When Jess Beattie was prescribed hormone replacement therapy by her GP in January 2025, she thought it would change her life after months of feeling exhausted and like her brain wasn’t functioning properly. But three months later, she found herself sitting on the bathroom floor at two o’clock in the morning, sobbing so hard she could barely breathe. “My husband was crouched beside me, asking whether he should call someone. I remember looking at him and saying: ‘I think I’m going mad.’”
Beattie hadn’t slept properly in days, as anxious thoughts were keeping her up at night. Her breasts were swollen and so tender that she wouldn’t even allow her husband to hug her anymore, and her periods had become painful and heavy.
The mood swings were what scared Beattie the most: “One minute I’d be crying uncontrollably; the next I’d be incandescent with rage over something as ridiculous as an unemptied dishwasher. Sometimes, my husband looked genuinely frightened by my outbursts.”
Just before Beattie turned 45, she’d gone to her doctor believing she had some kind of early dementia. The project manager from West Yorkshire says: “During an important work meeting, somebody asked me a straightforward question about a project I’d been working on for months. My mind went completely blank. I knew the answer, but I couldn’t reach it. At home, I’d put my phone down and immediately forget where it was. I’d walk into the kitchen and have no idea why I was there. My dad had dementia, and I was convinced I had it too.”
It wasn’t just a foggy brain that was affecting Beattie’s life. She was tired every morning, not just like she’d had a bad night’s sleep, but a bone-aching exhaustion that no amount of caffeine could help with. She figured her tiredness came from having a busy job she found it hard to switch off from, and while she didn’t have kids, she was responsible for caring for her elderly parents.
She found it increasingly difficult to concentrate, and her colleagues had commented on it, which made her embarrassed: “I always prided myself on being on the ball with work, but when other people started to notice I was a bit ‘off’ I thought I should get it checked out.”
Beattie hadn’t considered the issue could be hormonal until her male GP brought it up. “He told me ‘You have the classic symptoms of perimenopause,’ and suggested I start on hormone replacement therapy to see if that makes things better.”
Beattie was relieved to have an answer, even if not all of the symptoms seemed to fit. For one, her periods were still regular, and she had no hot sweats but reasoned that not every woman would experience all of the symptoms at once. “When HRT was offered, I didn’t hesitate. Lots of friends had great experiences on HRT. I remember collecting the prescription and thinking: In a few weeks I’ll be me again.”
Initially, nothing dramatic happened after starting the medication, which combined the hormone progesterone as well as oestrogen. “Then my breasts became incredibly tender, even taking off my bra was sore. I also felt permanently bloated. I’d look at myself in the mirror and hardly recognise my body. Then came the headaches, which were crushing. I remember sitting at my desk one afternoon with the blinds closed because the light was making my head throb.”
Beattie could have tolerated the physical symptoms if she’d felt emotionally well, but her mood seemed to fall off a cliff: “Before HRT, I’d been stressed; this felt different. I’d wake in the early hours with adrenaline surging through me, convinced something awful was about to happen. I became frightened of my own thoughts.” And despite the side effects, her initial exhaustion and brain fog hadn’t improved.
After the night on the bathroom floor, Beattie made an appointment with her GP to see if she needed to alter her HRT dose. This time, she spoke to a female doctor, who was more interested in looking at the wider issues that might be affecting her. “She asked about family life, work and other stressors. I told her I found it difficult to switch off from work and spent the evenings answering emails and that I spent my holidays checking my phone. That I found small tasks overwhelming at times. That I worried about my parents’ health while ignoring my own.”
Then she asked a question Beattie didn’t expect: “When did you last feel properly rested?” Beattie couldn’t answer, explaining, “I just started crying. Because I couldn’t remember. It had been months, maybe years.“
For the first time, another possibility was raised – burnout. “The symptoms I’d first experienced were all there. If I had been a man and I had turned up to the GP with physical exhaustion, brain fog, lack of concentration, and feeling overwhelmed, hormones wouldn’t come into the equation. Instead, perimenopause was the assumption, because I was a ‘woman of a certain age.’”
Women’s health GP and founder of The Female Health Doctor clinic, Dr Nikki Ramskill explains the diagnostic process for diagnosing perimenopause: “NICE advises that in otherwise healthy women over 45, perimenopause can usually be diagnosed from menopause-associated symptoms, particularly things like hot flushes and irregular periods. Although women can develop troubling symptoms during the early menopausal transition while they are still menstruating, and some will initially have relatively regular cycles.”
However, Ramskill says if a woman has completely unchanged periods and presents with non-specific symptoms such as tiredness, poor sleep, low mood, anxiety, brain fog or difficulty concentrating without more characteristic features of the perimenopause, she would want to keep the differential diagnosis wide rather than automatically put everything down to hormones.
As she explains: “Those symptoms can also occur with stress, burnout, depression or anxiety, thyroid disease, iron deficiency, anaemia, vitamin deficiencies and sleep problems, amongst other conditions, so it would be fair to investigate further before prescribing HRT.”
Nothing dramatic or dangerous will necessarily happen immediately if someone is prescribed HRT but not perimenopausal, according to Ramskill, “but they are being exposed to a medication from which she may receive little or no benefit while still potentially experiencing its side effects and risks”.
Ramskill thinks greater awareness of perimenopause has been largely positive: “For decades, many women struggled with significant symptoms without recognising what was happening, and some found it very difficult to access appropriate treatment. We shouldn’t go back to telling women that everything is stress. But equally, we shouldn’t start assuming that everything is hormones. Good women’s healthcare requires us to consider both.”
On medical advice, Beattie stopped HRT. She was also signed off work for six weeks. “Coming off HRT didn’t magically cure me, because the original exhaustion was still there. The first morning I didn’t have to log on to work, I slept until nearly midday. Then I woke up and cried because I felt guilty for sleeping in.”
Recovery from burnout took months. “I began seeing a therapist to help me cope with my compulsion to overwork. I started going for walks every day without my phone, and stopped answering work messages in the evening. Slowly, I started to feel better.”
Beattie is clear that she doesn’t want to demonise HRT. “For women who need it and can take it, it can be really helpful. But in my case, we’d been trying to treat the wrong problem.”
As Beattie says: “Sometimes the question shouldn’t only be, ‘What’s happening with your hormones?’ It should also be, ‘What’s happening in your life?’ My body had been warning me for months that I wasn’t coping, and I hope that more GPs will consider the bigger picture before assuming that every problem a woman experiences in her 40s must be hormonal.”
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