Why Your Doctor Wasn’t Taught This
By Delaney Cassidy · The Not Crazy Movement · Category: The Gap
Most doctors miss perimenopause because they were never trained to see it. Only 31% of OB/GYN residencies include menopause, and just 3% of physician associates get more than five hours of menopause education — so its mood, sleep, and cognitive symptoms are routinely misread as anxiety or depression.
You walked into that appointment with a list. Racing heart. Brain fog so thick you forgot your own kids’ school schedule. Anxiety that felt like a hand squeezing your chest at 2 a.m. Maybe rage — that white-hot, where-did-THIS-come-from rage that started about six months ago. And your doctor listened, nodded, and handed you a prescription for an antidepressant.
You left feeling dismissed. Maybe even a little crazy.
You’re not crazy. You’re menopausal. And there’s a very specific reason your doctor missed it.
The Numbers Don’t Lie — and They’re Infuriating
In November 2025, a national survey of more than 1,000 U.S. women aged 30 to 60 dropped a bombshell: nearly 40% of women felt misdiagnosed during perimenopause. More than half were treated for depression, anxiety, mood swings, or panic attacks — without anyone connecting those symptoms to their hormones. One in three was diagnosed with anxiety.
Nearly 39% of women who were prescribed antidepressants or anti-anxiety medications believed their diagnosis was flat-out wrong.
A separate global survey of 3,567 women across 71 countries, published in early 2026, found that before receiving hormone treatment, almost two-thirds of women had their symptoms attributed to other causes — most commonly “anxiety,” “aging,” or “lifestyle factors.” Almost half were prescribed medications that didn’t address hormonal changes at all. Antidepressants. Sleeping tablets. Benzodiazepines. Beta blockers.
And perhaps the most jaw-dropping finding: more than 60% of women saw multiple healthcare professionals before receiving appropriate care — and one in ten attended more than ten appointments before being prescribed hormone treatment.
Let me say that again. Ten appointments.
The Medical Education Gap — It’s Real, and It’s Documented
Here’s what’s happening behind the exam room door: your doctor probably wasn’t trained to recognize perimenopause.
A 2023 national survey of OB/GYN residency program directors found that only 31.3% of OB/GYN programs included menopause in their residents’ training curriculum. Only 29.3% of residents had any dedicated time in a menopause clinic.
That number hasn’t improved much. A 2025 analysis found that less than one-third of residents in internal medicine, family medicine, and OB/GYN programs receive structured menopause training. In October 2025, a survey of physician associates found that only 3% reported receiving more than 5 hours of menopause-related training during their entire professional education.
Five hours. For a health transition that affects every woman on earth and lasts, on average, seven to fourteen years.
Meanwhile, roughly 6,000 women in the U.S. reach menopause every single day. The math doesn’t work. The supply of trained clinicians is nowhere near the demand — and women are paying the price with years of wrong diagnoses and medications that don’t help.
The Symptoms That Get Misread
Here’s why diagnosis is so hard, even for well-meaning doctors: perimenopause doesn’t show up the way we expect it to. Hot flashes might not be the first symptom. In fact, for many women, the earliest signs are neurological and psychological — and they are textbook anxiety or depression symptoms if you don’t know what to look for.
The symptoms most commonly misattributed include:
• Anxiety and panic attacks — estrogen fluctuations directly affect the brain’s amygdala and serotonin pathways.
• Depression or anhedonia — loss of interest or pleasure, clinically indistinguishable from clinical depression without hormonal context.
• Brain fog and memory issues — often mischaracterized as early dementia or ADHD in women over 40.
• Heart palpitations — frequently sent for a cardiac workup with no conclusive findings.
• Rage and irritability — often labeled as mental health concerns or relationship problems.
• Insomnia — treated with sleep aids rather than traced to declining progesterone.
Only 15% of surveyed women felt sufficiently informed about perimenopause when their symptoms began. Fewer than half said their primary care physician or OB/GYN even initiated a conversation about perimenopause during routine appointments.
Why “Your Labs Are Normal” Isn’t the Whole Story
One of the most common ways perimenopause slips past even a careful doctor is the lab report. You get your bloodwork back, it reads “normal,” and the conversation stops there. But perimenopause is defined by fluctuation, not a steady decline — estrogen can swing from high to low and back within a single cycle, and a one-time blood draw can easily catch a normal-looking moment on a rollercoaster.
There is no single blood test that rules perimenopause in or out, which is exactly why the clinical picture — your symptoms, their timing, and your changing cycle — matters more than any one number. When a clinician leans only on a normal FSH or estradiol result to tell you nothing is happening, they’re reading a still frame of a moving picture.
That’s not proof you’re fine. It’s proof the test wasn’t built for a moving target. And knowing this is its own kind of power: it lets you say, out loud and with confidence, that a normal lab doesn’t close the question — it just means the next step is a symptom-based conversation, not a dismissal.
A Long History of Being Dismissed
This isn’t new. Women have been gaslit about their hormonal health for generations. The medical system was built on data from male bodies — prior to 1993, women of reproductive age were largely excluded from early-phase clinical drug trials. Female lab animals were frequently omitted from research because their hormonal fluctuations were considered a complication, not a variable worth understanding. I wrote an entire blog about this called The 70 Kilogram Man. Definitely worth the read.
The consequences of that exclusion still sit in the exam room with you. As recently as 2019, women made up only about 42% of participants in cardiovascular, cancer, and mental-health trials — and they report adverse reactions to medications at nearly twice the rate of men, a direct downstream effect of being chronically understudied and dosed on a male template.
The result? A healthcare system that is extraordinarily good at treating prostate cancer and cardiovascular disease in men, and far less equipped to recognize the hormone-driven crisis happening in half its patients. When your doctor reached for the antidepressant pad, it usually wasn’t malice — it was the training they were handed. That distinction matters, because it tells you where the fix is: not in doubting yourself, but in finding the clinician who was taught the part yours wasn’t.
What You Can Do Right Now
You are not powerless. Here’s how to advocate for yourself:
• Track your symptoms with a menopause-specific lens. Keep a log with the date, your menstrual-cycle status, symptom type, severity, and time of day. Patterns that connect symptoms to hormonal fluctuations are harder to dismiss.
• Name it explicitly. Walk in and say: “I believe my symptoms may be related to perimenopause or the menopause transition. I’d like to rule that in or out before we proceed with other diagnoses.”
• Ask about hormonal evaluation. There is no single lab test that definitively diagnoses perimenopause — estrogen fluctuates too wildly — but FSH, estradiol, and a clinical assessment of your symptoms together can paint a picture.
• Seek a menopause-informed provider. The Menopause Society (formerly NAMS) maintains a directory of certified menopause practitioners at menopause.org. These clinicians are specifically trained in what your primary care doctor likely is not.
• Don’t accept “you’re just stressed” without a follow-up conversation. Stress and perimenopause interact — but stress is not the whole story.
The Good News
Awareness is growing rapidly. The global conversation about menopause has shifted dramatically in the last three years — and advocates, researchers, and clinicians are pushing hard to close the education gap. A 2025 global report found that only 5% of women currently receive evidence-based menopause care — which means 95% are underserved. That is a crisis, but it is also a mandate for change.
You deserve a doctor who understands what’s happening to your body. And now you know enough to walk in and demand it.
Download our free 7-Day Symptom Tracker & Doctor Visit Guide to bring to your next appointment — designed to help you track, organize, and advocate.
Sources & References
1. Nearly 40% of Women Say They Were Misdiagnosed During Perimenopause, National Survey Reveals — national survey, November 2025.
2. Menopausal women ‘struggle with symptoms and delayed care’ — global survey of 3,567 women across 71 countries (commissioned by Biote).
3. Needs assessment of menopause education in United States residency programs — 31.3% of OB/GYN programs include menopause; 29.3% of residents had menopause-clinic time.
4. Menopause Education Lags in Residency Training Across Primary Care Specialties — 2025 analysis.
5. Menopause Education Wholly Inadequate for Physician Associates — only 3% received more than 5 hours of training.
6. Postmenopause statistics — ~6,000 U.S. women reach menopause each day.
7. From physiology to psychology: an integrative review of anxiety and depression in menopause — estrogen, the amygdala, and serotonin pathways.
8. The Menopause Transition: Estrogen Variability, HPA Axis and Affective Symptoms — hormonal fluctuation and mood.
9. Women’s Health Is Chronically Understudied and Underfunded — trial exclusion, ~42% participation, adverse-reaction rates.
10. Menopause Knows No Borders: Groundbreaking Report Reveals Global Crisis — only ~5% of women receive evidence-based menopause care.
Medical note: This article is for education and self-advocacy, not medical advice. Talk with a qualified, menopause-informed clinician about your symptoms and options.
© The Not Crazy Movement · notcrazymovement.com
