The Journey through Peri-Menopause
How mothering ourselves through the loss of the young feminine can open the door to a more empowered, expansive sense of Self.
While some women move through peri-menopause with little or no discomfort, others struggle tremendously, both physically and emotionally. It can seem like a prolonged wilderness experience that’s difficult to navigate, and even harder to chart a path through.
Q & A with Shira Myrow
Q: Do all women go through peri-menopause? Why is there a stigma around it?
Yes, every woman goes through some version of it. Peri-menopause usually begins in a woman's 40s, but it can start in her 30s as well. Peri-menopause lasts up until menopause, when ovaries finally stop releasing eggs. When women have a drop in estrogen levels they may start to experience menopausal symptoms. While not all women experience severe symptoms, none of us escape the fact of menopause. Each individual is so unique in this regard so I’m speaking to those who suffer with it.
The stigma is part of the negative bias towards aging in general-- and it’s so entrenched in our culture, it obscures the potential value and meaning underneath the experience of this hormonal transition. When we think of peri-menopause, some of us just want to run for the hills--we don’t want to deal with that just yet. Luckily the conversation in the wellness world has been how to live well, how to age well, how to find optimal balance. These are much more empowering frames.
We forget that there’s a natural life continuum. Adolescence is what we see as the major biological and psychological transition into adulthood. We gear up for adolescence as parents so we can cope with the roller coaster of changes. We talk our kids through it. We try to reassure ourselves as parents when we hit low points. We conceptualize it differently than we did in the past. But it’s an ongoing decade of conversations around identity, hormones, sex, social and emotional changes, peer pressure, autonomy, and morality, etc—as our teens eventually emerge into adults.
Peri-menopause can also be a very generative stage of our development. It’s one piece of the midlife transition. Women who struggle with peri-menopause in particular are forced to confront some of these questions through the gateway of the symptoms, as opposed to the grief of a failing marriage, or an illness or dissatisfaction at work. But we may only come to that understanding in retrospect. Initially most of us feel burdened by what we’re encountering because we can’t make sense out of the experience. So in that respect, it feels like we’re in a wilderness period. But actually, it’s the passage that we emerge from into the second half of life which may be the next 30 or 40 years.
Q: Do people seek out psycho-therapy for peri-menopause?
Not initially. A client might come in for depression or anxiety or relationship problems--and not realize that they are struggling with a hormonal imbalance as well. Peri-menopause is completely tied into mid life questions but it’s often hard to parse through and separate what the root cause is. I’ve been on my own personal journey for seven years with peri-menopause, and have been witness to it as a therapist to both individual women and couples. But it isn’t necessarily integrated into the larger narrative of our lives. So now I routinely ask clients ( both men and women) in their mid to late 40’s to consider getting a hormone panel and have their blood work done if they’re describing certain kinds of symptoms. Because our psychological health is completely intertwined with our physical health, we need to rule out certain factors to zero in on the particular set of causes that create suffering. For example, desire discrepancy in a couple may have a connection to a drop in hormones in either partner. Or it may be borne out of a disconnect that was brewing for a long time--or what I’m finding more often--is that it’s both. We’ve been treating peri-menopause as something in isolation, to manage and contain —often silently, privately and without enough support. I’d love to see the conversation change around this.
Q: What do you think causes so much psychological anxiety and distress, beyond the mood swings and hot flashes?
Part of the anxiety and overwhelm may be the inability to understand how all the pieces work together and affect each other. How our hormones affect our behavior and our well- being is really quite complicated. So the first order of business is to educate yourself. Do the research, get comprehensively tested, and be proactive about making changes. There are amazing resources available now.
Another cause of anxiety is the palpable feeling that you are not driving the bus! Your hormones are. You may feel like you’re in a free fall….and it’s the lack of control which begs the bigger question here--what is within our power to influence and change? What must we accept? Mid life forces us to come face to face with certain limits any way. We have to honor certain limits or conversely, it’s an invitation to break through certain self-imposed limitations. For example If you’ve been in an unhappy or toxic relationship or career—where you feel invisible or devalued —you may feel the imperative to renegotiate or leave it all together. Is that hormonally driven? No, but your hormones may amplify a brewing dissatisfaction or sense of resentment that is already there.
Therapy can be part of your wellness program. I recommend learning how to self soothe with mindfulness, with compassion, meditation and exercise that you enjoy as well. There are going to be times when those hormones do drive the bus. And you’ll need to have a compassionate process, a way to dialogue with yourself so you can discern what’s happening internally, and hopefully become more responsive to what needs attention--versus emotionally reactive. We forget that there is tremendous intelligence in our emotions. A good therapist can help you sort through and integrate your experience
If peri-menopause is affecting you--recognize that this transition could also affect your intimate relationships—with your partner, your family and your children. Share to the degree that is safe and appropriate with your close relationships. Lisa Selin Davis wrote an op-ed piece in the New York Times entitled “Puberty for the Middle Aged” where she argues for the wisdom of having “the talk” from health care providers to women about what kinds of changes to anticipate on the road to middle age. That’s a great beginning. But like adolescence, I think we need to be in continuous conversation around it.
Q: We already have trail blazers like Dr. Sarah Gottfried and Dr. Christiane Northrup who have made it their mission to help women understand the intricate inter-relationship of hormonal symptoms to find relief, balance, and empowerment during this transitional period. What do you feel is missing ?
Many of us get caught up initially in the intense discomfort and drama of the unpredictable physical changes. Changes that seem resistant to the already healthy and conscious life styles many of us have worked incredibly hard to forge through diet and exercise. The symptoms can include fatigue, insomnia, hot flashes, irregular cycles, brain fog, decreased libido, exhaustion, overwhelm, mood swings, depression and anxiety, etc. . But we don’t go beyond dealing with the physical/emotional symptoms and ask the bigger questions. We put it in some kind of silo.
What’s really going on biologically-- is that we are losing our fertility along with our young feminine identity in a culture that is completely obsessed with beauty and youth. We associate this loss with feelings of limitation, devaluation and reduced potential--to find a mate or have children let’s say. We have to face that in an intelligent, conscious way. We also have to identify with our value as women in a different way.
You might experience purely hormonally induced depression and anxiety and you may also experience a natural depression and anxiety around the grief and loss of your youth. That’s real. If it wasn’t, we wouldn’t be spending billions of dollars to turn back the clock—men and women alike. Men go through hormonal fluctuations as well, but for women, there is an intricate and complex relationship with the psychological and the biological aspect of fertility.
Q: Mid life is often a time of empowerment, agency, and growth for women, yet we are acutely aware that we’re physically aging as well. Does one interfere with the other?
Accepting impermanence would go a long way to de- pathologizing aging. We’re all aging every moment. It’s not something we have to medicate ourselves through or inoculate ourselves against. Aging is part of the cycle of life. The focus should be on living well. The 40’s does not have to mean physical diminishment and limitation--not if you take care of yourself and you are intentional about your choices. However, if you are not conscious about your choices, you’ll be forced to confront them one way or the other.
The 40’s are a decade where many women move directly into their prime, into their agency, into a deeper sense of their own power. It’s a time of individuation. The clarity we possess about who we are expresses itself in relationships and work, around limits and boundaries. It can be a period of expansion, accomplishment, and quite frankly, not caring as much about what other people think, which is liberating. We may also feel compelled to break out of old patterns, relationships and situations that keep us small, confined and constricted. But in breaking out of those containers, it creates disruption in our relationships or in our family system. It’s a system that depended on us being bound out of duty and sacrifice. The disruption is absolutely necessary.
Q: Can you speak more to the idea of mourning the loss of the young self?
Yes, we have to grieve the loss of the young self so we can redefine femininity as it is now. Feminine beauty is not static. It’s not bound by age, but it looks different at every age.
There is a freedom in letting go of the young self. It’s really important to differentiate that it is a LOSS of the experience and identification with young femininity and the sexual power that often comes with it. If we can accept it, then we can transition into a different kind of femininity. One that isn’t fighting to be something it can never be again, but a more expansive definition of identity with a capacity for beauty and sexuality that is not confined to a particular stage of life. If your beauty card is your primary power card, you have an opportunity to redefine beauty for your age.
As women—we don’t have to give up sexuality or desire or beauty. Not at all. If anything, we can explore what all these things mean to us now. Many women at this stage re-discover dormant or lost aspects of their sexuality. As young women, we may not have the courage or the ego strength to explore these questions in the same way. But in adopting an attitude of kindness, compassion, and curiosity, we can embrace the metaphorical death and rebirth.
Q: Can you say more about death and rebirth here?
Yes. Grieving the loss of a young self and letting go is absolutely necessary to making space for a new, consciously constructed identity. And that’s what is fundamentally different about this stage versus adolescence. During adolescence there is a great deal of experimentation and risk taking and floundering—but peri-menopause has different demands. It requires first a vigilance and tenacity that we become the stewards of our health, that we mother ourselves through a process that is so intimate, so unpredictable and fraught with uncertainty at the beginning. The irony of course, is that the mothering is around a process that moves us from fertile to ultimately infertile.
And yet we birth into a new self—because the discomfort forces us to-re order our lives, re-privilege our health, and focus on making radical changes that are based on our values. We also must mother ourselves through the mid life questions: where we are in our lives, what do we value, what behaviors no longer serve us, and who we want to become going forward, how we move in the world. So the transition becomes a doorway into much deeper questions around re-defining feminine identity. Are you an overachiever, a perfectionist, a martyr, an over giver? Have you been unable to actualize your potential in some way?
Mid life is about taking inventory of our lives when we have the capacity to hold a level of complexity, ambivalence and ambiguity that we simply don’t possess during adolescence. This is so overlooked--but it’s huge. You have life experience on your side! You can tolerate paradox. You can tolerate complexity. You can tolerate uncertainty. And in a sense these are the golden keys you will need to face the second half of life if you’re willing to grapple with the questions. Fundamentally, your Identity should be based on being in alignment yourself and with your values.
If we can expand our perspective around the transition of peri-menopause , its biological function doesn’t have to dampen the incredible value and meaning we can make by working through it. The loss of the young feminine can make space for a deeper, more empowered, expansive version of ourselves.
