Understanding Perimenopause and Menopause: Biology vs. Emotion

A woman’s body experiences many developmental changes throughout a lifetime, bringing beautiful sentiment to the notion, “I AM WOMAN.” From the earlier stages of puberty through early adulthood and childbearing years, through perimenopause, menopause, and post-menopause, our bodies are resilient as they navigate challenging experiences biologically and emotionally. Most young girls prepare for puberty with support from caregivers, friends, and health classes in school, which normalizes this developmental change. Women in adulthood need better understanding, resources, and support around menopause, as this experience is not widely spoken of. Menopause or perimenopause signals a change in a woman’s reproductive and hormonal system, which will be the onset of disruptive symptoms such as irregular periods, hot flashes, mood dysregulation, sleep disturbance, vaginal changes, brain fog, etc. Perimenopause is when periods are irregular but have not entirely stopped, yet the symptoms of menopause persist, typically for women between the ages of 45 and 55 years old. A woman is considered to be in menopause when they have not had a menstrual cycle for 12 months. The onset of menopause often signals biological and hormonal changes and decreased estrogen, which will contribute to intense emotional disturbances. Emotional disturbances may include anxiety, depression, sadness, and irritability. Unfortunately for most, these stages are not short-term but instead last an average of four years in the perimenopause stage. Women deserve all the praise and compassion for the unavoidable hardships that come with the territory.

Hormonal imbalances are a significant contributor to women’s mental and physical state, which is a unique experience. Even the slightest changes in estrogen and progesterone may result in irregular periods, heavier bleeding, spotting between menstrual cycles, or missed periods. Naturally, with these bodily changes, fear and anxiety are high as we can’t typically anticipate the exact onset of changes. The changes in hormone levels are one of the first signals of decreased fertility. Estrogen directly impacts the reproductive system along with sexual development. Progesterone also influences the reproductive system, considering it is produced within the ovaries and will support a healthy pregnancy. A woman’s fertility is a highly sensitive topic as the identity of women is often rooted in their ability to bear children. The centuries’ worth of implicit pressure placed on women to desire children and have a family has led to women being shunned when there is resistance, whether by choice or biology. When perimenopause begins, women will often feel the initial shock that comes with grieving the youth that is associated with fertility. There are instances of premature menopause, which could be a result of surgically removing reproductive organs like the uterus or ovaries, cancer treatment such as radiation or chemotherapy, and other medical conditions/diseases. There are no defined indicators for the early onset of menopause other than genetic predispositions and lifestyle/environmental factors. There are many cases in which the early onset of menopause cannot be explained, which should be explored with a doctor to ensure appropriate long-term health care is given.

These hormonal imbalances will contribute to changes in skin, body weight, bone density, and digestive issues, which only adds to the frustration that our body is changing without notice or permission. The skin may appear drier or even acne-prone, worsening the insecurities around physical appearance. Body weight may fluctuate, disrupting any healthy regimen between movement and intuitive eating. The imbalances of these hormones may lead to increased body dissatisfaction and body dysmorphia, subjecting women to a distressing mental state. The psychological impacts of menopause are as daunting, if not more so, than the physical changes. Imagine being at war with your body as you could previously anticipate monthly menstrual cycles and your body’s unique symptoms during this time of each month. During menopause, you lose that foresight and familiarity of knowing your body. The disorienting feeling creates high dissonance between the mind and body, which may lead to confusion and sadness. Your typical triggers for anger may heighten, and instead of having increased mood swings or irritability when pre-menstruating, you now recognize you are dysregulated for weeks and months on end. The constant increased feelings of stress or low affect will compound with the chemical imbalances, potentially resulting in the onset of anxiety or depression. Higher anxiety may feel like perpetual nervousness, fear around the future, indigestion, hot/cold sweats, fear of the worst happening, numbness, inability to relax, etc. Symptoms of depression will include increased sadness, appetite impacted, sex drive affected, higher guilt, feelings of disappointment, and, in severe cases, feelings of suicide. The emotional turmoil of menopause can be incredibly isolating, but when met with understanding and care, we can help women through this vulnerable season.

​​While the process of menopause will feel like a whirlwind, modern medicine has led to effective forms of treatment, from medication management to hormone therapy and antidepressants. Menopausal hormone therapy (MHT) includes both estrogen therapy and combined hormone therapy to regulate hormones and reduce undesirable symptoms in the form of pills, patches, or vaginal creams. Unfortunately, these are not without the risk of additional side effects such as bloating, weight gain, and water retention, though they often resolve quickly. Holistic forms of treatment are also explored by many women who prefer herbal treatments and acupuncture to experience the benefits and relief of symptoms. Lifestyle changes such as:

  • eliminating harmful substances, drinking alcohol/caffeine, smoking
  • introducing foods rich in protein, calcium, vitamin D, natural supplements, fruits, and vegetables
  • reduce the intake of processed food and refined sugar
  • increased water intake
  • increased bodily movement with regularity
  • introducing mindfulness activities such as deep breathing and yoga

Perimenopause, menopause, and post-menopause are tangible indicators of aging and the biological clock within us. As time passes, and we feel the physiological changes to our body, we are reminded of our body’s resilience from the myriad of life experiences it has overcome. Identity rediscovery is an integral part of this journey as we shed the layers of our past selves and find new meaning in being a woman. There is beauty in returning to yourself with grace, self-compassion, and the most genuine form of self-love. The following statements can help promote self-love during menopause:

“My body is changing; as I’ve overcome it before, I will overcome it again. This is for now, not forever. My body changing is a reminder of the life I’ve lived and continue to live. My body is not all of who I am but the vessel that carries me through life. I can embrace my body today with one form of self-care.”

Step into this season with a newfound purpose by identifying changing values, interests, and experiences that will empower acceptance. Share your symptoms, seek support from other women and friends, and reconnect with your body intentionally. The outcome of navigating this season of menopause will feel reassuring and serve as another form of validation of all a woman’s body experiences within a lifetime. The embodiment of a real-life powerhouse, we are WOMEN.

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