Written by Chokey Tsering
I was only in my early 40s when I entered perimenopause. The news came as a shock. I felt it was too soon. In spite of the relief in finally understanding the cause of my disruptive symptoms, emotionally, I struggled with what it entailed: the loss of womanhood, and the obsoletism that seems to brand most women in midlife.
My doctor’s perfunctory diagnosis was followed by a swift scratch on his pad - synthetic hormones, a quick fix to a pesky problem, but I didn’t stick with it for very long. I loathed the heavy perfume of chemicals that followed me to bed each night.
Wanting to try a natural approach to my symptoms, I realized how little I actually knew about perimenopause. The end of menstruation, mood swings and hot flashes were the extent of my knowledge. Before then, I’d rarely given menopause much thought, content to let it loom in the hazy, distant future. With a gradual understanding of what was happening to my body came a period of self-investigation that has impacted my very sense of self.
Perimenopause, peri meaning ‘around’ or ‘near’, is the period of transition leading up to menopause, the full cessation of periods. As the body begins to sense and react to hormonal fluctuations, the early stages of perimenopause can be especially turbulent.
This was certainly true for me: night sweats waking me up shivering in the middle of the night tangled in cold, drenched bedsheets, hot flashes that came on so intensely and abruptly that people asked if I’d got caught in a rainstorm and wild mood fluctuations, where anger featured the most prominently - an enduring, hot rage.
There were a host of other, random and strange symptoms as well. They had me running from one baffled medical specialist to another: heart palpitations that lead to full blown panic attacks, momentary losses of vision from ferocious migraine attacks, recurring cysts on my eyeball. Eventually, these too were also all traced back to falling levels of estrogen.
If this was a natural transition in a woman’s life, why hadn’t I heard more about it?
The peri-menopause transition can be experienced differently for each woman but what many seem to share is a lack of knowledge for this inevitable stage of life that can impact not just women but their loved ones, gender-neutral people, transgender men with ovaries, and women who experience artificial menopause through surgical removal of reproductive organs.
Our ignorance harms us - it precludes the critical support systems that women need, amplifies rates of depression and anxiety among this demographic and makes them vulnerable to serious health risks. Less tangible, but just as impactful, is the stigma that surrounds the menopausal woman, especially an angry one. Society’s prevailing aversion to female fury prompts women to disown their intense emotions, passing up a tremendous opportunity for personal scrutiny and wisdom.
The limited understanding of menopause reflects prevailing attitudes towards ageing and death, specifically in western culture. It also points to how our notions of femininity and womanhood are still deeply connected to childbearing and to appealing to the male gaze. Once a woman has outlived these prescribed roles, she loses her social viability making menopause feel like a symbolic death
Menopause doesn’t have to upend our lives. There are steps we can take now prepare for it and to protect our mental and physical health from its potentially disruptive effects. Early awareness will even enhance quality of life during our reproductive years. Most importantly, it will help us recognize and seize the unparalleled opportunities for profound renewal and purpose that await us in midlife. In order to achieve this, however, we must first debunk some common misconceptions.
Myth: Menopause happens when estrogen is depleted.
Perimenopause is actually a process that can begin well before obvious signs occur, such as the subtle changes in bone density. It can also last up to ten years or more before menopause sets in. The early stages of perimenopause are actually a time of a gradual decline of the hormone progesterone while estrogen levels either stay the same or even increase, known as estrogen dominance. When signs of excess estrogen first appear, unfortunately, women are commonly prescribed estrogen which can intensify symptoms. Speak with your medical professional to discuss the different kinds of hormone tests available to get an idea of your current place in the perimenopause timeline. Hormone testing may not reveal everything but can help to determine the best treatment at a given time, if desired.
Myth: The uncomfortable symptoms of menopause are inevitable.
Menopause is inevitable. Its symptoms are not.
A woman’s body has the capability to meet all her hormone needs throughout her entire life, but this is dependent on the state of her health. Lifestyle, specifically the quality of one’s health before entering menopause, can be an indicator of what the transition will entail. This underscores the importance of self-care in mind, body and spirit throughout the reproductive years. Unresolved conflict or issues in any of these areas may lead to chronic stress, undermining the body’s endocrine system and leaving it vulnerable to the demands of perimenopausal changes.
There is not one universal menopause. We tend to view it primarily within a biological context, but geography, genetic history and culture are also notable factors in how a person undergoes this period. Across different cultures and societies, menopause is experienced differently, suggesting that attitudes and the perceived role of women in the broader society play important roles. Across indigenous cultures, for example, menopause is seen as a time of spiritual renewal where women are elevated to the status of healers and priestesses. In some other cultures, women report few or no disruptive symptoms, despite undergoing the biological transition of menopause.
Myth: Menopause means the end of childbearing years.
Yes, and no.
While the official start of menopause marks the cessation of a woman’s period and her reproductive abilities, a woman can still become pregnant during perimenopause, in spite of experiencing symptoms. In fact, just like the final wild bloom of a dying plant, the body senses the impending end and the ovaries begin to allow whole groups of follicles to mature, instead of just one at a time. This is why twin births are not uncommon among older women.
Yet menopause is not just a reproductive matter. The body’s entire endocrine system is impacted and significant neurological changes occur. As a result, symptoms can potentially show up anywhere in the body, impacting multiple organs.
Myth: Menopause means sexual irrelevance.
Women’s sexuality and notions of femininity are still in large part shaped by a male-dominant culture. In fact, the word ‘vagina’ has a Latin origin to mean the sheath or covering for a sword.
Although hormonal decline and fatigue during perimenopause can lower one’s libido, these aren’t necessarily permanent states. As the body acclimates to the new internal environment, it’s not uncommon for perimenopausal and post-menopausal women to experience a surfeit of energy, which bodes well for a rejuvenated sex life. Further, in spite of the visible changes in the landscape of her body, women in midlife are typically more confident in their bodies. Menopause is a time of introspection, when a woman generally retreats from life for a while. As her relationship with herself fundamentally changes, there is tremendous opportunity to redefine and express what sexuality means for her.
Focusing on one’s mental, physical and emotional health throughout our reproductive years is the best means of ensuring our likelihood of not only easing into the menopause transition but of taking advantage of the profound opportunities for transformation that await us. If you’re struggling with uncomfortable symptoms, like I did, developing an openness to the discomfort can be beneficial. It will help us become attuned to unmet needs and lead us towards greater insight into ourselves. Higher life expectancy today means postmenopausal women still have several decades of living, and with that comes choices and new life directions. The release from the prescribed roles of womanhood frees us to explore our identity and purpose in the world on our own terms. Now isn’t that something to get excited about?