Field notes from perimenopause

What the body can tell us about how we are living

Image by Alexander Grey on Unsplash

I’ve lived with an autoimmune diagnosis for close to 20 years, and symptoms that extend back further than that.

As inconvenient as this has been to my life plans, it has taught me a lot.

One of those lessons is how to listen to and decipher the subtle (and sometimes not so subtle) language of body symptoms.

It took a long time to join the dots, but it eventually became clear that there is nothing random about my autoimmune flare-ups. They follow on from periods where I have overextended myself, emptied my bucket of resources, and gone into debt with my body (I‘ve written more about this here).

The symptoms don’t generally show up in the period during the intensity – this is the phase where I ride a wave of adrenaline and cortisol, and feel like I have extra energy. They tend to show up in the aftermath, when everything has quietened down a little, and the debt must be repaid.

What does all of this have to do with perimenopause, I hear you ask?

Actually, everything.

Seven years into perimenopause, I’ve learned that the patterns are essentially the same. My years of experience with chronic illness turned out to be exactly the training ground I needed to learn how to navigate the challenges of mid-life and hormonal shifts.

The key for me has been learning to understand the language of my nervous system and to recognise when it’s out of balance – when my system is flooded with stress hormones and a survival response that is above and beyond what the situation demands.

This knowledge, and the toolbox of practices I’ve cultivated over the past 10-15 years, have been an absolute godsend in recent years.

Perimenopause was heralded for me in my mid-40s by a sudden upsurge of anxiety, and heightened sensitivity to sensory stimulation. Almost overnight, I found I could no longer tolerate excessive noise, light, crowds, people, and socialising. Sleep became a barometer, and will very quickly go out the window whenever my sensory system is overloaded. If I override this, I struggle. If I listen to what my body is requesting – simplicity, solitude, slowing down, screen-free time – my body thrives.

Now, I’m not a physician (my doctorate is in clinical psychology), and I won’t pretend to speak for everyone, but I think there’s something important here, and I observe similar patterns in many of my mid-life clients.

My understanding is that the adrenal glands play an increasingly important role in oestrogen production as the ovaries wind down their hormone production at menopause. It makes sense that if our adrenal glands are overloaded with the production of stress hormones like adrenaline and cortisol, there will be a hormonal trade-off, and the body will always prioritise stress hormones for the purposes of survival. I’ve come to believe that navigating stress and balancing the nervous system are key for many of us in finding balance through menopause.

There is so much wisdom in this life stage.

It is a call to take a long, hard look at how we’re living. It highlights lifestyle patterns that are out of balance, ways in which we are depleting ourselves, and living out of alignment with our needs. It challenges us to let go of what is no longer serving us. The more we resist the body’s wisdom and ignore its needs, the more we suffer.

I find that if I am ruthlessly honest about what my mind, body, and soul need, then my body is at peace. If I'm over-doing, appeasing, and ignoring my boundaries, or even simply spending too much time on screens, my body speaks loudly in the language of symptoms.

I recognise there’s a certain amount of privilege required to be able to heed the body’s calls. A flexible work life and access to periods of solitude have been essential medicine for me. These are not readily available to everyone. It highlights not only our individual imbalances, but also societal and cultural norms that work against our physiology. Our capitalism-driven culture does not make space for our health and wellness needs in a meaningful way. This is particularly true for women, who have been sold the myth that having it all – career, motherhood, travel, social life – is the holy grail. It’s possible in theory, but very often comes at the expense of our health. The vast majority of autoimmune diagnoses belong to women, and a recent literature review found that up to 65% of women experience disruptive symptoms during perimenopause¹.

I believe this is our body’s distress call. Of course, medication such as Menopausal Hormone Therapy can be enormously helpful and life-changing for some, but can we also ask whether we are medicating ourselves to continue to live an unsustainable lifestyle? And what would happen if we tried to tackle the imbalances at the root-cause level, rather than just the symptom level?

I love that there is so much more conversation about menopause in the mainstream media. But I also hope these conversations can dig a little deeper, and not simply treat hormone therapy as the one-size cure-all for everything. I want women to empower themselves to understand their physiology and become experts in navigating their own needs.

I want women (and all genders) to learn to befriend their bodies and learn to speak the language of somatic wisdom. To learn to trust that our physiology is not inherently flawed and that there are many ways of returning to a more balanced and harmonious relationship with our own system.

Sometimes the body needs us to face some stark choices about how we are living and where we are expending our energy. Sometimes it needs us to change long-standing patterns of how we show up in relationships and navigate boundaries. Sometimes the work is to heal past trauma, grief, and emotional wounding. Sometimes we need a toolbox to dial down our nervous system response. And sometimes we need to challenge the social and political status quo, the cultural norms that deem it acceptable for individuals to burn themselves out to feed their family and keep a roof over their head.

I believe that menopause is a threshold and an initiation, where we are invited into closer relationship with our bodies, our wisdom, and our intuition. We can choose to turn towards this growth edge instead of simply suffering through it. The challenge is great, the lessons are stark, but the learning can be deep and potent, preparing us to step into elderhood carrying embodied wisdom and quiet power.

Thank you for reading. As always, I’d love to hear your thoughts and comments on this subject. If you’re in this transition, have you noticed a relationship between your nervous system and your symptoms? Do drop into the comments to join the conversation.

If you value what you read here, you can support my work by liking and sharing this post, and by becoming a free or paid subscriber to The Therapy Room.

---

Disclaimer - Content is intended for educational and entertainment purposes only, and is not a substitute for individualised healthcare or advice.

1. Fang, Y. et al (2024) Mapping global prevalence of menopausal symptoms among middle-aged women: a systematic review and meta-analysis. BMC Public Health, 2, 24(1):1767