Why Your Chronic Illness Got Dramatically Worse in Perimenopause: The Hormonal Cascade Driving Gut, Mast Cell, Brain Fog, and Fatigue Symptoms in Your 40s — What Standard Medicine Says, and Why It Is Incomplete

The standard medical framing of what you are experiencing runs along two parallel tracks that almost never integrate. Track one is perimenopause. Standard medicine recognizes perimenopause as the transition period in the years leading up to menopause, characterized by fluctuating and ultimately declining estrogen and progesterone. The clinical attention focuses on the classical symptoms: hot flashes, night sweats, cycle changes, mood changes, sleep disruption, vaginal dryness, libido changes. The standard interventions are HRT, the contraceptive pill in some cases, antidepressants for mood, sleep aids, and lifestyle counseling. The framing is that perimenopause is a discrete reproductive event with its own symptom profile and treatment plan. Track two is your chronic illness. If you have a chronic illness diagnosis (long COVID, MCAS, SIBO, an autoimmune condition, ME/CFS, the hEDS POTS MCAS triad), it is being managed by a different set of specialists using a different set of interventions, with attention to a different set of symptoms. Your gastroenterologist is not thinking about your hormonal cycle. Your immunologist is not thinking about your estrogen. Your rheumatologist is not thinking about your progesterone. Your menopause specialist is not thinking about your mast cells. The integration is left to you, the patient, to perform. Which is to say it is not performed at all