WHAT A STRESS FRACTURE TAUGHT ME ABOUT MY OWN PERIMENOPAUSE
By Alexis Anderson, DO
California Psychiatrist | Hormone-Informed Care for Women in Midlife
Last year, I fractured the fifth metatarsal in my right foot. Not from a fall, not from any injury I could point to — just from walking. A stress fracture, the kind that shows up when bone has quietly lost more strength than you realized. I'm a psychiatrist who has focused exclusively on women's mental health since 2010, and my work sits squarely at the intersection of hormones and the brain — sleep, mood, anxiety, focus, the sense of feeling like yourself. And even I didn't see this coming in my own body.
I'm sharing this not because it's dramatic — it healed, I'm fine — but because it was the moment perimenopause stopped being something I understood clinically and became something I was living through, the same as my patients.
WHERE I ACTUALLY LIVE AS A PSYCHIATRIST: SLEEP, MOOD, AND THE BRAIN
My clinical world isn't bone density scans. It's the 3 a.m. waking, the flattened mood, the anxiety that arrives out of nowhere, the "I can't think clearly anymore" that so many women in their 40s and 50s describe. What I've spent my career explaining to patients is that these aren't character flaws or stress alone — they're partly neurobiology. Estrogen and progesterone act directly on the brain circuits that regulate sleep, mood, and body temperature, so when those hormones start fluctuating and declining, the brain feels it early — often years before periods become irregular.
INSOMNIA ISN'T JUST A SYMPTOM I TREAT — IT'S ONE I LIVED
Around the same time as the fracture, my own sleep changed — not trouble falling asleep, but waking at 3 a.m. with my mind fully alert, unable to settle. For me it didn't come alone: I was also having significant hot flashes, and the night waking often arrived with night sweats. I've listened to hundreds of women describe this exact pattern. And I understand the mechanism as a psychiatrist: sleep fragments both directly, through the effect of shifting hormones on the brain's sleep-maintaining circuitry, and indirectly, through vasomotor symptoms like night sweats that pull you out of sleep.
Understanding the mechanism didn't make the 3 a.m. wakefulness any less disorienting. If anything, living it — the waking, the heat, the racing mind — sharpened my appreciation for how much it erodes mood, patience, and clarity the next day, and how isolating it feels before anyone connects it to a hormonal cause.
THE FRACTURE IS WHAT MADE THE WHOLE PICTURE CLICK
Bone health isn't my clinical lane — it belongs to my physician and gynecologist. But the fracture was the alarm that made me stop compartmentalizing. Estrogen protects bone, and as it declines around the menopause transition, bone loss can accelerate quietly, with no symptoms until something breaks. I knew this as a fact. Feeling it in my own foot is what finally made me look at the whole picture — my sleep, my mood, my hot flashes, my bones — as one connected transition rather than a list of unrelated complaints. Then I did what I tell my patients to do: I brought it to my own physician and had it properly evaluated.
WHY I DECIDED TO START HORMONE THERAPY
Between the fracture, the disrupted sleep, and hot flashes that had become hard to ignore, I started menopause hormone therapy — a decision I made with my own physician, weighing my full history and risk factors. I want to be clear this isn't a universal recommendation. MHT depends on individual health history, and it isn't right for every woman. And it isn't something taken for bone protection alone.
I also want to be honest about what "helped" looked like. Hormone therapy made a real difference — my hot flashes settled and my sleep improved — but I still have the occasional 3 a.m. night. Better, not gone. As a psychiatrist, I think that distinction matters, because so much of what's online promises a clean before-and-after. Real management is usually about turning the volume down, not switching a symptom off.
What surprised me most wasn't the decision — it was how long I waited. I've spent years telling patients not to wait until symptoms are severe. And then I waited for a fracture to take my own advice. Physicians are often the last to apply to ourselves what we tell our patients every day.
WHAT I WANT YOU TO TAKE FROM THIS
If you're in your 40s or early 50s and something feels different — your sleep, your mood, your anxiety, your focus, or even something as unrelated-seeming as bone health — it's worth a real conversation, not a wait-and-see approach. You don't need to wait for a fracture or a breakdown to justify asking for help. As a psychiatrist, my job is often to help women see these scattered symptoms as one connected story with a name and real options.
I'm no longer just the physician on the other side of this conversation. I'm also a 53-year-old woman living through it, and that's changed how I practice — with more patience for how long it takes to notice, and less patience for waiting until something breaks.
FREQUENTLY ASKED QUESTIONS
As a psychiatrist, why are you talking about bone health?
Because it doesn't exist in isolation from the brain-based symptoms I treat. Bone health itself is managed by your primary care physician or gynecologist — but the same estrogen decline that thins bone is also disrupting sleep and mood. My role is to recognize the whole pattern and make sure women get evaluated by the right clinicians for each piece.
Will hormone therapy fix my sleep?
Not necessarily, and not always completely. When sleep disruption is driven by night sweats and hot flashes, hormone therapy often improves it substantially by treating those symptoms — but it isn't a sleeping pill, and some nighttime waking can remain. In my own case, my sleep is much better than it was, though not perfect. When sleep stays a problem, I look at other contributors too — mood, anxiety, sleep habits, and other medical causes.
How do I know if my sleep or mood changes are hormonal?
There's no single test. As a psychiatrist, I take a full hormonal and psychiatric history and look at the pattern: new middle-of-the-night waking in your 40s, mood or anxiety shifts that don't track with life stressors, often alongside night sweats, hot flashes, or cycle changes. Sorting out what's hormonal, what's psychiatric, and what's both is exactly the work.
Is hormone therapy right for everyone with these symptoms?
No. MHT is one option among several, and whether it makes sense depends on an individual's full health history, risk factors, and preferences. It's a decision best made with a clinician who can review your specific situation.
This article reflects my own experience and is for general education. It isn't a substitute for individual medical advice. Please talk with your own clinician about your symptoms, your history, and any treatment — including hormone therapy — before making changes.
About the Author
Alexis Anderson, DO, is a California psychiatrist providing hormone-informed psychiatric care for women during perimenopause and menopause. She completed adult psychiatry residency training at Yale University and child and adolescent psychiatry fellowship training at the University of California, San Francisco. Since 2008, she has provided integrated psychotherapy and psychiatric medication management in private practice. Learn more about Dr. Anderson’s approach to concierge psychiatry for women in midlife.
Looking for hormone-informed psychiatric care during perimenopause? Learn about perimenopause and menopause psychiatric care for women throughout California.