What Your Doctor Didn't Tell You About Menopause (or Perimenopause)

Menopause.  We’ve all heard about it whether we’re 24 or 57 years old.  It’s that time of life, you know, when you’re a little shorter in patience, sleeping a little less well, no longer getting your periods.  But there is so much more to it than that.  Did you ever realize that many women spend about a third of their life in menopause and that the average age for menopause is around 51.  Personally, I am somewhere in that nether land between end of perimenopause and beginning of menopause, so am speaking from personal as well as professional experience. Menopause can be tough but it can also be a time of rebirth, with the kids are out of the house or at least more independent, allowing women the opportunity to focus on themselves more including pursuing hobbies, romantic relationships, travel and/or career. Post menopause, a woman is more likely to (really) speak her mind; somehow she doesn’t care quite as much about what other people think of her.  And yet, so little is actually known by most women about menopause; they know even less about perimenopause, the years preceding the cessation of the fertile period of one’s life.

Perimenopause can last for up to ten years.  It is the time that bridges one’s peak fertility period (late teens through mid thirties) with the cessation of monthly menses. During this time, our hormones start to fluctuate more and progesterone, the other primary female hormone that is not estrogen, starts to decline markedly creating an imbalance between the two sister hormones. The decline in progesterone may lead to sleep disruptions, and possibly even uterine fibroids. What women are usually not told about perimenopause is that it is harder than menopause both mentally and physically.  It is the time when most women become the most symptomatic, particularly the year prior to menopause.  Other possible symptoms that are less well known during this time include anxiety and/or depression, difficulty with memory (word recall, issues with attention and focus, and the daily struggle to remember all the details of a busy life).  Some women may now have a harder time recognizing faces even though most of their lives they “never forgot a face”.  Other women may struggle to spell words correctly despite always having been good spellers.  In addition to weight gain, there can be other obvious changes in the body including the thinning and drying of skin and hair, heart palpitations and menstrual periods that become more irregular, more painful or lighter or heavier, depending on the individual woman. 

Some women have their own unique variety of symptoms that can even include nausea (like pregnancy morning sickness) or rage.  A lucky minority of women have no symptoms at all.  Those with more severe symptoms may worry they are experiencing early onset Alzheimers or feel like they are “going crazy” or “losing it”.  Needless to say, this is no fun at all especially if they do not understand what is happening.  In many ways, menopause is the reverse of puberty.  In puberty, the brain and body is drunk with female hormones, the skin oily and the sleeping is deep and often late into the morning.  In perimenopause, the brain and body are coping with the withdrawal of these same female hormones.  Skin and hair become drier and thinner, and sleep becomes more elusive, with sleeping in only a pipe dream. 

So how does one manage this challenging life transition? Fortunately, biology is not destiny, and like the postpartum period and that week before your period, what you do matters a lot. Basic self care, including exercise, time for self, supportive intimate relationships and time with friends make a huge difference in how a woman fares. Diet also matters, with a bountiful selection of fruits and vegetables, especially leafy greens, providing the body’s precursors for serotonin production, an important hormone to support positive mood. Just knowing that this time of life is biologically challenging can make a huge difference.  Some women will struggle more than others purely because of biological happenstance.  Like during the perinatal period or the monthly cycle, some women’s bodies cope with hormonal fluctuations better than others.  If your body is more sensitive to the hormonal shifts and you find yourself unmanageably depressed or anxious, you may want to consider anti-depressants to help you through this temporary but tricky time.  Some women have also found relief with alternative treatments such as naturopathy or acupuncture.

More and more commonly in the last few decades, perimenopause and menopause arrive in a woman’s life just as her own daughters are heading into puberty.  This can make for a challenging time for all.  But the more support you get and the more you know, the better off you will be.  Psychotherapy can also be helpful in navigating this transition period.  What better way to start a new phase of life than with a guide to help you read the signposts along the way? For more information on how to successfully navigate menopause and  perimenopause, check out either The Silent Passage by Gail Sheehy or The Wisdom of Menopause by Christiane Northrup.

 

 

 

Crib Notes on Being a Good (Enough) Parent

I was 37 years old when I had my first child.  I had wanted to be a parent many years before this, but this was when the stars aligned in my life to make it happen. Before I had children, I imagined the perfect little family with well-loved little ones with whom I was perfectly attuned.  While the well-loved part certainly became true, the perfect attunement was fantasy.  In reality, my husband and I have done our best to prepare our children emotionally and otherwise to eventually leave us, a bittersweet goal at best.  This takes both appropriate boundaries and unconditional love.  Throw in a little good luck and you can watch your children grow into interesting confident and kind young people.  Still there are those occasional hard days. . . . because parenting is not for the weak of heart.

I became a teacher, parent educator and psychotherapist in my pursuit to learn as much as possible about what young people need. I’ve read books and books, some professional, some for parents, and some more helpful than others.  (And some counterproductive because they just make it seem easy which leaves you wondering what you are doing wrong.) After my many years of working with other people’s children and now my 17th year into parenting my own, I offer the following as the most important aspects of parenting well.  (And still there will be those hard hours, days and sometimes even years.)

Send your child out into the world with love and confidence.  Be their cheerleader and delight in their delights and accomplishments. Don’t overpraise but notice deeply what they like and who they are. Welcome them back when they are tired, hungry, defeated or scared with love, comfort and reassurance.  Work on your own stuff, because as much as possible you have to be the steady one, with emotions regulated and the wisdom of having lived longer and seen more about the joys and pitfalls to life. Understand that you will often get the worst of their behaviors because they feel safe with you. Don’t take what they say to you personally (especially when they are teenagers) but set gentle limits so they know there is a basic level of respect that everyone deserves. Treat your children the way you want them to treat you (at least eventually). Punishment will ultimately back fire if you want to grow children who enjoy your company as an adult, and are neither too passive or too aggressive.  Trust that a gentle voice is ultimately more powerful than a raised, angry one. 

Finally, and this is more for you than your child, be gentle with yourself.  The above is all worthwhile doing, but thankfully we don’t have to do any of this perfectly.  At times, we may not be steady and emotionally regulated. (I certainly would not claim that I have always lived up to my aspirations.) The ghosts from the past can occasionally possess us, leading us to make poor choices with our children.  When we do make mistakes, for whatever reason, apologize and then without beating yourself up, assess how you can do better next time. If you are sincere and concerned, your children will always forgive you.  Trust that the bond between yourself and your children is the most powerful tool that you have.  Your children will want to please you most of the time if you have seen them and delighted in them, and loved them enough to say “no” when it was in their best interests. This is both very simple and very hard to do. 

 

 

No One Told Me This Post-Baby Marriage Would Be So Hard

“When you have a baby, you set off an explosion in your marriage. And when the dust settles, your marriage is different from what it was.” Nora Ephron

 Among the dirty little secrets that surround new parenthood, relationship conflict with a partner or spouse almost always make the short list, often rising to the very top of the list.  It is not possible to imagine, pre-baby, how much your intimate romantic and sexual relationship could alter so drastically just from the arrival of a 5 to 8 pound bundle of “joy”.  It is equally unfathomable to imagine the amount of work that will be added once baby makes three. Making matters worse , the full story about marriage is rarely told leaving many a mother feeling isolated, like she is the only one struggling in her marriage. Meanwhile, the non-birthing partner, usually dad, is often feeling rejected by the mother, even resentful and jealous of his own progeny. It’s a recipe on both sides for anger, frustration, even rage.

Many mothers complain about being touched out by the end of the day, feeling like sex has become just another chore on the to do list. By far and away the biggest complaint, however, is about the husband/partner not doing their share of the household chores.  It is also usually the mother who does the mental work of the family: keeping track of the doctor’s appointments, and determining the best baby products and baby practices (Are there enough diapers and baby food in the house and what is the best way to carry the baby or put her down for a nap?).  This role often causes tension with the father/partner.  Even when she is not physically exhausted from the endless loads of laundry and feedings, the mother often can’t just relax because even a night out requires someone (usually her) to find and arrange for a babysitter. It is not uncommon for women to  lose power in the relationship after giving birth or adopting because they are no longer earning money outside the house (at least temporarily).  This wouldn’t necessarily be problematic,  but for the value that society puts on making money. The partner may come home from work and ask “What did you do all day?”.  Whether the question is benevolent or not, the mother may believe that keeping a a fussy nap-avoidant baby alive all day has less value than being the family wage earner.  Or the partner may became disproportionately powerful, taking control of the family decisions and finances.

The complaint list for the partner often looks very different. The partner may complain about not having sex, or enough sex. This is often intimately related to emotional closeness.  In short, the (usually) men in question miss the sex but they also miss their partners.  The number two complaint is being shut out of the mother-baby bond.  The partner may desperately want to take care of and bond with the baby, but the mother doesn’t trust her partner and lets him or her know in no uncertain terms that s/he’s not doing it “right”, discouraging the partner from trying at all.

Here are a few tips and suggestions to get through this challenging time when spouses and partners struggle to adjust to their post-baby relationship.

1. Sit down and divvy up the household chores.  Make sure it’s clear who is doing what.  Consider a white board or wall calendar where more urgent chores get listed. Check in regularly, perhaps weekly, to discuss what is working and what is not.  Make sure that one partner isn’t doing more than their fair share of the load. 

2. Don’t be a gatekeeper for access to the baby even if you feel that you would provide better care than your partner. Sometimes we have to let our partners struggle or just caretake differently from us.

3. Find ways to be intimate whether that includes sex or not. Schedule regular dates and times for hanging out with each other with and without clothes on. Don’t expect spontaneity and a burning sexual desire to get you through.  Establishing an emotional connection by holding hands or leaning into each other.  If need be, schedule sex.  You may be pleasantly surprised that it’s not actually such a chore after all. (And don’t be afraid to ask the partner to arrange for the babysitter.)

4. Ask for what you need and prioritize self-care before you’re burning with resentment and rage. No one can continually give from an empty well without withering.  Don’t expect people to read your mind.  Take time every week to exercise, socialize with adults or just be alone and do nothing. 

5. Respect each other’s roles and jobs.  You’re probably both working harder than you ever have in your life.  Don’t equate bringing home a paycheck (or a larger paycheck) with who gets more power in the relationship.  If you believe that your stay-at-home spouse isn’t working as hard as you, try caring for the baby for a week to experience first-hand how challenging it can be.

6.  Communicate, communicate, communicate.  Relationships, by definition, include occasional conflicts, and everyone needs to know to how to deal with them. Your partner may not realize that you want him or her to take care of bottles in the sink WITHOUT being asked.. You may not realize that your partners feelings are hurt when you take the baby every time s/he cries..  One way to start a difficult conversation is  “The story that I’m telling myself (about this situation) is. . . . “ Use “I” statements and be concrete in what changes you need to see. In turn, be a good listener and try to hear the story from your partner’s perspective.

 

Why Trauma is so, well, Traumatizing (and what we can do about it)

Triggering.  It’s a word that gets thrown around a lot these days. You hear it in relation to trigger alerts on college campuses. You also certainly hear it in relation to rape, war and child abuse. But despite it being more commonly known than in the past, most people don’t really understand what it is or what it is like to experience trauma. 

For those suffering from trauma, whether a single-incident trauma like a car accident or childbirth, or more pervasive childhood trauma, it is disorienting at best and crazy-making at worst.  It can lead to lost weekends of binge drinking, with marriages destroyed and jobs lost. To understand trauma, you have to understand a little bit about the brain.

It all starts with the flight/fight response.  When we are in danger, our capacity to think, including planning, analyzing and seeing the bigger picture rapidly goes out the window.  We have gone into survival mode. Blood flows out of our brains into our heart, arms and legs, literally preparing us to run or fight.  A more primitive part of the brain, the amygdala, kicks in. This part of the brain is the emotional memory center of the brain.  It is also the brain’s smoke alarm.  The amygdala has memories, but not storied memories with a beginning, middle and end.  In fact, the amygdala doesn’t even have words, or a sense of time.  So, when the amygdala gets activated which it does in fight/flight, it does so with extremely strong emotions propelling the person into unreflective action mode, or in even more severe circumstances, into deer-in-headlights freeze mode.  The amygdala is also hyperalert after trauma, activating often whenever there is a sensory event even vaguely similar to a sight, sound, smell or body sensation from the trauma.  When the amydala is activated is does so with a feeling of immediacy as if the traumatic event were happening right now all over again.  Shards of sensory memories  like visual flashbacks or bodily sensations roar to the forefront of consciousness along with such traumatic beliefs as “I am in danger” and “It is all my fault”.  Making this all the more confusing and discomfiting, these sensations are completely disconnected from the actual, fuller trauma, and may not even be recognized as traumatic.  Instead, the person often thinks they are just losing it. This is a trigger, and it’s not remotely fun.

The big “T” traumas like rape, child abuse or on the battlefield often result in nightmares, high startle response, emotional dysregulation and a pulling away from various reminders of the trauma in the world at large in attempts to avoid them.  But small “t” traumas like ongoing verbal abuse also pay a very heavy toll.  These kinds of trauma often escape under the radar for even being traumatic, partly because they are woven into the person’s model of the world and partly because there isn’t a single dramatic event to look to and so, “Yes, this is trauma”.  Both types of trauma are, well, traumatizing, and create low self-worth, high guilt, an inability to regulate emotions, feelings of lack of safety, and the inability to just go about your day in relative peace and calm. I personally, have been affected by the lower “t” kind of trauma, and understand how being triggered feels like the “truth” instead of a body memory of the past.  I am also grateful that effective help is now available.

Women, even more than men have been disproportionately affected by trauma.  While most survivors of war trauma are men, a greater majority of women have suffered from abuse at the hands of others, largely, but certainly not exclusively, family members ranging from parents to partners to siblings, coaches and teachers, and, yes, even health care providers.  Women also suffer trauma from childbirth, usually when there are birth complications and the mother does not receive the emotional support that she needs during this challenging time. Regardless of gender, trauma causes great suffering as the ability of the brain to cope with stress is overloaded, and then later struggles but fails to recover from the assaultive stress.

Fortunately, there are effective trauma treatments available now.  This was not always the case, even as recently as 20 years ago.  But now, researchers and clinicians understand how the brain works, and what the brain needs to reright (and rewrite) itself into health. Individual and group therapies have both proven effective in providing the raw materials needed to nudge the brain towards its own self healing. Usually, treatment involves some form of telling a more healing story about the trauma as well as a desensitization and reprocessing of the trauma event in the brain.

If you have suffered from any kind of trauma, I hope that you seek the help that you need and deserve.  Life is brighter without the lens of trauma clouding your life.  It’s like the scene from the Wizard of Oz when the picture goes from black and white to living color.  And what a difference that makes!

 

 

 

 

 

 

 

A Mother's Self-Compassion (or You are Perfectly Imperfect)

It can happen to anyone. We make a mistake and we get down on ourselves. We say things like “I should have known better,” or worse yet, “I’m so stupid.  I always make the worse decisions.” Regardless of the exact words we say to ourselves, making a mistake or not predicting a left turn in our lives can send us spiraling into self-doubt, self-criticism and create or contribute to already existing depression and anxiety.  But it doesn’t have to be this way.  What if, instead of treating ourselves harsher than we treat others, we spoke to ourselves with compassion, like we often do to our friends?  What if instead of saying, “You always goof up” you pretended you were talking to a good friend and said something like, “You did the best you could” or “It’s normal to make a mistake.” How would that feel?  Do you now have a little more energy to solve the problem instead of stewing in your own juices?

If talking more kindly to yourself seems impossible, you may want to consider joining a support group or seeing a therapist to help you figure out the blockage.  A good general book on the subject of self-compassion is aptly named Self-Compassion by Kristen Neff.  

Framing the issue of being hard on ourselves is a broader, societal issue of motherhood and perfectionism.  Since even before we were aware of it, many of us were socialized to not just be a good mother, but to be a perfect one. Aside from the expectation of looking our best and never getting angry, we expect ourselves as mothers to always feed our children healthy food, provide them with the latest educational toys and classes, and be available 24/7 as willing and happy playmates. And the list goes on.  So the next time you find yourself beating yourself up about a mistake, please try to remember that as women and mothers we don’t have to perfect.  Good enough is, well, good enough!

 

Shame: It Isn't What You Think It Is

Shame.  It’s a relational emotion (meaning one that develops as a result of interactions between two people) that comes on line when where we’re about 18 months old.  No baby is ever born feeling bad about herself because she is incapable of feeling shame.  Shame can be described as ingesting whole cloth the negative reactions of loved ones.  Unlike guilt, which is an emotion that we feel when we've harmed someone, shame is experienced as who we are. A little bit of shame in appropriately small doses is a common and adaptive occurrence.  For instance, a parent tells a child in front of her friend to clean up her mess.  The child feels a little embarrassed and responds by doing as requested.  The mother praises the child for her compliance and all is well.  Unfortunately, the scene is not always so benign.  As children we learn to see ourselves based on the mirror that our parents reflect back to us. They teach us who we are and, most importantly, whether or not we are worthy.  If the parent feels unworthy him or herself, then that message of less than will likely pass down to the child often even without the parent’s awareness.  In its more extreme forms, shame mutates from an appropriate regulator of behavior to a one of the most painful emotions that humans experience.

Children are so vulnerable for such a long time.  They depend on the big people in their lives to literally keep them alive and safe, putting food on their plate and clothes on their back. Without much power or control, children often depend on the survival strategies of compliance and submission.  This is especially true if the parents are emotionally or physically abusive or abusing substances.  But children are even more often shamed by ordinary, ongoing put-downs and parental blaming and yelling. 

Counter-intuitive to our knee-jerk perspective, the shame a child feels, while painful, is often highly adaptive.  Just think about it for a moment.  What happens when you feel shame? Do you get bigger or smaller? Do you speak up more or shrink back into silence? Do you feel more confident or less?  Now, you are probably still wondering how this relates to a survival strategy, so hang in there for a moment.  Think about what happens when you get smaller, quieter and less confident.  Have you become less threatening to the other person?  Are you flying under the radar and doing damage control, reducing the likelihood of being abused or belittled by the other person?  Compliance is a fantastic strategy for a relatively powerless child to survive to the next day.  And that is all that really matters when one is in survival mode.

 Let’s do an experiment.  Sit in a chair in a relaxed position.  Go ahead, no one is looking. Bow your head and get small.  Stay in that position for a moment and notice how you feel.  Are you closer to feeling powerful or powerless?  Are you feeling shame? Now slowly and gently unfurl your spine at little at a time. How is that?  Do you notice any difference? Pull your shoulders towards your ears then let go, with your upper back down but relaxed.  Now how do you feel?  I’m guessing you feel better than before.

So how does this all relate to shame?  Shame is a body experience as much as it is an emotion.  We automatically go into the shame position (think of a chastised dog) whenever we feel shame.  When we are powerless as children, our bodies go into shame as a damage control strategy.  Now here’s the hardest part about shame.  Shame is just an emotion but we often don’t experience it that way.  Instead, we experience it as who we are.  Think about that for a moment.  When shame comes on line and takes over, we are the shame, and we have always been the shame.  It doesn’t get more painful than that. And if we’ve been shamed from childhood constantly or if we’ve been traumatized in any way, shame will kick in and tell us it was our fault or that we aren’t any good or we are less than others.  Now, this strategy of feeling bad about ourselves wouldn’t work if we didn’t really buy into the belief.  If our body didn’t conform to the position of shame.  So we do and it does. And at least as children or trauma survivors (or both), we’ve maximized limiting damage of the external harm with the unfortunately steep price of not feeling worthy and/or feeling everything is our fault.  But we have survived to live another day.  And that is a true victory!

Unfortunately, this strategy doesn’t work as well for us once we’re older and not in danger anymore.  The danger may have passed but the body experience and the feelings and beliefs do not.  Trauma can be described as the past being misplaced whole cloth onto the present.  That is what shame is once we’re grownups.  Shame also helps us avoid a terrible reality about an abusive childhood or any trauma.  We are not in control of ourselves or our safety.  It is easier to blame ourselves thinking we are the problem, than realize that we truly aren’t (or weren’t) safe, and that the problem lies with the other person who lacks the ability (for whatever reason) to make us feel valued and protected.

I’m no stranger to shame myself.  Intergenerational trauma passed from one generation to next certainly had reverberations in my own family’s life when I was a child.  I remember thinking when I was young that others were just better than me.  I couldn’t explain why but I certainly felt it deeply.  It just was.  And yet, now I know this was not true. The price that I paid for shame’s help was not being as happy as I might have been, but survival always comes first and foremost.  To this day, a younger part of myself will occasionally get triggered and forgets that the shame is just a survival strategy or adaptation to being powerless in an unsafe environment; it isn’t the truth.  The good news is that once you know shame’s m.o., you can help your younger self remember this.  You can take that younger shame part under your wing, and become unblended with it and move back into your wise adult self. 

For anyone who has experienced chronic shame, you know this is not an especially easy thing to do and no small matter either.  It can make the difference in whether or not we find happiness in relationships.  Or finding contentment and peace in our perfectly imperfect lives.

If you struggle with shame, I invite you to engage your wise self to notice how shame functions in your life.  Start seeing shame not as who you are but as a strategy from the past that helped you to survive.  This may be difficult or impossible to accomplish on your own.  I encourage you to talk to trusting others about it or even seek a support group or therapist if need be.  If you are currently not safe (domestic violence etc.), you need to get safe first and foremost.  Only then can you start to see shame for what it really is.

Suffering in Plain Sight

I wanted to be a mother since I was a child.  I remember playing house (and mother) on the empty lot that eventually became the home that I grew up in. It took a long time to realize that dream of parenthood.  When I finally became pregnant in my mid-30’s, I was ecstatic. While I did not suffer from full-blown mood complications, I do remember very clearly experiencing an anxiety that was new and all-encompassing.  I worried about my baby dying of SIDS, or rolling off the changing table.  I felt like I had to hold her constantly in my arms fearing that if I didn't, she would not feel secure.  And the big mother of them all - I worried about me being a good enough mother. I remember family members noticing and commenting on my increased anxiety.   I did not know at the time that the emotional alarm system in my brain, my amygdala, was on hyperalert. This is true for all new mothers in the first two months of a baby's life.  I didn't think to talk to anybody about my fears.  I didn't realize that they were typical.  I wish I had because I think it would have helped. I didn't quite realize how vulnerable that first year after give birth is for all new mothers.

I was ready and willing to bleed myself dry (literally and figuratively) if that’s what it took to make my child feel loved and valued. (I didn’t know how much was enough so I decided to err on the side of giving and then giving more.)  I survived on less sleep than I thought possible. I nursed day and night and day again, feeling sometimes more cow than human. 

In the first year of my daughter's birth, I was fascinated with this whole transition to motherhood.  I read book after book about child development and the changes that women go through as they transition their identity up the generational chain from daughter to mother.  I was already a psychotherapist but did not return to work in this capacity for a while. I did not want to be separated from my daughter and I also did not feel like I had enough left over to give to my clients. I attended an intensive conference on perinatal mood complications and loved it, and simultaneously felt frustrated that I couldn’t put any of it to use just yet.

 As my children grew older, I eventually returned to work as a psychotherapist. (In the mean time, I had been doing part-time work as a parent educator and loving it.) I’d never forgotten my interest in the perinatal period, and so I begin to work with new mothers.  I am struck over and over again by the both the resilience and the pain that these women carry as they walk into my office. They come in smiling and confident, and are often in tears the moment I ask them how bad they really feel. They often do not understand what is happening to them, nearly all stating they no longer know who they are. They blame themselves for their struggles, wondering if they made a mistake becoming a mom, or worse. Some come from other therapists or doctors having been told they are not safe to be alone with their baby or worried about their literal sanity.  (This is only true with psychosis which is extremely rare.)

It is an honor and a privilege to be part of this great sorority called motherhood and to be a guide for those still finding their balance.  As a perinatal therapist, I focus on the practical matters at the beginning: sleep, social support, exercise, and possibly medication.  I instill hope that my mothers can feel better (truly believing that they can). Sometimes the hardest thing they often need to learn is to ask for and accept help instead of being the one to give it.

Aside from being a mother, I never really knew what I wanted to do when I grew up.  Now I do.