By Leah Levenson, Psy.D. Psychologist | October 25, 2026
If you could permanently get rid of one symptom of perimenopause, which one would you choose?
ONE. Gone forever!
This should be super easy.
Brain fog has to be a really strong contender. Being able to walk into a room and remember why you’re there would be pretty nice. So would finding the thing you’re looking for when it is sitting exactly where it’s supposed to be. And finishing a sentence without losing the word you wanted halfway through it.
Okay, brain fog.
Except…
What about sleep?
Because getting into bed, going to sleep, and then staying asleep until morning seems like a pretty sweet deal. No waking up at 3 a.m. completely exhausted but somehow also completely wide awake. No lying there wondering whether you should keep trying to sleep or just accept defeat and get your butt out of bed before the sun wakes up.
So maybe sleep is the way to go.
But, if we are getting rid of things, maybe anxiety deserves some serious consideration.
And, irritability.
Ugh, this is getting really difficult now.
The problem with choosing only one perimenopausal symptom is that the minute you think you’ve picked your winner, another one pops into your head.
And now it seems like hot flashes might not even make the final cut. Which is kind of funny, considering hot flashes were basically the entire menopause education many of us got. Your periods became unpredictable, eventually they stopped, and you got hot. Maybe you got a little moody, but that was about it.
Nobody mentioned that you might suddenly struggle to find words you’ve known your entire adult life. Or that sleep could become weirdly complicated. Anxiety might show up when it was never an issue before, or show up differently if it was already there. And your patience for completely ordinary things might be shot.
And then there are all the physical symptoms that leave you wondering whether it’s perimenopause, getting older, something completely unrelated, or whether you simply slept wrong or moved funny.
So this hypothetical needs rules.
If you choose sleep, do you also get the benefits that might come from actually sleeping? Because that could definitely change the entire strategy. Maybe you’re less irritable because you’re not completely exhausted. Your brain might work a little better and everything might feel a little easier when you’re not starting the day already tired. If that’s allowed, sleep might be the smart choice.
But if we only get to eliminate one symptom, this is going to require a lot more thought.
This Is Harder Than It Should Be
Anxiety deserves more consideration than it initially got. Maybe you’ve always been a worrier, but suddenly it’s worse. Or maybe anxiety has never really been your thing, which makes it especially confusing when you start feeling anxious about things you would normally handle without much thought.
Irritability is up there too. “Irritable” can actually be a pretty mild word for wanting everyone to stop talking, chewing, asking questions, or needing anything from you for at least five minutes.
We haven’t even gotten to headaches, joint pain, heart palpitations, changes in libido, or any of the other things you may or may not have realized could appear during perimenopause.
This is why picking one gets so complicated. The symptoms are so hard to separate.
If you’re barely sleeping, you’re probably not going to be at your most patient. You’re also probably not going to be thinking particularly clearly. Anxiety can keep you awake, and being awake half the night certainly doesn’t help anxiety.
So if you eliminate sleep problems, how many other things improve with it?
So again, I need to see the rules.
Annoying Is One Thing. Disruptive Is Another.
Maybe the better question isn’t which symptom is the most annoying. It’s which one is actually interfering with your life.
Forgetting the name of an actor is annoying, but losing words in the middle of a work conversation is different. Being irritated that someone left a cabinet open is pretty normal. Feeling like you’re going from zero to furious over things that normally wouldn’t bother you much, or even worse, realizing you were the one who left the cabinet open, can be much harder to understand.
And feeling anxious is one thing. Starting to second-guess decisions, avoiding things that suddenly feel overwhelming, or repeatedly asking other people what they think because you don’t trust your own judgment quite as much is another.
That’s where some of these symptoms can really throw you.
You know how you usually function. You know what tends to bother you and what doesn’t. You know whether you’re someone who worries, sleeps well, forgets appointments, loses words, or gets disproportionately angry because someone asked what’s for dinner.
And then some of that changes.
Without perimenopause somewhere on the list of possible explanations, it’s pretty easy to assume you’re the problem. That doesn’t mean every difficult thing happening in your 40s and 50s is hormonal. Sometimes you’re anxious because something is stressful, and sometimes you’re irritated because something really is irritating. Other times, something else genuinely needs attention. But perimenopause deserves to be considered too.
So, Which Perimenopause Symptom Wins?
Sleep still has an excellent argument, but so do brain fog and anxiety. Irritability probably has overwhelming support from everyone you live with. Yet somehow, hot flashes, the symptom we heard the most about, might not even make the final cut.
So which one wins? Truthfully, I have no idea. Apparently, neither does this blog, which started with one very simple question and has now spent an unreasonable amount of time negotiating the terms of an imaginary deal.
But if you’re surprised by which symptom you’d choose, I’m certain you’re not alone. A lot of us were warned about hot flashes, but nobody mentioned having to choose between everything else.
And frankly, ONE symptom was a ridiculous offer in the first place.
When Perimenopause Is Affecting More Than Your Period
If anxiety, irritability, overwhelm, or feeling less like yourself has become a part of your perimenopause experience, you don’t have to wait until it’s completely disrupting your life to talk about it.
I work with women dealing with anxiety, relationship strain, and the emotional side of perimenopause and menopause. If you’d like to talk about whether we’d be a good fit, schedule a free 15-minute consultation.
