What surprised me the most about hot flashes is how they almost feel like contractions. The slow wave, the tensing, the immersion in sensation, the fad, and the relief when the discomfort is over. The way I get through them is the same way I got through contractions, too: by breathing slowly and riding the wave instead of fighting against it. The only thing I had ever heard about hot flashes was how miserable they were.
Turns out, there is a whole lot of stuff no one says about about menopause and its precursor, perimenopause.
First, some definitions: Perimenopause is the time period where a woman’s body experiences a lot of hormonal ups and downs as the ovaries begin to produce less and less estrogen and progesterone. The body is preparing to stop ovulating and menstruating – menopause is literally the end of menstruation. A woman is considered to have reached menopause when she has gone without a period for 12 months.
It is a big time of transition and for some women, it is more difficult than being 13 all over again.
I think menopause seems to get blamed for a lot of things that are actually perimenopause. As our hormones fluctuate, everything in our bodies gets affected. Just as when we were teenagers, there may be acne, bloating, mood swings, hair changes, weight changes, and other symptoms. Psychologically, we may have a hard time because estrogen is closely tied to serotonin, which affects mood. Many times symptoms peak after menopause and then settle into a “new normal,” but getting treatment early on can make a huge difference for future health.
I remember when my Mom was about 40, she once got so enraged by a change in some vacation plans that she literally threw her bowl of noodles across the room. We were finding shards of that bowl for years afterwards. Other times? She would get weepy and just fall apart. Her emotions were the first signs that her hormones were changing; since she had really heavy menstrual cycles, she hadn’t noticed any changes with those yet.
Some days I feel like I owe my Mom a huge apology because now? Now I get it.
Mood swings similar to premenstrual syndrome (but much less predictable) are definitely a factor in this time of life. And a lot of us have teenagers or other children in the home, making it seem like a maelstrom of emotion. Or not.
Some women may also grieve the loss of their fertility during this time. If you have always wanted a baby but your body starts showing signs that it’s closing up shop, it can be a real gut punch. Even if you are done having children or don’t want to have children at all, there are some (sometimes societal) ideas about being a woman that may be affecting you.
Another symptom that I certainly never heard about is the brain fog and distractedness that can come along with perimenopause. Because of the hormonal changes, I struggled enough so that previous coping skills I used for ADHD became much harder to use and less effective. I have post-it notes everywhere, lists upon lists, and still sometimes my brain will just kind of…fuzz out.
A previous month when I had a blog post due, I knew it was going to be late. The internet was wonky and I had some technical issues submitting it, but that wasn’t the main reason that I had problems submitting on time. The main reason was that I was feeling like a crazy person. Grumpy, itchy, sensitive to sound and distraction, hungry with zero appetite, and just about ready to toss all our cats and my husband out the door. I was all 7 of Snow White’s dwarves, and it was not pretty. I was in no frame of mind to write anything. Most days I am fairly calm, collected, and productive – perimenopause has occasionally taken that and flipped it on its head.
Did I mention that this is a huge time of transition?
When my symptoms started, my partner was retiring from the military. One daughter had moved away from home a few years prior and the other one was getting ready to graduate high school. Then my mom died, and suddenly I was navigating a whole LOT of things at once. This can be a volatile time of life, and I don’t know why we don’t talk about it.
Maybe it’s because it starts earlier than many (including medical professionals who should know better) think. Some estimates are that perimenopause can last 10-15 years and usually starts around age 40-45. Some women go through this early, however, and it is important to find a doctor who can treat the patient they have versus treating the patient in the textbooks. Far too many women in support groups on Facebook and Reddit have said that they have all the symptoms of perimenopause, but their doctors tell them “they’re too young” or dismiss their discomfort.
Bodies just change, sometimes in weird ways, when our hormones aren’t produced as frequently or evenly as before.
We may get hair where we didn’t before, such as the chin whiskers my mom rued until the day she died. Alternatively, and kinda nicely, we may end up not getting as much hair as we used to on legs or other places. The hair on our heads may thin or become somewhat fragile.
Another thing that doesn’t get mentioned about perimenopause or menopause is that our sex life can change. Without the normal doses of estrogen and testosterone (yes women have this as well, just in lower amounts), it can be harder to feel arousal or desire. Those lovely emotional changes can affect this as well. Vaginal walls can become drier, causing discomfort. There are definitely products out there that can help with this, and a loving partner can go a long way to keeping things alive.
Because of the hormonal changes, our metabolism may change. Nutrition during this time is extremely important – getting an annual physical to analyze your bones, vitamin D levels, etc would be a good idea early on. Many women notice that it is more difficult to lose weight or that weight seems to magically move. I know my belly is much squishier than it used to be, even though I’ve been lucky enough to keep a steady weight so far. Exercise and nutrition can be life changing as you begin to build the body you get to keep through old age.
By the way, did you notice back there when I said this process can last 10 years or more? That was not a typo.
While women’s bodies and their experiences differ, this is a marathon and not a sprint. Chances are, unless menopause is brought on via medical means (such as a hysterectomy removing ovaries), some symptoms were noticed earlier and dismissed as PMS or some other irregularity. Most women do not experience 10 years of utter hell and if you are in that kind of situation, please find a doctor who will listen and help you.
So, what does help look like?
Help can look like Hormone Replacement Therapy (HRT), which has many more options than in previous years. There are concerns and debates about hormone therapy and safety, but having a doctor who is well informed on these issues can help a great deal when you make your decisions.
Help can look like mindful self compassion, which helps us treat ourselves like we would a good friend. Help can look like a trusted therapist, or regular walks or other exercise. Since sleep can definitely be affected by both the mental and the physical symptoms, fixing your sleep cycles and sleep hygiene can really improve things as well.
Help can look like many things, and there is no better time to focus on your health, creating foundational practices for the rest of your life.
For me? The same things that helped me when my babies were tiny and again when they were teenagers are helping me now. Taking care of my own mental health allows me to take care of my physical health. I remind myself, as this writer so beautifully put it, “Hormones will balance, and emotions will stabilize.”