The Symptoms That Were Never in Your Head

The Appointment You Left Doubting Yourself

You did the sensible thing. Something had shifted, the sleep that would not come, the anxiety that arrived without a reason, the rage that frightened you, the fog that made your own name feel far away, a body that had started to feel like someone else’s, and so you made the appointment, and you went. You tried to find the words for a set of symptoms that are hard to describe, and you hoped to be met. And then, in one sentence or two, it was over. It is probably just stress. You are a bit young for that. Your bloodwork came back normal. Try to get more exercise, and come back if it gets worse. You nodded, and you thanked them, and you walked out to your car, and somewhere between the waiting room and the parking lot a quieter and more corrosive thought arrived: maybe it really is all in my head.

If that is the thought you have been carrying, this piece was written for you, and it begins with a single sentence you may not have heard said plainly. Your symptoms were never in your head. The experience was real when you walked in, and it is real now, and the fact that it was waved away in a seven-minute appointment is not evidence that you imagined it. It is, far more often, evidence of something the research has measured directly: that perimenopause is one of the least understood passages in all of medicine, that most clinicians were barely trained in it, and that women’s symptoms have long been the first to be filed under stress and nerves. Being dismissed is not a verdict on your sanity. It is a very common experience, and understanding why it happens can give you back something the appointment took.

What follows is not a reason to distrust medicine or to stop seeking care, and it is the opposite of a suggestion that you treat yourself. Good medical care matters enormously here, and part of the point of this piece is to help you go back and get it. What follows is three things: what the studies actually show about why perimenopause gets missed and dismissed, what a woman who has spent more than two decades helping other women come back to trusting their own bodies has to say about that particular self-doubt, and a gentle practice for steadying yourself and finding your voice before the next appointment. None of it is medical advice. All of it is on your side.

What the Research Actually Shows

Start with the most quietly staggering finding, because it reframes everything. When researchers surveyed postgraduate medical residents, the doctors in family medicine, internal medicine, and even obstetrics and gynecology who are being trained to care for you, and asked how prepared they felt to manage women going through menopause, only 6.8 percent, fewer than one in fourteen, said they felt adequately prepared (Kling et al., 2019). Read that again slowly. The problem the number describes is not that your symptoms were too vague or too small. It is that the person across the desk was very likely never taught this. The gap is in the training, not in you.

The second finding explains the particular shape so many of these dismissals take. In a careful review of how gender operates in health care, researchers found a long-documented pattern: women’s physical symptoms are more readily attributed to emotional or psychological causes, women are more often described as complaining and their accounts treated as less credible, and the same symptoms that earn a man a test can earn a woman a referral for her nerves (Samulowitz et al., 2018). When a doctor reaches for just stress before reaching for a real workup, that reflex did not begin with you. It is a bias with a research literature of its own, and knowing that it exists is the first step in refusing to swallow it.

The third finding points the way back, and it is a hopeful one. Being dismissed does something beyond the practical harm of a missed diagnosis: it teaches a woman to distrust her own body, to second-guess the very signals that were trying to tell her something true. Researchers who study interoception, the body’s felt sense of itself, have shown that the ability to notice, stay with, and accurately read your own inner sensations is not a fixed trait but a skill that can be deliberately rebuilt, and that strengthening it supports emotional steadiness and a restored trust in one’s own experience (Price & Hooven, 2018). The connection to your own body that a dismissive appointment frays can, with gentle attention, be grown back.

What Perukua Says About Trusting the Body

Long before the current conversation about menopause and medical bias, women were arriving in Perukua’s rooms carrying exactly this wound: not only the symptoms themselves, but the quieter injury of having been made to feel that they were making it up. A vocalist and women’s facilitator whose practice-based work has reached women in more than 63 countries across more than two decades, she is an artist and a facilitator, not a doctor or a therapist, and nothing she teaches is a diagnosis or a treatment or a reason to change what a doctor has advised. But on the human experience of a woman learning to trust her own body again, she has watched closely, and for a long time.

She names the wound before she names the way out. A woman, she observes, is so often “made to feel wrong for the way she feels,” as if she is wrapped in a kind of cotton-wool ball that muffles her own truth from the inside (translated from Russian). That is a precise description of what a dismissal leaves behind, the sense that your own clear experience has been fogged over, that perhaps you are overreacting, perhaps it is nothing. And against it she sets a conviction she returns to again and again, drawn not from a clinic but from a lifetime of close attention to women and to herself: “the body and the emotions are always sincere. They never lie” (translated from Russian).

The whole of her teaching, in a sense, rests on that line, and on what follows from it. “If you learn to listen to them,” she says of the body and its feelings, “you understand what is really happening, and not only in your head, but in real life” (translated from Russian). It is a striking phrase to find here, because it answers the exact accusation the dismissed woman turns on herself. Not only in your head. The body is not inventing the symptom; it is reporting one. Perukua reports that a great deal of her work is simply helping women come back to feeling, accepting, and trusting their own inner knowing more quickly than she once could, because for her, she says, there were no guides, and the road was long.

What she offers in place of self-doubt is not defiance but a kind of rootedness, and she describes it almost as a stance you can take in the body. In her vocal work she speaks of helping a woman become rooted enough to say, and mean, “I’m in my body. I trust my body, my voice. I’m confident” (from her English teaching). Her whole approach, she explains, is “pro-trust, pro-intuition, pro your knowing and understanding about who you are” (from her English teaching). That is the ground a woman stands on when she walks back into a doctor’s office, not to argue, but to be heard: not I might be imagining this, but I know my body, and something has changed, and I need you to look properly.

Why the Dismissal Happens, and Why It Is Not a Verdict on You

Put the research and her decades of watching side by side, and the reason these appointments go the way they do comes into focus, and the focus is clarifying rather than defeating. Perimenopause is genuinely hard to see from the outside. The hormones that drive it do not decline in a tidy line; they swing, sometimes wildly, from one week to the next, which is why a single blood test drawn on a single day can land in the normal range and still miss a body in upheaval. A lab result that reads normal is a snapshot of one morning, not a verdict on your experience, and a great many perimenopausal women are told their numbers look fine precisely because the thing that is wrong does not sit still long enough to be caught by one measurement.

Lay the training gap over that, and the picture is complete. If most clinicians were barely taught to recognize this passage (Kling et al., 2019), and if the older reflex to read a woman’s distress as emotional rather than physical is still alive in the room (Samulowitz et al., 2018), then a dismissal is not information about whether your symptoms are real. It is information about a blind spot in the system you happened to walk into. The experience is real. The signal is real. What failed was the receiver, not the broadcast.

Here is the boundary that matters most, and it cuts both ways. Understanding why you were dismissed is not a reason to turn away from medical care; it is a reason to go back and insist on better. Perimenopause can be evaluated and, where appropriate, treated, and real relief is possible, but that is the territory of a qualified clinician, and ideally one who knows this stage well, a menopause-literate or certified specialist. Any question about hormone therapy or medication belongs entirely with such a doctor, never with an article and never with a practice like the one below. What the practice can do is something medicine does not quite address: steady you, return you to your own body, and help you walk back in able to say clearly what you need. And if your symptoms are severe, if you feel hopeless, or if you ever have thoughts of harming yourself, that is not a perimenopause footnote; please treat it as urgent and reach for a doctor or a mental health professional straight away.

A Practice: Coming Back to the Body You Were Taught to Doubt

This practice has two aims, and they belong together. The first is to rebuild, in small and steady doses, the trust in your own body that the dismissal shook. The second is to gather that steadiness into a clear voice for the next appointment, so that you go back not pleading but grounded. It takes only a few minutes, and you are not doing it to prove anything. You are doing it to come home to the one person who has been reporting the truth all along, which is you.

First, land in the body and let it speak. Sit somewhere quiet, rest your right hand over the center of your chest and your left hand low on your belly, and take a few slow breaths down into the lower hand so that it is gently pushed forward on each in-breath. Then, instead of narrating or judging, simply ask the body what it has been trying to tell you, and listen the way you would to someone you believe. Where is the tiredness sitting. What does the anxiety feel like, exactly, and when does it come. This is the skill the interoception research describes, the trainable art of noticing and trusting your own sensations, and every minute of it is a small repair of the trust that was frayed.

Second, write down what you heard, plainly. Keep a short note, on paper or your phone, of the symptoms as they actually are: what they are, when they started, how often they come, how they touch your sleep, your work, your moods, your days. You are not building a case to win an argument. You are refusing to let your own experience be fogged over, and you are giving the next clinician something concrete and specific to work with, which is far harder to wave away than a few hurried sentences in a seven-minute visit.

Third, practise your voice out loud. This is Perukua’s own ground, that the voice carries what the body knows. Before the appointment, say your sentences aloud, once or twice, in the car or the kitchen, until they come out steady: I know my body, and these specific things have changed, and I would like them properly looked into. If you can, add the ask that so often changes the room: I would like to see someone who specialises in menopause, or I would like a second opinion. Hearing your own voice say it calmly, in advance, makes it far easier to say it when it counts.

Finally, close with a hand on your heart. Rest a warm palm over the center of your chest, feel it rise and fall for a breath or two, and give yourself the one message this whole piece comes down to, the kind Perukua gives: my body is not lying to me, it never was, and I am allowed to trust it and to be heard. That is all. You are not diagnosing yourself and you are not turning away from care. You are standing back up inside your own experience, so that the next time someone reaches too quickly for just stress, you already know better.

In Closing

So if you left that appointment doubting yourself, let this be the thing you were not told: the doubt was never warranted. Your body was not lying, and it is not lying now. Being dismissed is a common experience with documented causes, a passage most clinicians were barely taught and an old habit of reading women’s symptoms as nerves, and neither of those is a measure of what is real in you. Keep seeking care, and seek it from someone who knows this stage; bring your specifics, ask for what you need, and do not let a single normal lab or a hurried sentence talk you out of your own experience. And alongside that, come gently back to the body you were taught to distrust. Rest a hand on your heart. Breathe low and slow. Listen to what it has been telling you all along, and believe it. The symptoms were never in your head, and you were never the problem to be managed. You are a woman who knows her own body, learning, once again, to say so out loud.

This piece is general information about wellbeing, not medical or psychological advice, and Perukua is an artist and facilitator, not a doctor or therapist. Nothing here is a diagnosis, a treatment, or a reason to delay or avoid medical care; perimenopause can be evaluated and, where appropriate, treated, and any decision about hormone therapy or medication belongs with a qualified clinician, ideally one who specialises in menopause. The practices described here are gentle, non-clinical self-care meant only to steady and support you, never a substitute for professional care. If your symptoms are severe, if you feel hopeless, or if you have any thoughts of harming yourself, please contact your doctor or a mental health professional right away.

References & Quote Sources

Do you have any questions? Contact me now

Should you have any questions, please contact me via messengers below. I'll reply you shortly.

• Text me on Telegram
• Text me on WhatsApp