Until recently, perimenopause had a reputation of being something that was only of concern to “older” ladies. Think: gray-haired grannies playing bridge. In fact, perimenopause, the transitional period where hormones begin to fluctuate, causing symptoms like irregular periods and hot flashes, typically begins in the early to mid 40s but may start earlier. (Once women skip a period for an entire year, they’re in menopause.)
But that pre-period, previously, has been glossed over, not only by women going through it, but the very doctors who could be helping them through it. Recently, that stigma seems to be lifting, thankfully, in part because celebrities like Naomi Watts and Drew Barrymore are speaking out about their experiences.
Says Barrymore: “I realized that I was in perimenopause when I started having my period every two weeks. One doctor also just told me this could last, in the worst-case scenario, 10 years. And I was like, I will never make it 10 years like this!”
Drew is right, of course—10 years is way too long to not feel like “yourself”. The Local Moms Network turned to Dr. Jennifer Okwerekwu, a Harvard-trained reproductive psychiatrist who is a leader in this field, to share a bit about what all women should know—and how specialists like herself can help.
Is it true that perimenopause can last years—and what are signs a woman is in it?
Yes – you’ve reached menopause when you have not had a period in 12 months, but before that milestone is reached, you can have irregular periods and a variety of physical and mental symptoms due to hormonal fluctuations. That’s what we call perimenopause or the perimenopausal transition. The average age in the US for menopause is around 51 or 52, and perimenopause can start almost a decade beforehand.
Hot flashes are commonly recognized symptoms of perimenopause, but it can also be associated with other symptoms from your head to your toes. For example, some women may experience joint pain, weight gain due to metabolic shifts, genitourinary issues which can cause problems with sexual function or incontinence. From a mental health perspective, hormonal fluctuations can also be associated with insomnia, depression, anxiety, and what patients often describe as “brain fog”. It’s so important to note that people who have struggled with mental health issues in the past – especially during other periods of hormonal transition, like the postpartum period – can experience a recurrence or worsening of their symptoms.
As a reproductive psychiatrist I help my patients key into the mind-body connection and the relationship between how you feel physically and mentally. If you’re having hot flashes at night for example, and it’s disturbing your sleep, that insomnia can really impact your mood and anxiety.
Such helpful information. Are there myths around perimenopause that you’re seeing debunked?
People capable of menstruation spend about half of their lives in menopause. Menopause is a natural transition and not a disease. As a society we’re uneducated about what that means. We need to stop thinking of menopause as a scary ending, but rather a new beginning. We are more equipped to weather natural transitions when we are prepared. Stigma and shame around menopause often stifle our opportunities to empower ourselves with education and support. Just like with motherhood, there is a myth or misconception that women should struggle in silence. If we don’t have cultural conversations around changes like motherhood or menopause, they can be even more difficult than they need to be.
If you are seeking help, why is seeing someone who specializes in these issues important?
Women’s mental health specialists have a deep understanding of what women experience in mid-life and beyond. Expert care takes a holistic view and the symptoms their patients are struggling with and offer treatments that address the root cause. For example, if you seek treatment for depression but you’re still not sleeping at night due to the frequent urge to urinate, your mood may not improve very much because your treatment is missing a big piece of the puzzle.
With so many diverse symptoms impacting nearly all of our body systems, it can be hard to tell a doctor all that’s going on in a 15-minute visit. Even if you don’t have access to a specialist, empowered patients that are educated about what’s happening to their bodies can be much more effective at advocating for themselves too.
How do you help women going through perimenopause?
As a reproductive psychiatrist I most commonly see perimenopausal women that describe a depressive funk, irritability or anxiety that they just can’t shake. We start by talking about all the symptoms they may be experiencing – both mental and physical – and how they are connected. We also explore the psychological stressors that uniquely impact women in mid-life too.
Then we explore mental health treatment strategies– which can involve prescribed medication, integrative strategies, lifestyle modification, and psychotherapy. For many women, collaborating with OBGYNS or women’s health specialists that offer Menopausal hormone therapy or hormone replacement therapy can also be quite useful, so we explore the options of engaging other specialists too.
Treatment can be quite varied, so it’s important to understand how perimenopause is specifically impacting each patient.
Some women complain of poor focus and attention or memory issues during the perimenopausal transition, for example, and wonder if they have developed ADHD or early dementia. I help them sort out what’s perimenopausal and what’s not and can offer treatment strategies to help support cognitive function during this chapter.
Sleep is so fundamental to everyone’s ability to feel well. Sometimes that means exploring medications that target mental health symptoms and help minimize hot flashes at night. For others, it could mean exploring medications and behavioral strategies that target mental health symptoms and also help reduce the urge to urinate several times a night.
Weight gain is another common complaint during this transition. As a psychiatrist I often discuss the importance of exercise during this transition – but it’s not about losing weight as much as it is about being mindful of your mental health and your body composition. Exercise becomes dually protective against both physical and mental challenges that may accompany perimenopause. It’s an investment in yourself — it’s not about vanity. Again, treating perimenopause is a beautiful marriage between physical and mental treatment strategies. Investing in your physical and mental health today sets you up for tomorrow. With half of your life lived after menopause, that’s a lot of tomorrows!
That makes sense. Anything else you’d like to share?
The good news is that there is a “cure” for the symptoms of perimenopause and that is menopause – your hormones won’t be fluctuating forever. We need to talk about what is bothersome and what is intolerable and encourage women to take steps to reduce any symptoms that may be too burdensome. For instance, if you have a headache, we take Tylenol and can make it go away – even if it will go away on its own eventually. Caring for yourself during the perimenopausal transition is about maintaining a quality of life over this time. As your hormone levels stabilize, you’ll feel better. But a decade is a long time to manage.
Psychiatrists can be a very instrumental part of your treatment team. Perimenopausal women may be at high risk for burnout because they may abandon themselves and put themselves last because they are doing so much for other people. During this chapter, women who work outside the home are also approaching the peak of their careers which can be a lot of responsibility. They may also be sandwiched between taking care of kids and their aging parents, again, there is a lot of stress. Mental health professionals can help you process the reality that you’re living in. This work is augmented by the medical assessments and treatments that alleviate the physical symptoms and biological drivers of mental health problems that undermine your ability to thrive.
Thank you! What is the best way for anyone interested in working with you to reach you?
To learn more about Dr. Jennifer Okwerekwu, read our Meet a Mom interview with her.