Dr. Sugata Duygu Akartuna
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Perimenopause: Each of Us Is Unique

Dr. Sugata Duygu Akartuna16 October 20269 min readTürkçe oku →

Perimenopause has shown me something very clearly, once again: each of us is unique. The process each of us goes through is our own.

So I have come to realize that recommendations built on averages, such as “this dose, this lab range, this much exercise,” can make it harder to see our own experience when they are applied rigidly.

Of course, science guides us. But how fair is it to assume that the average results of scientific studies can explain every individual’s experience? After all, none of us is just a statistical average.

A visit to the doctor

On the third day of my period, I went to the hospital to see a gynecologist and have my estrogen level measured. But the doctor firmly refused to order the test.

I told her that I had stopped the mini pill, my antidepressant and my sleeping pills, and that I wanted to follow the changes in my hormones. (I stopped these medications gradually, in consultation with my physician. I would not advise anyone to stop their medication on their own.) The doctor’s reason was that I had already had these tests in January.

Then she asked me two questions:

“Do you have night sweats? Are you still getting your period?”

“I get night sweats before my period. Yes, I am still getting my period. But I am not sleeping well.”

“Well then, you’re fine. See a psychiatrist about your sleep.”

I was stunned.

After a long discussion, her assistant ordered the test.

Yet it was through exactly this kind of process that I had started taking an antidepressant two years earlier.

The research I am reading now shows how strongly hormonal changes can affect sleep, anxiety and mood. That is why I believe what I went through was not only psychological, and that hormonal changes may have played an important role.

What is more, hormonal changes and psychological symptoms are not completely separate processes. They can influence each other. Medications, stopping medications, sleep patterns and other health problems can also contribute to the picture.

In fact, on 15 October 2026 the American College of Obstetricians and Gynecologists (ACOG) published its new guideline on managing menopause symptoms. The guideline addresses sleep problems caused by night sweats as a separate issue and strongly recommends hormone therapy for them. It also emphasizes that hot flushes, sleep and mood symptoms influence one another, and that this relationship varies from person to person.

Shouldn’t all of this be considered together?

What does a single measurement tell us?

At the time, I could not see which tests the doctor had ordered. When the results came in, I realized that only estradiol had been measured.

So what was a single estradiol value going to tell me?

Of course, it can answer a specific clinical question. But in a phase like perimenopause, when hormones fluctuate constantly, how can a single measurement capture the whole of what I am going through?

Current guidelines may, to some extent, support the doctors’ reluctance to test. The UK’s NICE guideline and the European Society of Endocrinology’s 2025 guideline recommend that in healthy women over 45, the diagnosis should usually be based on symptoms and menstrual patterns rather than hormone tests. However, the European guideline also notes that additional tests may be needed when a woman’s history points to another cause. That was exactly my situation: I had just stopped medications that affect my hormones, and I have a diagnosis of scleroderma.

What hurt me was not only that no test was done, but that everything I described was brushed aside with two questions.

How could I not question this approach?

There are women waiting there, one after another. Perhaps their symptoms are much more severe than mine. Perhaps they are trying to understand what is happening to them. Or perhaps they have grown used to hearing, for years, that the changes they experience are just stress, aging or psychological problems.

Being treated this way is very painful. Especially when what new research is revealing is not sufficiently reflected in the consulting room…

Research on which women should be tested, and when, is still insufficient. And no guideline recommends routine hormone testing for women without symptoms. That is why I personally recommend having your hormone levels measured from your 30s onward. That way we at least have some data, and later assessments become more concrete.

But what I am really questioning is not the tests. It is the way a woman’s symptoms, history and medications are brushed aside with a few questions, without being properly considered.

Explaining why a test is not needed is one thing. Giving the impression that what a person is going through is not worth looking into is quite another.

That is why I am here: to talk about my own process and about what is happening in the world of science right now.

Why does our hormonal health matter?

Hormones are not only about sexuality and reproduction. They play a role in many areas of our lives, from how we think to how we regulate emotions, from muscle and bone health to physical activity, from sleep to our social relationships.

So evaluating hormonal health only in terms of the menstrual cycle, fertility or hot flashes seems insufficient to me.

For example, we now know that progesterone is not just a hormone needed for pregnancy. It interacts with various receptors in the brain and can be converted into a neurosteroid called allopregnanolone. This substance affects the functioning of GABA-A receptors, one of the nervous system’s main inhibitory mechanisms.

This mechanism may explain why progesterone can be associated with better sleep and calm in some women. In a study conducted in Canada, women who took progesterone at night reported sleeping better. However, ACOG’s 2026 guideline does not support using progesterone alone to treat hot flushes, sleep or mood symptoms. So this finding is not a treatment recommendation that applies to everyone.

What is more, progesterone does not have the same effect on everyone.

In some women, changes in progesterone and its metabolites can be associated with anxiety, irritability or low mood. Research shows that even women with normal hormone levels can respond differently to hormonal fluctuations.

So the question is not only how high or low a hormone is, but how our body and brain respond to these changes.

A comprehensive review published in 2025 in Frontiers in Neuroendocrinology examines the relationship between progesterone and the brain, stress, mood and cognitive function. The researchers emphasize that the effects of progesterone can vary with the type of hormone used, its dose, route of administration, metabolism and individual sensitivity.

Yet the same researchers also note that many of these effects have not yet been studied sufficiently in humans.

And this is one of the things I value most in science: being aware not only of what we know, but also of what we do not yet know.

So what can we do?

Just as it matters to notice the early signs of an illness and follow them up when needed, I believe the changes we experience during the hormonal transition should also be taken seriously.

Of course, perimenopause is not a disease. But the fact that it is a natural process does not mean our symptoms are unimportant.

Besides, not every symptom is caused by hormones. Thyroid disease, iron deficiency, sleep disorders, medications or other health problems can cause similar symptoms.

That is why, rather than tracking hormone levels alone, it is important to also observe our menstrual cycle, sleep quality, mood, pain and changes in our daily lives.

When needed, it is possible to make use of appropriate tests, investigate other possible causes and consider treatment options.

But the first step in all of this is listening to women.

Because the fact that a woman still has her period does not mean she feels well.

Illustration of a woman in thought over an open notebook, pen in hand, beneath a flowering branch with a bird

In this process, I am trying to understand my own body better. I read research, I ask questions, and when necessary I question the explanations I am given.

I do not reject the averages of science. But I do not want my own experience to get lost among those averages either.

Perhaps then, on this up and down hormonal journey, we will not have to wait until we feel we have hit a wall before we try to understand what is happening.

Each of us is unique. Our approach to our health should take that difference into account.

Which test, and when?

This information is for general guidance only. Decide together with your doctor which tests you need.

  • Estradiol (E2): Usually measured between days 2 and 5 of the menstrual cycle, most often on day 3. It is especially evaluated together with FSH.
  • Progesterone: Often recommended on day 21 of the cycle. But this only applies to a 28-day cycle with ovulation around day 14. A more accurate time is about seven days before the expected next period.
  • Total testosterone: Preferably measured in the morning, and if possible in the early follicular phase of the cycle (days 2 to 5).
  • DHEA-S: Does not need to be measured on a specific cycle day. Because it is more stable than DHEA, DHEA-S is usually preferred in clinical practice.
  • SHBG (Sex Hormone Binding Globulin): Not tied to a specific cycle day. Measuring it together with testosterone helps calculate free testosterone.
  • FSH (Follicle Stimulating Hormone): When needed, evaluated together with estradiol on days 2 to 5 of the cycle.
  • LH (Luteinizing Hormone): Usually measured on days 2 to 5 of the cycle. However, it is not routinely needed to diagnose perimenopause.

Note: Because cycles become irregular in perimenopause, it also becomes harder to work out timings such as “day 3” or “seven days before the next period.” This shows once again why a single measurement may not be enough.

References

Note: Research on perimenopause and menopause has gained momentum in recent years, so the information keeps being updated. I may therefore add new material to my posts from time to time. Last updated: 17 October 2026.

Note: This text shares my personal experience and what I have learned from scientific research; it is not individual medical advice.

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