The hot flush in a meeting is public. Everyone watches. The three in the morning has no witnesses, so nobody counts it. Between forty and fifty-six percent of women report insomnia symptoms in the transition, and one in four meets full diagnostic criteria. This is what is happening in those hours, why progesterone leaving is the part nobody explains, and why the treatment with the strongest evidence behind it is almost never the one you get offered.

Four men were laughing about their "hormonal" wives when the only woman at their level crossed the room, dropped her jacket on the floor, and showed them the sleeves she'd cut out of her blouse. Perimenopause hormones do not fade on a gentle slope. FSH rises first, estradiol spikes higher than it did at twenty-five, and progesterone leaves years before anyone mentions menopause. What is actually happening, why a single blood test cannot see it, and what the evidence says helps.