The Roller-coaster Ride of Mental Health During Perimenopause
I am perimenopausal. I am almost 46 years old and my body seems to have a mind of its own. Sometimes I wake up and wonder why I feel as though the body I inhabit no longer feels like “me”. Until recently, (the last 10 years or so), most people had NO idea about the period of life immediately preceding the permanent end of menstruation, (which is actually what “menopause” is), even had a distinct name. I myself did not until lo and behold, it started happening to me. Although we hear many jokes about the physical symptoms of perimenopause like weight gain, changes to menstrual cycles, hot flashes, night sweats, loss of bone density, poor memory, changes in libido and lubrication, we generally do not think about the mental health concerns that arise as a result of simply aging out of our reproductive years.
As it is World Mental Health Day on October 10 of this year, I thought it a good idea to write this post to shed some light on my own journey through perimenopause as well as what I have learned as a mental health practitioner and a patient about its negative effects on mental health. After noticing that my moods were swinging like a pendulum for a number of months, my waistline beginning to expand no matter how much I monitored my diet and exercised, the hot flashes and night sweats that often woke me up, and that my already poor memory really began to fail, I started asking around about the bizarre symptoms I had been experiencing slowly over time since the age of 40. My doctor never thought to check for fluctuations in hormone levels because according to the medical system I was told I was “still too young” to begin the process of transition out of my reproductive years even though some women begin perimenopause as early as their 30’s. I became frustrated and felt as though no one was listening to what I was saying. Eventually, I decided to see a naturopathic doctor in Vancouver who specialized in women’s reproductive health. She collaborates with my family doctor around my care and my own therapist has been given permission to talk to either of them to monitor my progress.
After ordering blood tests for me, she went through the results to let me know that I was in fact in perimenopause. The relief I felt at knowing that it was not “all in my head” was indescribable. I immediately asked what could be done to help me so that I did not continue suffering as I had been. I was offered herbal supplements or hormonal replacement therapy (HRT). Initially I had been dead set against HRT as I had heard several horror stories about negative things that can happen to women after starting take it. I instead opted for supplements to see if those would work. We tried them for a year and they helped. However, there was one symptom I was NOT prepared for at all and for which the supplements were not helpful…compromised mental health.
One day after a particularly dramatic decline in my mental health, my doctor and had a in important conversation. She administered screening tools for depression and anxiety as part of her routine work with perimenopausal women and based on my insistence that my mental health was declining. Coming out of that process, she determined that my depression score was so high that it warranted immediate intervention. As a mental health practitioner, I was unsurprised but nevertheless alarmed.
She went on to explain that onset of mental health challenges, (specifically anxiety and depression), in perimenopause is common and that the risk of developing a mood disorder specifically during this period is fourteen times higher than at any other time during the lifespan. Many studies bear this out, (see here and here for additional information), but most of the time, women are not informed about this phenomenon possibly due to enduring taboo around female reproductive health and its interaction with mental health stigma. It is time for us to include this in our discussions around the perimenopause experience.
Thankfully, I have noticed that since I have been going through this process, popular culture has started to talk more about the issue. On the T.V. show Blackish, there was a conversation between a perimenopausal woman and her usually critical mother-in-law that was worth the watch. It helped with reframing the process of perimenopause as an opportunity for reclaiming, which it is, (see clip here). Wanda Sykes’ jokes about her perimenopausal “belly roll” she has named Esther normalizes one of the most sensitive aspects of the process. Many other prominent females within the global community have been coming forward and talking about the journey to menopause including Michelle Obama. However, I will always have special appreciation for Gabrielle Union’s candor when she opened up about the suicidal ideation she experienced during perimenopause.
I resonate with Gabrielle Union’s contribution to the discussion because just prior to having my doctor screen me for depression, I too had suicidal ideation related to perimenopause that was very serious. As someone in mental health and who advocates for people speaking openly about it to de-stigmatize struggles, I was comforted to know that someone with as large a platform as her could name the thing that many of us experience but are very hesitant to share. In that regard, I am able to say that I too know what that feels like. I also know that this is very common as nine in every ten women in perimenopause struggles with mental health, (see here).
The truth is, the sense of betrayal by one’s body and mind can be so overwhelming that it truly does feel like a better option to just cease to exist. This is what suicidal thoughts are really about. The feeling of pain is so intense that you want it to stop at all costs and the idea of no longer existing feels far more comforting than continuing to suffer. It is the reason I was unable to write anything on this blog for months. Thankfully, I chose life. Unfortunately, not everyone does.
What changed my life was deciding on HRT however, this is not a choice that everyone can or should make. Working with a competent health care provider to measure your risks of adverse effects including the development of various cancers is essential as is ensuring that you stay on top of your blood tests, pap smears and mammograms. However, in my case, I have not struggled with severe mood issues for a few months. For me, that made it worth it.
I want to encourage everyone going through the perimenopause process to check in with themselves and their doctors. Advocate for yourself even if your doctors tell you that you are “too young”. You know your body and you know when it feels different. Notice what is happening and if you have never been to therapy before, now is an excellent time to start. There is NO shame in reaching for help it could literally save your life.