Real lives.
Real bodies.
Real voices.

I had submitted an e-referral to speak with my GP. The person who prescribed my medication. The person with whom I had a pre-existing arrangement to reconvene once the first course of HRT was finished. A plan. A specific, documented, mutually agreed plan involving two people who had previously met and discussed my medical history at length.

A different person called.

He was very helpful. Asked all the relevant questions.

I said my sleep had improved immensely. That my mood was partially better. That I had experienced a single episode of nausea on the first night of progesterone that had not recurred. That there were no hot flushes, no vaginal dryness, no cause for concern.

He confirmed the repeat prescription would be on the app within twenty-four hours. He mentioned that there would be a follow-up e-consultation in three months to review symptoms and bleeding pattern. A built-in review. Already scheduled. Already documented. Three months away.

We hung up.

Fifteen minutes later he called back, because something had occurred to him. About my progesterone. He felt I should stop taking it daily and instead take a higher dose on the last twelve days of my cycle. This would, he said, be better.

I asked why.

It would be better this way.

I asked why again.

My cycle might change. I was still having periods. The last twelve days made more sense.

I see.

I pointed out that I was on HRT. That I am in possession of a uterus, a cervix, and the full supporting cast of relevant anatomy. That oestrogen without progesterone, in a person whose uterus remains very much on the premises, does not simply go about its business quietly and with good manners. It builds. The uterine lining thickens, unchecked, without opposition. This is not a footnote. This is not a lifestyle consideration. This is the reason progesterone exists in this prescription. It is not decorative. It is not optional. It is the thing standing between me and a significantly more serious conversation.

I also pointed out the practical reality of what he was proposing. I was currently taking progesterone. He was recommending I stop, wait for my next cycle, and begin the new regimen on day fifteen. Depending on when my period arrived and how long it lasted, this would mean approximately twenty days without progesterone. Twenty days of unopposed oestrogen, in a person on HRT, with an intact uterus, because my cycle might, at some unspecified point in the future, change.

He said it would be fine.

I would like to pause here and give that the attention it deserves.

He called me — voluntarily, fifteen minutes after we had already spoken, of his own initiative — to recommend that I stop taking the medication that makes my HRT safe. When I explained, clearly and in clinical terms, exactly why that was not a thing I was prepared to do, his medical assessment was that it would be fine.

It would be fine.

A brief observation. I am a woman. The person on the phone was a man. I note this not as a digression but as context for everything that follows.

I asked, out of curiosity, when I should start the new prescription. He said the last twelve days of my cycle. I asked when that was. He said to count back twelve days from my period. I asked for a specific date. Four times. He did not have one. So I did it myself. Out loud. On the phone. In real time. For him.

Next period. Days to finish. Twelve days after that. Two weeks of progesterone. At the end of which, per my calculations — conducted without assistance, on a phone call I did not request — my following period would have already started. The protocol he had telephoned me to recommend would conclude inside my next menstrual cycle. I presented this finding.

I also mentioned, in passing, that I had a general sense of when my period was due.

He told me I couldn't know that.

I have had a uterus for going on five decades. I have been recording my cycle dates for over twenty-five years. Over twenty-five years of data, logged, tracked, a Swiss clock of biological punctuality that has never once required a man to interpret it on my behalf. I told him I was, in fact, moderately confident on this point.

He said my cycle might change anyway. Not the current one, which had not yet finished. Not the next one, which had not yet started. The one after that. He was dismantling a functioning prescription on the basis of a hypothetical change located two full cycles in the future, while informing me in the same conversation that my knowledge of my own body was not to be trusted.

I declined. I asked to speak to my GP. She wasn't in. I said I would call Monday.

Afterwards I opened my NHS app to retrieve his name, as I was already composing the formal complaint in my head.

I found the consultation note. I found the name. And next to it, the title.

Mr.

Not Dr. Mr. Every other clinician in that record is a Dr. He is a Mr — a senior pharmacist, as the practice website makes clear. A senior pharmacist called me back, uninvited, to recommend I stop taking the medication that makes my HRT safe, could not produce a start date for his own proposed prescription, informed me that my twenty-five years of cycle data were not a reliable source, and documented me as confused when I asked him to justify it.

He seemed surprised I wasn't more grateful.

I had to leave dinner tonight. Just... got up and left while everyone else was still waiting for food that never came.

We'd been at the museum all afternoon — lovely, actually. Then dinner at 8pm. Pre-ordered everything because it was a big group. Should have been simple.

By 9pm, I could feel it starting. That familiar tightness in my chest. The way my hands start to feel shaky. Brain going fuzzy around the edges.

By 9:30, I was holding on. Trying to stay present in conversation while my body was screaming. That specific rage that builds when your blood sugar crashes — not anger at anything, just this wild, primal fury that makes you want to flip the table.

10pm. Still no food. I had to leave.

I mumbled something, grabbed my bag, and walked out. Got on the bus home with my hands trembling and my vision going a bit sparkly at the edges.

Here's what no one saw:

• They saw someone leaving early. Maybe rude. Maybe impatient.
• They didn't see that my body literally cannot regulate itself anymore.
• They didn't see that what used to be "I'm hungry and a bit cranky" at 30 is now "my entire nervous system is in fight-or-flight mode" at 46.
• They didn't see me on the bus, alone, trying not to cry from sheer physical overwhelm.

Here's what perimenopause doesn't tell you:

Your basic needs become emergencies. Skipping a meal isn't "oh well, I'll eat later." It's your cortisol spiking, your hands shaking, your brain fogging, your rage building until you want to scream at everyone and nothing all at once.

And the worst part? You can't explain it without sounding dramatic.

"I had to leave because I hadn't eaten" sounds like nothing. It sounds like a choice. It sounds manageable.

But "my fluctuating hormones mean my body can't regulate blood sugar properly anymore, so going 6 hours without food sent me into a physical crisis that would have resulted in either a panic attack or saying something I'd regret" — that sounds insane. Even though it's the truth.

The aftermath:

Got home. Too late to eat, according to every rule I've ever learned about healthy eating.

Ate anyway. Mixed nuts. Because the alternative was going to bed in crisis mode and guaranteeing I wouldn't sleep.

Couldn't take my supplements because I'd eaten. Another small failure to add to the pile.

Lay in bed, wired and exhausted at the same time. Cortisol still pumping through my system. Fell asleep sometime after 2am.

Woke up at 5:30. Headache. Exhausted. Emotionally raw. Body still recovering from yesterday's emergency.

What I sent to the group chat:

A cheerful, apologetic message about having a health condition that requires regular meals. Mentioned the museum was lovely. Added an emoji.

Made it sound manageable. Made it sound like a quirk.

Didn't say: "The restaurant's incompetence put my body into crisis mode and I'm still paying for it 12 hours later."

This is perimenopause:

Your needs become invisible emergencies. The world isn't set up for bodies that can't just "push through." And you spend half your energy managing the actual symptoms, and the other half managing other people's perceptions so you don't seem difficult, dramatic, or broken.

I'm not broken.

My body is just operating under different rules now. Rules that the world doesn't acknowledge. Rules that even I am still learning.

And I'm so tired of pretending it's all fine.

I was talking to a friend about perimenopause when she asked me if I'd seen the ads on the tube about "male hormones." She said they were everywhere in the tube stations.

"How come they don't do this for women?" she said. "What about PCOS, or endometriosis, or peri and menopause?"

She was right. The ads were everywhere.

Read that list again: irritability, tiredness, low sex drive, low mood, poor sleep, mental fog, depression.

These are the exact same symptoms women experience during perimenopause and menopause.

But when men have these symptoms, it's a medical crisis worthy of massive advertising campaigns across every tube station in London. Beach-running ads. Promises of feeling "healthier, happier, stronger."

When women have these symptoms, we're told:

• "It's just stress."
• "Have you tried yoga?"
• "You're depressed — here's an antidepressant."
• "It's just ageing."
• "Lose some weight."

We're dismissed. Gaslit. Not taken seriously.

The double standard is staggering. Men's hormonal health is validated, medicalised, and marketed to. Women's is invisible.

PCOS affects 1 in 10 women. Endometriosis takes an average of 7–10 years to diagnose. Perimenopause can start in your 30s and last a decade. These aren't rare conditions — they're affecting millions of women who are just expected to suffer quietly.

No tube station ads for us. No promises that we'll feel healthier, happier, stronger. Just silence.

"This is why Alinea exists. Because someone needs to talk about it. Because the silence is deafening. Because women deserve the same visibility, validation, and support."

We're not asking for special treatment. We're asking for the same treatment.

Three in four women don't know perimenopause can trigger a new psychiatric illness. That's not a knowledge gap — it's a systemic failure.

Last week, the Royal College of Psychiatrists published its first ever position statement on menopause and mental health. It shouldn't have taken this long. But here we are.

A YouGov poll commissioned by the RCPsych — representing over 20,000 psychiatrists — found that only 28% of women in the UK know that menopause can trigger a new mental illness. Meanwhile, 93% associate menopause with hot flushes. The awareness gap isn't just embarrassing. It has consequences.

These are not fringe statistics. Perimenopausal women are more than twice as likely to develop bipolar disorder, 30% more likely to develop clinical depression, and the risk of eating disorder relapse rises significantly during this hormonal transition. Suicide rates, the report notes, are higher among women of menopausal age.

For women with a history of postnatal depression or premenstrual mood symptoms, perimenopause isn't just a difficult chapter — according to the RCPsych's Dr Cath Durkin, it may represent "a period of particular clinical danger that has historically gone unrecognised."

"I was 35 when I first went to my doctor with symptoms I couldn't explain. For seven years, I was treated for depression while the real cause — perimenopause — went unidentified."
Sonja Rincón, founder of the Menotracker App, via The Guardian

The account published alongside the RCPsych report in The Guardian is the kind of story that should stop you. A woman, 35, presenting with crushing fatigue and low mood. Seven years of antidepressants — adjusted, increased, swapped out — while perimenopause went undiagnosed. "I lost confidence in my own body," she writes, "and even in my own judgment."

She is not an outlier. She is a pattern.

And the pattern is not distributed equally. A UCL study published concurrently found that 58% of Black women in the UK felt completely uninformed about menopause — and that many found the experience "psychologically damaging." More than half reported anxiety, yet significant numbers were misdiagnosed with anxiety or depression rather than perimenopause. As a result, barely one in five took HRT. The information gap compounds the access gap, and both are compounded by race.

The RCPsych is calling for mandatory menopause education in all medical and psychiatric training, workplace policies that address mental health alongside physical symptoms, and urgent government action across all UK nations. These are the right demands. They are also demands that shouldn't need to be made in 2026.

Dr Lade Smith, president of the RCPsych, put it plainly: "Women account for 51% of the population and all will experience menopause at some point. This is a societal issue for everyone. Simply put, we must do better."

At Alinea, we believe that information is the first form of care. That when a woman knows what is happening to her body — really knows, with language and data and other women's stories — she is less likely to spend seven years wondering what is wrong with her. She is more likely to walk into a GP's office and name it. She is less likely to leave without answers.

This report matters. Share it. And if any of it sounds familiar — the fatigue, the low mood, the sense that something has fundamentally shifted — you are not imagining it. You are not broken. You might just be in perimenopause.

Source: The Guardian, 1 March 2026 — Anna Bawden. Data: Royal College of Psychiatrists position statement on menopause and mental health; UCL study published in Post Reproductive Health.

Wednesday. 3:10pm. Or rather, 3:13pm. But who's counting.

I booked the appointment online. I was specific. I filled in the form the way you're supposed to — careful, considered, a woman who has done her research. I wrote that I wanted to speak to someone about perimenopause. About symptoms. About what happens next. I was not vague. I was not asking for miracles. I was asking for a conversation.

What I got was a general health check.

Which is fine. I needed one. I know I needed one. But I had also needed the other thing — the thing I asked for — and somewhere between me and the appointment system and the nurse's screen, that ask had simply ceased to exist. No one lost it deliberately. That's almost the worst part. It just dissolved. The system is not malicious. It is something more efficient than malicious: it is indifferent.

So. I sat in the waiting room at 3:13, noting the time the way I have started noting everything — because that is what you do when you've decided to bear witness to your own healthcare. I had my phone in my pocket, voice memo already running. A woman documenting the ordinary. The wait. The chair. The particular quality of NHS waiting room air, which is its own category of atmosphere.

The health check itself was thorough, as health checks go. Blood pressure — low, apparently. "Have you drunk enough water?" Yes. Not ten litres, but yes. Blood taken for cholesterol and sugar. Height measured. I have lost 1.5 centimetres. I have lost 1.5 centimetres and nobody in that room seemed to find this particularly interesting. I find it interesting. I find it interesting because I know what bone density loss looks like in the early stages, and I know what perimenopause does to it, and I know that a shrinking woman is not a trivial thing.

And then: the heart age calculation. The nurse looked at the screen. Then she looked at me. That small pause — the one where a healthcare professional is deciding how to frame something — is a sentence in itself. "Your heart age is 54." I am not 54. "Sometimes it's the data," she said. "Family history. And you're an ex-smoker." I vape now. I don't smoke. I don't drink. I eat well. I move my body daily. I do yoga. I am, by any lifestyle metric, doing the things. And yet: 54. The algorithm has spoken.

What nobody mentioned — what is perhaps worth knowing — is that cardiovascular risk tools were largely built on male data.

They've been updated, yes. They now include a field for sex. But the underlying architecture, the assumptions baked into the model, the populations whose data taught the algorithm what risk looks like: predominantly male. A single blood pressure reading on a perimenopausal woman, in a system that did not know she was there to talk about perimenopause, generating a heart age number that made the nurse raise an eyebrow. This is not an anomaly. This is how it works.

After, I went to the desk to book the follow-up — the appointment I'd actually come for. "Fill in the online triage form," the receptionist said. I looked at her. I said, with the particular patience of a woman who has been here before: no. That's how I ended up here without the appointment I needed in the first place. She booked me in. Next Wednesday. 9:20am.

I walked home with a recording in my pocket and 1.5 fewer centimetres than I arrived with. I have a heart age of 54, a blood pressure that apparently requires more water, and a body that is changing in ways the system keeps not quite having time for.

I am keeping notes.

A day I will look back on with the particular warmth reserved for experiences that did not kill me but made a reasonable attempt.

The appointment was at 9.20. I arrived at 9.10, operating under the quaint assumption that these two facts would prove relevant to one another. The young man at the front desk — handsome, vape in hand, emanating the energy of someone who has achieved a profound and enviable detachment from the concept of urgency — asked for my date of birth. Then my address. Then my date of birth again, in case biology had intervened since the first time. He could not find me. The NHS, in what I can only assume was an administrative act of surrealism, had chosen today — of all the days available to it — to erase me from its records entirely. A bold creative decision.

I told him: I was booked for an appointment for March 11th, 9.20am.

He looked at the screen. Frowned with the gravity of a man solving something. "Oh, March 11th."

"Yes," I said. "Which is today. Which has been today since midnight, as is customary."

He found me. The relief in the room was entirely mine. I sat down and waited twenty-five minutes, during which I developed a hypothesis about the vape and whether it was NHS-issued.

The GP was young and thorough in the way that feels less like genuine curiosity and more like a checklist wearing a stethoscope. She asked about my symptoms with the careful, rounded diction of someone who has been trained to communicate with patients as though they are bright children who have recently graduated from simple puzzles. I told her about the sleep — or rather, the nightly theatrical production that gestures vaguely in sleep's direction without committing to the role. I told her about the anger, which is persistent, poorly timed, and not enhanced by spending one's working hours in the company of the general public, who remain, collectively, a lot.

I may have used my hands expressively. She appeared to find this more interesting than anything I was actually saying.

She prescribed Evorel 25 — lowest dose, let's observe how you react, as though my endocrine system were an intern on a trial period — and progesterone. I left carrying a prescription and no instructions, which is, I have come to understand, the standard premium offering.

The pharmacy was busy in the way that makes you question not just the healthcare system but your broader relationship with organised society.

A queue. A relentless, building noise that suggested everyone present had somewhere else to be and had accepted that they would not be going there soon. A phone — ringing. Continuously. Unanswered. Possibly ringing since the previous government. Staff moved serenely around it, having clearly negotiated a separate peace with the sound some time ago.

I approached the counter and gave my details. My date of birth. Then again. Then, as a bonus, my NHS number, which I provided with the weary fluency of someone who has been reciting personal information into a void since before breakfast. The NHS's decision to delete me had been thorough and had followed me across town without breaking a sweat.

Eventually a young woman appeared with my prescriptions and the bearing of someone about to share important information. I asked if this particular brand of progesterone was body-identical. She looked at me. I asked again, with the patience of a person who has learned that clarity does not arrive voluntarily, whether it was synthetic or body-identical. All progesterone capsules, she finally told me, are synthetic. She said this with the calm authority of someone reading from a source she has never thought to question.

I looked at her.

I explained that micronised progesterone is body-identical. That this is not a technicality but the entire point, the reason it exists, the reason I had asked for it by name. She considered this and determined that I was mistaken. I elaborated. She held her position with impressive conviction. We went several rounds — a spirited exchange between someone who has spent months researching her own healthcare and someone who has a laminated sheet from 2009 that says otherwise — until she dispensed the medication with the energy of someone making a concession they refuse to acknowledge as a concession. I accepted it graciously. I did not push my luck.

I went home. I had breakfast. It was approaching noon. I am releasing this detail and moving on.

I looked at the prescription. When was I supposed to start the progesterone? The prescription only said to take one capsule a day from day 1 to 25 of the cycle. Of what cycle, and from when, it did not elaborate. The GP had not mentioned it. The space where this information should have lived was simply empty, a void where clinical guidance might one day grow.

I called the pharmacy. Google, entering the scene with characteristic timing, furnished me with the phone number of an entirely different pharmacy that shares the same name — a fact I uncovered only after providing my date of birth three more times to a stranger who could not find me, because I do not exist at that pharmacy, because I have never been there, because it is not the pharmacy I needed, a distinction that felt important and that Google had not considered worth raising.

I called the correct pharmacy. I gave my date of birth. I was transferred. I was placed on hold. I was transferred again. I spoke to three people in succession, each of whom received my question as though it were an unusual philosophical proposition they were encountering for the first time, offered something tentative and slightly incompatible with what the previous person had said, and passed me along. The third person informed me to consider it day four to twenty-five and then, with the satisfaction of someone who has concluded a matter to their own complete satisfaction, hung up.

I held the phone for a moment.

Patch on tonight. Progesterone tonight. Day four to twenty-five. The NHS and I have reached a formal understanding, brokered largely by myself, at personal cost, over the course of an entire morning.

For now, I am considering this a win.

At approximately 10pm on the evening of March 11th, having applied the patch, taken the progesterone, and achieved what I had understood to be a complete victory over the NHS, my body lodged a formal objection.

It did not send a letter. It did not fill in a portal. It simply made its position known in the most direct terms available to it, repeatedly, across the course of a night that I will generously describe as long.

The cold arrived first. Then the nausea, which built with the unhurried confidence of something that had nowhere else to be. By half midnight I understood that something was wrong — not in the abstract sense that characterises most of my interactions with the healthcare system, but in the specific, immediate, non-metaphorical sense. My body, encountering a foreign substance for the first time, had reached a verdict. The verdict was no. It delivered this verdict twice, into a toilet, at intervals, with conviction.

I would like to note that I had done everything correctly. I had taken the medication as directed. I had taken it with food, at the recommended time, in the recommended dose. This did not appear to be a relevant consideration.

By morning I had slept in the way that suggests sleep occurred nearby and occasionally made contact. I had also, as a secondary achievement, vomited a second time. I was still cold. The nausea had not left so much as relocated to a more permanent address.

Work, in the way of work, required attention. A message to the group chat. A read receipt. A silence that stretched with the particular elasticity of someone deciding whether inconvenience is, on balance, their problem. It was not. Cover was eventually found, in what I am choosing to interpret as a gesture of institutional goodwill and not as the bare minimum arriving slightly late.

I called the surgery. A voice answered — I recognised the cadence, and I like to think I recognised the vape. He directed me to the Accurx portal, which is the NHS's preferred method of receiving urgent information and doing nothing with it for two working days. I filled in the form. I described my symptoms with the exhaustive specificity of someone who has stopped expecting the relevant questions to be asked. Under how would you like us to help, I wrote: phone call to advise whether to continue medication. Under when are the best times to contact you, I did not write before I have to take this thing again tonight, though I considered it.

We will review this request within 2 working days.

I called 111.

The man who answered was kind. He went through the script with the careful thoroughness of someone who takes the script seriously, which I found, under the circumstances, genuinely moving. A callback was arranged. A nurse called. She reviewed my symptoms, asked the relevant questions, and arrived at her conclusion with a decisiveness that has been, until this point, conspicuously absent from the proceedings.

Stop immediately, she said. Remove the patch. Take nothing until you've spoken to your GP.

She also attempted to contact my GP practice on my behalf. She could not get through.

I want to sit with that for a moment. A medical professional, operating within the NHS, calling another part of the NHS, on behalf of a patient who had been made ill by a prescription issued by that same NHS, could not get through. The NHS, which had deleted me from its records, dispensed my medication without instructions, provided three incompatible answers to a single question, and directed me to a portal with a two-day response window, was also, it turns out, unreachable by its own staff.

I removed the patch. I ate half a banana, which is either a breakfast or a metaphor, and went back to bed.

There is a particular feeling that arrives at half midnight when your body is rejecting something and you are cold in the way that starts at the feet and doesn't negotiate. It is not pain exactly. It is closer to clarity.

My body, which has been managing without assistance for years — through the sleeplessness and the anger and the allergies and the eczema and the slow accumulation of symptoms that nobody joined into a single sentence until yesterday — had encountered something new and made a decision about it. Not a considered decision. Not a decision open to appeal. A decision rendered in the oldest possible language, which does not use words. I understood it completely.

Whether the reaction was the dose or the brand or the timing or simply the shock of something foreign arriving in a system that has learned to expect nothing, I don't yet know. There will be another appointment. Another prescription, possibly. Another pharmacist with a laminated certainty.

But last night, in the dark, with cold hands and no instructions and a body making its position known — I thought: this is what it costs. To have spent years unacknowledged and then to finally receive something, and for the something to be wrong, and to have to start again. This is the full price of the experience.

The GP called at noon. She apologised for not mentioning that the progesterone might make me sick. I accepted this with the graciousness of someone who had spent the previous fourteen hours being ill in instalments. She explained that some people are more sensitive than others — a fact that might have been useful yesterday, before the medication, during the appointment where she was physically present and I was physically there and the information could have travelled between us at no additional cost to anyone.

She prescribed anti-nausea medication. She adjusted my progesterone schedule. She then asked whether I had thrown the patch away. I had. "Oh," she said. We concluded the call.

I went to the pharmacy to collect the anti-nausea medication. I had a headache by this point that had opinions about everything. I came home.

Tonight I will try again.

I am, provisionally and with significant caveats, still here.