I crossed the threshold to 40 this last year, so I figured I ought to figure out what I am in for hormonally in the years to come. Many women have heard the medical term “perimenopause” and wondered what it means and what to expect. I hope this article serves to assist those curious about this reproductive life stage by providing some information on how to manage mood swings brought about by hormonal fluctuations. It has also been informative to learn more about this stage for myself, a woman newly in the decade of “40-something.”
Just what is perimenopause? Experts define this period as the 10 to 15 years in a woman’s life preceding menopause (the cessation of menstruation). Therefore, perimenopause can begin in a woman as young as 35 or within a few months or years before age 51, the average age of menopause. With the increasingly delayed age of child-bearing becoming common news in the U.S., it is even possible for a woman to become pregnant while simultaneously experiencing perimenopause.
Physically, many (but not all) women experience mild mood swings, fatigue, hot sweats, and irritability during this transitional period. Studies indicate that a woman’s body undergoes just as many rapid hormonal fluctuations during perimenopause as she endured during puberty. Without getting graphically medical, we know that all the hormones in a woman’s body interact in a delicate interplay with the neurotransmitters of the brain that regulate mood (specifically serotonin). When hormones are rapidly fluctuating, it stands to reason that neurotransmitters can fluctuate in response or in conjunction with estrogen and progesterone and the amount thereof in the body at any given time. Suffice it to say that perimenopause can be a tumultuous time of “mood instability.” Furthermore, studies show that women who have experienced depression or anxiety during prior periods of reproductive life events (i.e. menstruation, pregnancy, childbirth, breastfeeding/weaning, fertility treatments, etc.) are more susceptible to depression and anxiety during perimenopause.
Marcelle Pick, RN, at Women to Women (womentowomen.com), who is a colleague of well-known author Christiane Northrup, MD, suggests a holistic approach to balancing out hormones. Good nutrition, appropriate sleep “hygiene,” exercise, and managing stress are essential during this time of hormonal fluctuations. Although I do not endorse her products one way or the other, she recommends various nutrition supplementation accompanied by herbal support. Omega-3 fatty acids are also recommended during perimenopause, according to Pick.
From a psychotherapy standpoint, I work with many women who are in the decade of “the change.” I like to empower women to celebrate the capacity for their bodies and minds to create, whether or not they have chosen to bring new life into the world. Women need to honor the ability for their bodies to create/adopt new life, as well as their ambitions and dreams. In addition, if a woman is perhaps mourning the lost potential to conceive a child, I will work with her via grief therapy and help her with lifecycle role transition. For those experiencing a very physical hormonal fluctuation contributing to negative mood health, I prefer to work closely with medical/ holistic practitioners to be sure my clients are receiving adequate hormone support, as well as the possibility of antidepressant medication if indicated. Managing stress and focusing on self-care is vital for women in this life stage, as in any life stage, but very clearly during a decade where there can be competing demands of raising children and caring for elderly parents, all the while nurturing a career.
Women are, through and through, nurturers, and I feel that careful attention to nurturing oneself as a woman, mother, spouse, sister, daughter, worker, etc., isvital to helping women through this transitional decade of perimenopause. Although potentially stressful and topsy-turvy, this period of life change can be one of transformation and hope for less stressful chapters in the years ahead as children mature, careers blossom, and finances solidify and grow. Many women also report a newfound spirit of confidence and liberation during this time, as prior notions of worrying about physical appearance fall by the wayside and and acceptance of the aging process proceeds. New priorities emerge, freeing up women to embrace their fullest potential.
It is an honor to work with women and their families throughout the lifespan, and it is particularly exciting to help women undergoing perimenopause accept and enjoy the change of life as a welcome transformation. I myself look forward to the possibilities ahead as I carefully place one foot and then the other across that marker that says “You have arrived! Welcome!”
Some helpful books:
The Menopausal Years: The Wise Woman Way, by Susan Weed
The New Natural Alternatives to HRT, by Marilyn Glenville
Homeopathy for Menopause, by Beth MacEoin
What Your Doctor May Not Tell You About Menopause by Dr. John Lee and Virginia Hopkins
Dr. Susan Love’s Hormone Book by Susan Love
Women’s Bodies, Women’s Wisdom by Christiane Northrup, MD
The Wisdom of Menopause by Christiane Northrup, MD
The Power of Perimenopause by Stephanie DeGraff Bender, M.A.
Self-Nurture by Alice Domar, PhD
The Silent Passage by Gail Sheehy
For holistic health during reproductive life events, check out Women to Women at : www.womentowomen.com
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