Walking into a room and forgetting why, searching for a familiar word, or feeling irritable and tearful in a way that does not feel like you. Many women in their forties describe this and quietly wonder whether something is wrong. At THE FIT CLINIC we hear it often, and the first thing worth saying is that it is real and you are not imagining it.
Perimenopause is the transition before periods stop, and it can begin years earlier than most people expect. Oestrogen levels do not fall smoothly; they swing, and those swings can affect sleep, mood and concentration. Poor sleep from night sweats can by itself produce much of the fogginess. This is why the picture is often a cluster of symptoms rather than one.
It is also why we do not assume hormones are the whole explanation. Thyroid problems, low iron, low vitamin B12, depression, anxiety, high stress and sleep disorders can look very similar. Memory complaints that are sudden, severe, or come with confusion, weakness or other neurological changes need prompt medical review and should not be put down to age.
A useful assessment starts with your story: your cycle pattern, sleep, hot flushes, mood and what is changing at work or home. Blood tests are chosen to look for the other causes above rather than to diagnose perimenopause, which is largely clinical. Options then range from sleep and lifestyle measures to hormone therapy where suitable, discussed against your own history, with no promise of a particular result. Consultations are in English or Thai, with a fee of 1,500 to 3,000 baht by complexity plus a 300 baht clinic service fee.