The Medicalization of Midlife: A Critical Look at the Perimenopause “Epidemic”

A fresh film, “The M Factor 2: Before the Pause,” which premiered on PBS on March 19, 2026, is the latest effort to frame normal midlife experiences as a medical crisis. This sequel to “The M Factor” continues a trend of medicalizing menopause and, according to critics, risks misinforming both women and healthcare professionals. The original “M Factor” lost accreditation as a physician education activity after concerns were raised regarding its accuracy and potential for misinformation [1].

Expanding the Definition of Perimenopause

“Before the Pause” expands the scope of medicalization to include perimenopause, suggesting to women in their 30s that hormonal fluctuations will inevitably lead to cognitive, physical and mental health decline. The film features a woman recounting a frightening experience of forgetting her name, framing this as a typical symptom. The film encourages women to “shred the silence” on menopause and offers merchandise to promote awareness [2].

A Growing Narrative and its Concerns

This film joins a growing chorus of articles and social media discussions attributing a wide range of symptoms – from stress and burnout to normal aging – to perimenopause. This perspective is often presented as a feminist issue, but critics argue it is, in fact, the opposite. The idea that women are inherently destabilized by their hormones, and that hormonal manipulation is the solution, has a long and problematic history. In the early 20th century, women were subjected to unnecessary ovary removal for conditions ranging from “troublesomeness” to “erotic tendencies” [1].

Historical Context: Dismissing Women’s Experiences

Throughout history, women’s perspectives have been dismissed or minimized due to perceived hormonal imbalances during various life stages – puberty, menstruation, pregnancy, postpartum, and menopause. The inclusion of perimenopause effectively pathologizes nearly a woman’s entire lifespan. This narrative reinforces stereotypes of women as being emotionally unstable or irrational due to their hormones.

The Broadening List of Symptoms

The symptoms attributed to perimenopause have expanded beyond mood changes to include weight gain, decreased libido, dry skin, thinning hair, “brain fog,” and vague “flu-like symptoms.” The phrase “I’m just not feeling like myself” is even marketed on merchandise associated with the movement [2].

The Rise of Influencers and Commercial Interests

The prominence of perimenopause as a frightening stage is being fueled by influencers, advocates, and doctors who often profit from selling products or services marketed as solutions. Whereas hormone fluctuations do occur during perimenopause, attributing every symptom to this phase can be inaccurate and potentially harmful.

Defining Perimenopause: A Lack of Clarity

Defining perimenopause remains challenging. Menopause is defined as the cessation of menstruation after 12 consecutive months without a period. Perimenopause, still, encompasses the years leading up to menopause, characterized by irregular periods and fluctuating hormone levels. However, hormone fluctuations are not unique to perimenopause. they occur throughout a woman’s life, even hourly and daily during the menstrual cycle [2].

The Risks of Overdiagnosis and Misattribution

Attributing every symptom to perimenopause can lead to misdiagnosis and delay the identification of other underlying health conditions. For example, a journalist whose symptoms were initially attributed to perimenopause was later diagnosed with cancer [1].

Symptoms Experienced by Both Men and Women

Research suggests that many symptoms attributed to perimenopause are also experienced by men during midlife. A 1994 Dutch study found that, aside from excessive sweating, men and women reported similar symptoms during midlife, including forgetfulness, decreased sexual desire, and increased waist circumference [1]. A 2018 Korean study corroborated these findings [1].

A Call for Empowerment, Not Medicalization

Rather than viewing perimenopause as a disease to be cured, a more empowering approach focuses on healthy lifestyle choices, mental well-being, and community support. Experts advocate for an empowerment model for menopause, rather than framing it as a condition requiring medical control [1].