If you believe what you read online, perimenopause — the long, slow decline of estrogen and progesterone that leads to the end of menstruation at menopause — is the cause of nearly every imaginable ill for Gen-X women like me in our 40s and early 50s. One writer for Oprah.com even went so far as to call it part of the “new midlife crisis” for women.
You can’t blame us for complaining about our hot flashes and lethal moods. Much less the horror that accompanies learning of the litany of other symptoms that can occur, including irregular periods, extreme bleeding, vaginal dryness, loss of libido, migraine headaches, premenstrual dysphoric disorder (PMDD), night sweats and more.
However, does it have to be a battle of the body? Or is there perhaps another way to approach it?
Certainly I was not pleased when perimenopause kicked off for me at the relatively young age of 41. Suddenly, a single cup of coffee came with racing heart.
Certainly I was not pleased when perimenopause kicked off for me at the relatively young age of 41. Suddenly, a single cup of coffee came with racing heart, panic-level anxiety and an uncharacteristic migraine. Not long after that, I discovered that despite being a regular exerciser, activities like yoga made me so hot I felt full of burning coals from head to toe.
My doctor delivered the news that I was not, in fact, too young to be experiencing all these symptoms; this was perimenopause and it might be the beginning of a long haul.
As a still recovering workaholic, I first felt betrayed by my body, thinking: "I don't have time for this." I sought herbal supplements and meditations, threw a pity party for my midnight, sweat-drenched wakings and chalked every bad mood up to my changing hormones. But after six months of this misery, I realized the symptoms weren’t going away. Indeed, two years later, they are growing more intense and more frequent.
Imagine my dismay when I learned they can last anywhere from three to 10 years (though the duration of perimenopause averages four to five years). If I have up to a decade of this, the last thing I want is to live my life in a kind of longterm war with my hormones.
Due to the age of onset for many women, perimenopause has a way of adding insult to injury by arriving at a time when women are already facing other challenges, such as raising teenaged children or dealing with aging or ill parents — or both. Career stress and other aspects of mid-life may come into play, as well.
“I think of [perimenopause] as a time when women are more vulnerable,” says JoAnn Pinkerton, the executive director of the North American Menopause Society (NAMS), and a professor of gynecology at the University of Virginia Health System. “It may be a stressful time in women’s life, and perimenopause can make that harder.”
For many women, it signals not just the beginning of the end of menstruation, but a shift in our sense of potency and sexuality.
But it is also a natural experience, and one that I’ll be going through for some time. I wanted to find some deeper wisdom in the process. Perimenopause doesn’t have to be my enemy.
“We have a tendency to locate experiences in biology and we wrongly can think of those as deterministic,” cautions Catherine Monk, a professor of medical psychology in the departments of psychiatry and an OB-GYN at Columbia University Irving Medical Center in New York. In other words, the changes in one’s body can begin to seem like the root cause of all of one’s problems, when they’re actually just happening side-by-side.
Monk suggests that perimenopause be viewed as a shift into a different phase of life, one that can be rich with insight if we stop and pay attention.
Monk suggests that perimenopause be viewed as a shift into a different phase of life, one that can be rich with insight if we stop and pay attention. “If we don’t pay attention to the psychology, we miss an opportunity to reframe it,” she told me.
And as I took a closer look inward, I realized that my irritation often led me to put up less with bad behavior from others, and to speak my mind more directly. The truth is that I can manage the symptoms, it’s the symbolism that causes my struggle — perimenopause feels like a big shove from Mother Nature in the direction of old age, and the beginning of a loss of control over my biology.
However, Monk points out that youth is “over emphasized in our culture” in a way that makes aging seem like a penalty, rather than “a gaining of maturity.”
Thus, she acknowledges that many women may need to go through a mourning period. “I think we downplay the mental aspect of how perimenopause affects us,” she says. “The more you can be at peace with it, the better that will serve you.”
“I think we downplay the mental aspect of how perimenopause affects us. The more you can be at peace with it, the better that will serve you.”
So now, when my stamina flags in an exercise class, I remind myself that I’m investing in my future longevity and health. While my vanity may be offended by fresh wrinkles and reduced tone, I focus on the strength of my muscles and rejoice that I can still give my nearly 10-year-old son a piggyback ride.
I’ve also begun to treat my symptoms as a reason to shift my lifestyle and my priorities. Insomnia means I often have to take a mid-afternoon nap at my lunch break. Hot flashes are tolerable if I keep up regular, daily exercise, and meditations keep my moods from flying out of control. In general, the changes have forced a kind of walking mindfulness practice on me, whether I want it or not. And the more conscious I am of my body’s needs, the better able I am at making modifications.
Monk supports this approach of support versus battling the body, saying women in perimenopause “should take all that energy and put it toward taking care of oneself. Aging is not great, but the alternative is worse.”
At least there is a (hopefully cool) light at the end of the perimenopause tunnel — after menopause, most women’s awful symptoms go away, ushering in yet another new stage of life, one free of the nagging, exhausting menstrual cycle, to boot. I’m honestly looking forward to it.
Jordan Rosenfeld is the author of 7 books. Her work has appeared in The Atlantic, DAME, Quartz, New York Magazine, Scientific American and many more. Follow her @JordanRosenfeld.