What the perimenopause boom is selling women who are already exhausted

At about the point in life when your phone alarm is competing with school notices, an ageing parent’s cardiologist and the low-grade panic of waking at 3.14am for no obvious reason, the internet arrives with a very polished answer. Brain fog? Perimenopause. Sudden rage at the family dishwasher? Perimenopause. A skin flare, a flat mood, a week of bad sleep, the sense that your own body has started speaking in static? Also perimenopause. The pitch is seductive because it does what ordinary life in midlife rarely does: it makes the mess feel legible.

I understand why that lands. The women being sold this story are not naïve. They are underslept, time-poor and often working through symptoms that do not line up tidily enough to earn quick reassurance in a GP appointment, or anywhere else. In that mood, a slick reel about “hormone balance”, a pastel tub of capsules or a telehealth funnel promising to decode everything can feel less like consumer nonsense than a lifeline.

But the clinical skeptics quoted by STAT read the same landscape differently. Their argument is not that perimenopause is invented, nor that women should put up with feeling dreadful. It is that a real life stage, full of real symptoms, is being turned into an all-purpose sales category. The profitable move is not treatment. It is certainty.

That is the part I keep coming back to. Perimenopause has become a market for women who are already exhausted by ambiguity: the ambiguity of what belongs to hormones, what belongs to stress, what belongs to ageing, and what belongs to a medical system that still does a patchy job of sorting the difference. If that diagnostic fog feels unbearable, the market will happily sell you clarity by subscription.

“There’s a whole industry that seems to have sprung up.”

Adriane Fugh-Berman, via STAT

The symptom, then the funnel

The market analyst’s version of this story is brutally simple. Ambiguity monetises well. The broader NAD+ supplement boom described by The New York Times is not formally a perimenopause story, but it runs on the same emotional circuitry: fatigue, fear of decline, a promise that the right powder or capsule might restore the self you miss. Midlife women sit squarely in that audience. The language shifts from anti-ageing to hormone support to energy to sleep to cognition, but the commercial logic stays the same.

A recent PubMed-indexed study of 1,000 Instagram posts about menopause supplements puts numbers on that logic. In the sample, 661 posts promoted branded menopause supplements. Only 18.3 per cent were authored by credentialed clinicians. The average monthly cost landed at US$43.49, and 45 per cent of the posts promoted proprietary blends, that useful little bit of packaging which lets marketers imply sophistication without telling you much at all. If you want an answer to one of the user-affected perspective’s central questions, which claims have the weakest evidence but the biggest lift, that is a decent place to start: vague “hormone balance” formulas, branded as comprehensive, priced like self-respect.

This is where the perimenopause boom stops looking like a pure health conversation and starts looking like influencer infrastructure. As Vajenda’s analysis of the menopause attention economy argues, the product is not only the capsule. It is the story wrapped around it: you have been ignored, now here is the insider language; you have been confused, now here is the protocol; you have been told nothing is wrong, now here is a shopping basket full of proof that something is.

The answer to the analyst’s other question, why brands and creators outpace the evidence base, is boring and important. Evidence takes time, consensus takes time, access takes time. Content does not. STAT noted the sharp rise in Google Trends interest since 2023 and it has already been warning about perimenopause misinformation this week. Once attention moves that fast, the people with the least incentive to wait for good data often win the first round of trust.

I am not saying every woman who buys a supplement has been duped, or that every clinician on social media is a charlatan. That would be too neat. Some women do report symptom relief, and some interventions have a modest evidence base for particular complaints. The problem is that the feed collapses all of that into a single emotional proposition. If you feel bad, the market insists there must be a purchasable reason, and preferably several.

“you might end up spending a lot of time and energy and wasted money on something that might not have a whole lot of evidence backing it up.”

Patricia Bencivenga, via STAT

That warning matters because the pitch is no longer confined to herbal blends with dusty labels. It stretches from black cohosh and other inconsistent supplement ingredients discussed in Harvard Health to creatine, which The New York Times recently explored as a possible help for some menopause-related symptoms, to the shinier longevity language around NAD+. Some of these ideas deserve a careful look. Some do not. But once they sit side by side in a feed, each with a soft-focus before-and-after story, the distinction between “worth asking your doctor about” and “expensive maybe” gets washed out.

The care gap is where the money lives

Women are reaching for these funnels because orthodox care has left plenty of dead space. The skeptics are not wrong about the overclaiming. Still, the user-affected perspective has its own force, and it would be lazy to brush it aside. Symptoms can be diffuse. Appointments are short. Some doctors are excellent on midlife hormonal change; others still wave away fatigue, sleep disturbance, anxiety or heavy bleeding as if irritation were reassurance. Into that gap walks a market with better lighting, faster language and a checkout page.

Part of the honesty required here is holding two truths at once. First, evidence-based care does exist. Harvard Health’s review is pretty clear that menopausal hormone therapy can be effective for some eligible women, especially for classic vasomotor symptoms. Second, that evidence is narrower and more conditional than the market likes to admit. Hormones are not a magic solvent for every miserable thing that can happen in your forties. As Fugh-Berman put it in STAT’s piece, “the idea that hormones are good for whatever ails you … is absurd”.

That is the real answer, or at least the partial one, to the exhausted woman asking what actually helps first. Not a universal stack. Not a stranger’s cart. A slower process of ruling in and ruling out, looking at sleep, bleeding patterns, mood, metabolic health, stress, medication side effects, thyroid function, and only then deciding what belongs under the perimenopause umbrella. It is less Instagrammable than a supplement starter pack. It is also more like medicine.

Commercially, there is a second twist here. Once perimenopause becomes the explanation for every change, it also becomes the launchpad for every adjacent product. Healthline’s recent reporting on perimenopause as a window for cardiovascular risk prevention is useful because it gestures at the part the market would rather skip: this phase can be a cue for solid, boring care, blood pressure, lipid management, exercise, sleep, real prevention. Yet the more monetisable version of that idea is not prevention. It is tracking. It is optimisation. It is the fantasy that a wearable, a powder and a personalised protocol can turn midlife into a dashboard.

The next chapter is already forming. New Scientist recently reported on temperature-sensing wearables as a possible way to detect perimenopause earlier. That may prove useful. It may also become another invitation to outsource ordinary uncertainty to a device that promises fluency in your body before the evidence, or the access, is really there. Midlife women are not just being sold pills. They are being sold legibility.

And that, I think, is why the boom feels so potent. It takes a stage of life that is unruly, sometimes frightening and often under-served, then offers the sort of crisp narrative women rarely receive from institutions that should be helping them. Buy this. Test that. Book this telehealth consult. Name the problem in the right vocabulary and you can get yourself back.

Maybe some of that will help, case by case. I am less convinced by any product that arrives sounding like a verdict. What women in perimenopause need is not less seriousness, and not more shame about seeking relief. It is better care, cleaner evidence and a little suspicion when certainty turns up wearing millennial pink and asking for your card details.