to occasional and mild, the depression eased, and my joint pain improved considerably.

I will be honest about the rest, because I think honesty is more useful than a success story. HRT did not fix my insomnia. I still wake at 3 a.m. and I still wake up tired. My hair is still thinning, and I am still looking for what works there. My skin is still dry no matter what I do.

Alongside HRT I changed how I eat, moving to a whole-foods, plant-based, organic diet, and that shift did real work on the inflammation and the joint pain. I built a morning routine and a sleep routine that I treat as non-negotiable. None of it is one magic thing. It is a combination, and I found it by trying things and keeping what held.

Talk to your doctor about whether HRT is right for you. There are real contraindications and your history matters. But if you do not have one and you are suffering, you deserve an actual conversation about it, not a reflexive no.

What I would tell the 38-year-old version of me

She is sitting at her desk, counting on her fingers, quietly terrified and telling nobody.

I would tell her that this is not the beginning of a permanent decline. That it has a name, and a mechanism, and in her case, a treatment that will bring her mind back. I would tell her that the joint pain arriving in a few years and the hair thinning after that are not three separate misfortunes, they are one process, and it has been studied.

Mostly I would tell her that fifteen years is a long time to lose to not knowing, and that she does not have to spend them the way she is about to.

That is why a proclamation matters to me more than it might sound like it should. Not because a piece of paper changes anyone’s hormones. Because 602,326 women in this state are in that age band right now, and if this month means even a fraction of them read a symptom list and think wait, that is me, that is years of somebody’s life given back.

September is Perimenopause Awareness Month in Michigan. If you have been telling yourself it is just getting older, please consider the possibility that it is not.

Sources

• September 2026: Perimenopause Awareness Month, Office of Governor Gretchen Whitmer, September 1, 2026.
• New menopause report makes recommendations to help women thrive in midlife, Michigan Women’s Commission, March 26, 2026.
• Menopause Symptoms, The Menopause Society.
• Perimenopause, The Menopause Society.
• Most OB/GYN residency programs in US lack dedicated menopause curriculum, Healio Women’s Health and OB/GYN.
• Menopause Management Knowledge in Postgraduate Family Medicine, Internal Medicine, and Obstetrics and Gynecology Residents: A Cross-Sectional Survey, Mayo Clinic Proceedings.