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.