As a young psychologist starting out in my career, I gradually became aware that I was seeing a disproportionate number of women between the ages of around 42-52. It took me a while to start to figure this out; why were women in this age group seeking therapy in higher numbers than any other group? Initially, I thought that there must be extra stressors in this time of life, e.g., managing teenage and young adult children, marital grievances that had piled up, aging parents, money pressures, dissatisfying mid-life jobs, and an unending to-do list. Certainly, this seemed like enough to my 30-year-old brain to drive a disproportionate number of middle-aged women into therapy.

However, as the years went by and I kept listening to the experiences of women, I started to suspect that there was a complex story going on biologically— (not just a story of situational life stressors) that was bringing these women into my office in their 40s and early 50s. It turns out that these years are a time of largely invisible but significant biological stress on women’s bodies and minds. And I should also say that not every woman hits perimenopause in the “average” age range. Some women will go into menopause in their 30s, which means they can begin experiencing symptoms of perimenopause in their 20s.

In school, I never had a lecture about hormonal influences on women’s emotional or physical health, and I would guess that this is still true today for most psychology graduate students and also true for most medical students — (I say this as someone who takes care of a number of female physicians). This is not material most of them learned in school either.

So here are some of the things that I have picked up along the way about perimenopause and menopause:

1. Perimenopause is a period of hormonal change leading up to the official end of menstruation, and it and goes a decade or more for many women.
2. Once a woman stops having her period, the effects of hormonal changes linger on, often for many years going forward — (e.g., there are a lot of women out there still having hot flashes in their 60s).
3. Perimenopause and menopause are not a one-size-fits-all experience. Some women have a relatively easy course. Others have lots of symptoms and feel like they are under physical and psychological siege.
4. The number of physical, cognitive, and emotional symptoms that can be caused by perimenopause is mind-boggling. Itchy ears? Could be perimenopause. Dry eyes? Perimenopause. Frozen shoulder? Perimenopause. Thinning hair? Perimenopause. Feelings of doom and dread that roll over you while sitting at a stoplight, when 30 seconds before you were happily sipping your Starbucks? Perimenopause. Being so wide awake at 2 AM that it’s just easier to get up and start your day than hold out hope that you might go back to sleep? Perimenopause.
5. Some symptoms (e.g.; feeling tired, gaining weight, feeling down, having trouble remembering) can sound vague or could be attributable to lots of other factors, so professionals not well-versed in women’s health may be minimizing or dismissive. Anecdotally, I will say that the gender of your physician and the age of your physician both can play a role here.

If the descriptions above sound like you, I would encourage you to get an appointment with a trusted or well- recommended primary care provider or gynecologist to discuss your symptoms and possible treatment options. Ideas about how to manage perimenopausal and menopausal symptoms are quickly evolving, and working with a doctor you trust can be an important step in feeling better. Seeing a qualified therapist who is familiar with women’s health topics can also be a helpful addition to your care. This is not a road you need to go alone while suffering silently.