Brain fog, fatigue, mood swings: Defining ‘not feeling like myself’ in perimenopause

Key takeaways:

• Survey data show 63% of midlife women reported “not feeling like myself” half the time or more over 3 months.
• Symptoms most correlated with “not feeling like myself” included fatigue, overwhelm and low feelings.

The menopausal transition can be associated with a variety of bothersome symptoms, including hot flashes and mood swings, but some women might experience more subtle symptoms that can begin years before the final menstrual period.

“Not feeling like myself” is a phrase often used by women on the path to menopause — when symptoms related to mood or cognition arise that impact their daily lives, according to Nina Coslov, MBA, founder of Women Living Better, an organization focused on understanding and improving the perimenopausal years through education and research.

In a recent survey of more than 1,300 women aged 35 to 55 years who met criteria for the late-reproductive stage or menopausal transition, 63.3% of women reported “not feeling like myself” at least 50% of the time during the past 3 months. Researchers then correlated 61 individual symptoms and symptom-bother scale scores with the phrase “not feeling like myself.”

After accounting for education level and overall stress ratings, “not feeling like myself” was most strongly predicted by the symptom groups of anxiety/vigilance, fatigue/pain, brain fog, sexual symptoms and volatile mood symptoms.

“Because these symptom groups have not been typically associated with the menopausal transition, they may represent inexplicable and unfamiliar feelings and responses for which women lack an explanatory model and thus use the phrase, ‘I’m not feeling like myself,’” the researchers wrote.

The latest survey data build on earlier work conducted by Coslov and colleagues that found women in the late reproductive stage experience symptoms strikingly similar to those often associated with the menopausal transition.

Healio spoke with Coslov about the use of the phrase “not feeling like myself,” the symptoms women report while still having regular menstrual cycles, and the importance of educating clinicians and patients about the late reproductive phase. The latest data from the Women Living Better survey were recently published in Menopause.

Healio: Why center a survey question on the phrase “not feeling like myself”?

Coslov: “Not feeling like myself” was one element in a much bigger survey that we conducted in 2020. This is the seventh paper coming from that survey. “Not feeling like myself” is a phrase I had heard through talking to many people. Women Living Better, which launched in 2018, serves as a repository of people’s experiences through submissions to the website, and that is where a lot of the questions that comprised this survey came from. We tried to use women’s words to describe their symptoms.

I had used the phrase myself early in perimenopause. I remember going for a walk with a friend and saying, “I just don’t feel like myself and I don’t’ know what is going on.”

When we were designing the survey, co-author Marcie K. Richardson, MD, said, “I hear that all the time. It is vague and it is difficult to know what it means.” We discussed how it is much easier during a time-pressed appointment to focus on more straightforward symptoms typically associated with menopause, such as, “Do you have hot flashes? Do you have vaginal dryness?” “Not feeling like myself” is nonspecific. So, we decided to put the question out there.

In this piece of research, we used two different statistical approaches to determine what bothersome symptoms were associated with this phrase. The way we asked the question was, “What percent of the time over the last 3 months have you not felt like yourself?” Approximately 63.3% of women reported not feeling like themselves 50% of the time or more. That is a lot.

Healio: Did the number of women who reported not feeling like themselves surprise you?

Coslov: It did a little bit. With this work, we are trying to normalize and validate experiences for women. The hope is that when many women understand that most of these symptoms are part of the perimenopausal period of fluctuating hormones and that it is not a permanent state, they will feel less worried or scared. That is not to say that anyone should suffer — when symptoms are disrupting daily activities, seeking medical care can help. But for most women, knowing that these experiences of mood and sleep changes or just feeling “off” are normal can go a long way. That plays into not feeling like myself: Not having an explanatory model for what is happening.

Our research was cross-sectional, it was one point in time, but we had a lot of participants. They were a convenience sample, recruited through email and on social media, who were willing to take a survey about their midlife experience. When we set out to establish what symptoms were correlated, I did not know what would come up. Mood is strikingly associated. So are fatigue and brain fog symptoms. I would have felt so much better if someone had been able to tell me that that these things are commonly associated with perimenopause.

Healio: What does Women Living Better hope to do with these data?

Coslov: We want to normalize and validate what people are experiencing. We had a poster at The Menopause Society Annual Meeting in September about these data, and so many providers came up and said, “I hear this all the time.” Now, they can reference this study. They can follow up with specifics when they hear, “I’m just not feeling like myself.” We hope it will allow patients and providers to feel more connected and help start conversations about mood changes or brain fog. Ultimately, I hope it leads to more successful and satisfying health care interactions for both parties.

Healio: What are your plans going forward, beyond this latest survey data?

Coslov: To me, mood is the most under-researched and most misunderstood area on the path to menopause and we hope to do more here. Just like in our early work, we would focus on to what degree experiences with mood changes are happening before noticeable, significant menstrual cycles changes vs. after.

Once you say, “Oh, I’ve skipped a period” or, “I’ve had 60 days between periods,” most providers will recognize perimenopause. But for many women, these subtle [hormonal] changes begin before significant menstrual cycle changes. That is when it is most surprising, concerning — unexpected. That is when most health care providers do not identify and validate, and cannot validate, that this is the beginning of the path to menopause.

According to STRAW+10 criteria, the beginning of the menopausal transition is defined as two times where consecutive cycle lengths differ by 7 days or more. The problem is that many people experience the impact of fluctuating hormones before that. That is why I use this broader phrase: the path to menopause. A focus on the late reproductive stage, the official term of what comes before perimenopause as defined by STRAW, has been a major focus of Women Living Better’s effort and research.

We also hope to reach out to more women aged 38 to 42 years. In terms of timing, that age range is the holy grail. Those women need to know what might be coming and that it is generally normal.

References:

• Coslov N, et al. Menopause. 2024;doi:10.1097/GME.0000000000002339.
• Harlow SD, et al. Climacteric. 2012;doi:10.3109/13697137.2011.650656.
• Women Living Better. Available at: https://womenlivingbetter.org/. Accessed April 23, 2024.

For more information:

Nina Coslov, MBA, can be reached at nina@womenlivingbetter.org; X (Twitter): @womenlivingbetr.