Symptoms like insomnia, bloating and emotional shifts can occur before menopause begins, but they are often improperly addressed by doctors

In her 40s, Karen Cummings started to notice a shift in her menstrual cycle. The New Yorker’s typically mild and consistent symptoms had been replaced by bloating, emotional swings and overwhelm before she entered menopause five years ago, at 52.

She thought she might need to switch up her birth control. Her doctor suggested an antidepressant. But the symptoms seemed tied to her menstrual cycle. “I’m not depressed,” she remembers thinking. “I’m on the wrong birth control.”