Perimenopause and the Mental Health of ‘Letting Go’

For many women I work with and see in the clinic, they arrive at a point during or on the way to menopause, where they realise that their reproductive years are coming to a close, and that their physical body is changing in a way that can't be reversed. It’s often an unspoken or quiet sadness that can come up, realising that the fertile years are coming to an end.

We talk a lot about hot flushes, night sweats and irregular cycles. But we talk far less about what it feels like, psychologically, to stand at this threshold, especially for women who are still processing complicated feelings about motherhood, identity or moving through these phases of womanhood into the next cycle of menopause.

I have observed that a woman may not even want to have more children to feel a sense of loss at this time, when her capacity to have a baby comes to an end.

Perimenopause can bring up feelings about:

• The end of possibility. Even if you never planned to have (more) children, there's a difference between choosing not to and no longer being able to - which can become apparent for some women. That shift, from choice to biological reality, can feel unsettling for some.

• Identity. For many women, the capacity to bear children has been very much tied to how they see themselves as women, as potential mothers, as youthful, as having purpose in life. When this role changes, it can feel like losing a part of your identity. Perhaps you weren't even aware how much you were wrapped up in this until it starts to shift.

• Time. Perimenopause often arrives alongside other markers of aging like parents aging or passing, children growing up and leaving, changes in your body, your career, your marriage. It can feel like several griefs and ‘letting go’ arriving all at once.

  
  

This is such a vast topic to explore as it is a very real experience for so many women. In clinic, we will often explore their relationship with themselves as women and what this has looked like for them. What is their identify wrapped up in and how have they lived throughout these reproductive years that leaves them with a sense of loss?

The transition of menopause can be a lot to process about your relationship with life and with how you have seen yourself.

On a physiological level, in perimenopause, oestrogen and progesterone don't decline in a smooth, predictable line. They fluctuate, sometimes wildly, before eventually settling lower. Both hormones interact directly with brain chemistry, particularly serotonin, the neurotransmitter closely tied to mood regulation.

This can contribute to the reasons why many women in perimenopause report:

• New or worsening anxiety, sometimes for the first time in their lives

• Mood swings that feel disproportionate to the situation

• Increased irritability or a shorter fuse

• Brain fog, forgetfulness, and difficulty concentrating

• Sleep disruption, which compounds all of the above

• A heightened sense of overwhelm or a feeling of "not being myself"

  
  

Research suggests women are more vulnerable to depressive symptoms during perimenopause than at almost any other point in their lives besides the postpartum period. If you've never struggled with your mental health before and suddenly find yourself tearful, anxious, or flat, you are not imagining it, and you are definitely not alone.

This is all happening and women experience this in very different ways. Perimenopause and menopause are a very personal experience. Along with this, here are some reasons women may feeling a sense of loss and grief around this time -

·      For women who wanted children and didn't have them, whether by choice, circumstance, or loss, perimenopause can reopen that grief in a new form.

·      Some women are child-free by choice and can still feel a pang of sadness, and wonder if they’re allowed to feel it. They can be at peace with their decision and still feel something shift when this chapter closes.

·      Culturally, so much of a woman's worth has historically been tied to youth and fertility. As those markers change, some women describe feeling like they're fading from view, in the workplace, in relationships, in how the world seems to respond to them.

·      For some women, the end of monthly cycles, birth control decisions, or pregnancy scares is genuinely freeing. And sometimes women describe feeling both relief and grief.  

Supporting yourself through this time

The perimenopause and menopause phase can bring a lot up for women in many ways - physically, hormonally and emotionally. And one of the loving things we can do for ourselves, and for each other, is to stop trying to go it alone and move through it quietly. Talk to other women for support, or to a professional who can help you work through the things that are coming up.

Give yourself permission to be with the feelings as they arise, be curious and observant. Be open to the letting go and likewise, be open to what is there when you do. There is a beautiful sensitivity and vulnerability that comes with letting go of all the ideals and beliefs that we thought was us.

And more than that, there is an opportunity for a woman to be solid and present with her power, when she steps more into herself as a woman, rather than the roles she may have taken on throughout her life.  

This article is for general informational purposes and isn't a substitute for care from a qualified doctor or mental health professional. If you're struggling with persistent low mood, anxiety, or thoughts of self-harm, please reach out to a healthcare provider to get the support you need and deserve.