Migraine Mode + Midlife: My Perimenopause Plot Twist

This isn’t the blog I thought I’d be writing this spring. I thought I was just overworked, maybe tired, maybe catching a bug. I never even heard of perimenopause. But here I am—living it, with chronic migraines, missed workdays, and a growing list of symptoms I didn’t know were connected.

And the more I learn, the more I realize… I’m not the only one.

Perimenopause Isn’t Just Hot Flashes

You hear “perimenopause” and think: maybe some night sweats or mood swings. What you don’t think of? Blinding, knock-you-off-your-feet migraines. But for me, they’ve been relentless. Days where I can’t teach, can’t work, can’t even text without squinting.

After months of dealing with this, I’ve been learning everything I can about perimenopause symptoms, and wow—there’s a lot no one tells us. The PBS documentary “The M Factor” dives deep into how under-informed and under-supported women are in this phase. I felt seen, angry, and honestly a little relieved watching it.

By the Numbers: Perimenopause and the Workplace

What I’ve experienced isn’t rare—it’s just rarely talked about. And it’s costing women a lot.

• Up to 80% of women in perimenopause experience symptoms that interfere with daily life, including sleep issues, brain fog, depression, and—you guessed it—migraines.
  
  
• A 2023 Mayo Clinic study found that menopause-related symptoms cost the U.S. economy an estimated $1.8 billion annually in lost workdays—and that number climbs to over $26 billion when factoring in health care costs, reduced productivity, and job turnover.
  
  
• In the UK, 1 in 10 women reported leaving their jobs due to perimenopausal or menopausal symptoms.
  
  
• Many women don’t seek help because they don’t realize what they’re going through is hormonal—not just “burnout” or “aging.”
  
  

I never once heard about this stage of life in school, in doctor’s offices, or even in fitness trainings. But here I am now, navigating it in real time and realizing just how many women are doing the same.

Getting Answers: Using All the Tools in the Box

I’ve been working with Dr. Jess from 4th Tree Health, a local direct primary care doctor who’s helped me look at the full picture of what’s going on in my body. I’ve also been working with Dr. Case Troutman from Weight ReMdy, and just this past week we discovered what may be a major piece of the puzzle: the synthetic progesterone I was prescribed—norethindrone acetate—could be a key trigger for my migraines.

Dr. Troutman explained it might take 2 days, 2 weeks, or 2 months to see change once it's out of my system, but this is the first real lead we’ve had in months. That hope alone is enough to keep me going.

I’m also circling back to another powerful tool in my health journey: Deb Malkin, my former Pain Coach, who helps women reconnect with their bodies through trauma-informed nervous system healing. Her support has reminded me that chronic pain isn’t just a symptom—it’s communication.

And the latest book on my nightstand? Mind Your Body by Nicole Sachs, LCSW—a must-read. Nicole’s story and her science-backed framework rooted in TMS (Tension Myositis Syndrome) explain how the brain and body store emotional pain, often resulting in very real, physical symptoms. Her work has helped thousands of people rewire their pain pathways by addressing the emotional root of chronic conditions.

Personally, it’s helped me start to rework and rewire my brain, too. I’m still in the process of connecting the dots, but using Nicole’s daily JournalSpeak practice has become a powerful part of my healing toolbox. If you’re on a pelvic pain journey or navigating symptoms that seem to have no clear medical cause, this might just be the missing key you’ve been looking for.

You can also hear more from Nicole on her podcast, The Cure for Chronic Pain—it’s compassionate, informative, and so validating for anyone walking through invisible pain.

What It’s Looked Like Lately

🧠 Canceling more sessions than I care to admit
📵 Barely able to scroll, let alone post
🐶 Letting my dogs take the lead on emotional support
💤 Learning to rest for real, not just collapse

This has not been business as usual. But I’m still here, and I’m still doing the work—just a little differently right now.

What’s Next

Even though the migraines haven’t let up yet, I’m cautiously optimistic. May is my soft goal to reopen to new clients, refresh my class schedule, and get back to posting, sharing, and teaching.

The comeback may be slower than I’d like, but it’s coming.

Let’s Keep Talking

If you’re not already following Dr. Kelly Casperson, MD, go now. She’s changing the game on how we talk about hormones, pelvic health, sex, and perimenopause. She’ll make you laugh and teach you more in a 60-second reel than most doctors do in a 20-minute appointment.

You’re Not Alone

Whether you’re dealing with migraines, mystery symptoms, or just waking up in a body that feels totally new—I see you. We don’t need to stay quiet or suffer alone. This chapter is hard, but we’re not powerless.

May your coffee and your pelvic floor be strong today,
–Paula