Perimenopause: What it is and how to cope with the physical and emotional impact

March 1, 2024 Joyce Chong

Perimenopause: What it is and how to cope with the physical and emotional FALLOUT

By Joanne Collyer and Joyce Chong

Menopause is a significant time in a woman’s life, marking the end of ovulation and signalling the end of natural fertility. In the lead up to this time, hormones fluctuate, leading to a range of symptoms - physical (hot flushes, night sweats, weight gain), emotional (mood swings, irritability), and cognitive (brain fog, slower processing speed)[1]. As a result, relationships, work interactions, and performance can all suffer, leading to poorer quality of life, lower self-esteem, and depression. Discussions about menopause have largely been ignored in the media, and women often find themselves wading through a combination of uncomfortable symptoms, wondering what is happening to their mind and body. To demystify this, we take a closer look at the transition phase into menopause – perimenopause – and the changes that happen at this stage in life. This article covers:

What is Menopause (+ Perimenopause)
Perimenopause – the time(ing) of your life
Psychological distress and identity shifts in perimenopause
What predicts adjustment and coping during perimenopause
Tips to help navigate perimenopause

WHAT IS MENOPAUSE (+ PERIMENOPAUSE)

Menopause occurs following your final menstrual period and signals a time when your body is no longer ovulating, often occurring between the ages of ages of 45 to 55[2]. Menopause can also occur earlier due to medical reasons (medical condition such as primary ovarian insufficiency, cancer treatment, or surgery).

Perimenopause refers to the period of transition into menopause – it’s the last stage of your reproductive years during which ovaries slow down egg production, and hormones (oestrogen and progesterone) fluctuate. Perimenopause usually occurs in the few years prior to menopause, and generally occurs in your forties. Fluctuating levels of estrogen during perimenopause can result in a range of symptoms, including[3]:

Physical: Hot flushes, night sweats, dry skin, reduced libido, body aches, insomnia, and lower energy are all very common in perimenopause. irregular menstrual cycles and heavy bleeding. Additionally, declining levels of oestrogen leave you more vulnerable to osteoporosis[4] and heart disease[5]. Body shape may also change as oestrogen levels decline.
Cognitive: Brain fog, reduced psychomotor speed, memory difficulties are common symptoms[6]. This can lead to difficulties in word finding and information processing, which can impact performance and communication.
Emotional: Mood changes are very apparent in perimenopause, with anxiety, sadness, depression, and anger observed. These can lead to negative interactions with others, which in turn can exacerbate stress and anxiety[7][8].
Psychological: Perimenopause is also a time of significant psychological adjustment not only to the physical changes but also adjustment to life roles and a shift in identity. We’ll cover these in greater detail later in this article.

perimenopause – the time(ing) of your life

Compounding the challenges of perimenopause is its timing – usually in midlife, and often coinciding with increased responsibilities including:

Caring responsibilities – parenting children whilst also caring for parents (the sandwich generation), and also fur babies.
Work responsibilities - Those at this stage in life often find themselves in a senior role at work and in charge of a team. This can also lead to heightened responsibility for the wellbeing of your team.
Mental load - juggling the coordination of various healthcare appointments, multiple work tasks, multiple social calendars, balancing finances, and maintaining positive relationships.

Between increased responsibilities during midlife, and the physical and psychological effects of perimenopause (reduced sleep, concentration problems, mood swings), something has to give. Unfortunately, that may be a poorer quality of life, increased stress, impacted relationships, and increased vulnerability to burnout. The impact of these challenges is very real - research has highlighted, for example, that in workplaces the severity of the physical symptoms of perimenopause affect job performance, and the severity of the psychological symptoms affect job retention.[9]

PSYCHOLOGICAL DISTRESS AND IDENTITY SHIFTS in perimenopause

The psychological changes experienced during this time often centre on identity and ageing, but can also include feeling a loss of control overall and a perceived shift in personality. Take for example:

Someone who has not started or completed their family: Perimenopause can cause distress as it represents loss of hope, particularly if they have entered into early menopause.
Someone for whom youth and fertility are tied to their identity: Perimenopause and the inevitability of ageing may be hard to face, particularly in a society that values youth, and it can lead to feelings of invisibility and affect self-esteem and body image. It may also prompt reflection on where they are at in life (and whether there are dreams they haven’t yet fulfilled).
Someone used to being in control and capable of multitasking can find the perimenopausal symptoms of increased forgetfulness and lower energy can lead them to feel disorganised and incapable.
Someone who takes pride in being a calming influence may find experiencing irritability, mood swings, and even rage to be challenging to their sense of self and to their relationships.

Given the potential for identity to be impacted, it’s no wonder that grief, loss, anxiety, depression can emerge during perimenopause. Perimenopause can also exacerbate pre-existing anxiety and depression.

what predicts adjustment and coping in perimenopause

Several psychological factors have been linked to positive coping in perimenopause. These include:[10]

Optimism is linked with positive adjustment to perimenopausal symptoms.
Higher levels of emotional stability and emotion regulation are linked to lower levels of stress and depression symptoms during perimenopause.
Self-compassion predicts emotional balance as it promotes a non-judgemental approach to the self.
Higher self-esteem appears to be linked to better adaptation to stress, lower depression symptoms, and fewer menopausal complaints.

The presence of the above factors is related to lower psychological distress and higher life satisfaction, and more positive mental health in perimenopause.

Tips to COPE with perimenopause

With all of the changes that you face physically and psychologically during perimenopause, here are our top tips to help navigate this significant time.

1) Link in with your GP

With the multiple changes in your life (physical, emotional, behavioural, cognitive), it helps to connect with a GP well-informd about menopause to coordinate your team. This may include linking in with dietitians, exercise physiologists, and psychologists. Your GP can also provide guidance if you are considering menopause hormone therapy.

2) Look after your physical health

When it comes to looking after yourself during this time, take steps to improve your physical health to ease perimenopause symptoms and reduce future health risks associated with menopause.

a. Adopting a healthy diet to reduce hormonal fluctuations and maintain a healthy weight. A balanced meal consisting of whole foods, vegetables, and lean protein, with minimal sugary and processed foods, as well as foods high in saturated fats is recommended. Staying hydrated and limiting alcohol consumption is also beneficial, as is taking a bird’s eye view of your nutrition as you plan to reduce the risk of osteoporosis and cardiovascular disease.

b. Improving your sleep to help you to think clearly and regulate your emotions. Practising good sleep hygiene, reducing stress, and creating a relaxing bedtime routine all help.

c. Exercising to support stress, adjustment, and healthy ageing. Regular physical exercise supports healthy ageing and adjustment during perimenopause. Walking, swimming, weight training, and yoga are great choices and readily accessible. Exercise helps your physical health by preventing age-related conditions such as osteoporosis and cardiovascular disease, and boosts your energy levels. Exercise also benefits psychological health, helping with stress management, emotion regulation, and motivation levels.

3) Managing stress

Helpful coping skills can go a long way to reduce the impact of perimenopausal symptoms as increased stress can exacerbate sleep issues, brain fog, and hot flushes. Concurrently, reduce reliance on unhelpful coping skills such as relying on alcohol use and falling back on emotional eating. Replace them with more helpful coping skills including:

a. Problem-focused coping skills to help reduce stress where you can. This may draw upon time management, assertive communication, and goal-setting.

b. Emotion-focused coping skills can including building helpful self-talk through cognitive reappraisal, practising self-compassion, talking through emotions, mindfulness, meditation, and social support.

4) WORK WITH a psychologist with knowledge of issues associated with perimenopause

Link in with a psychologist well-versed in working with menopause and the challenges in this stage of life. A supportive psychologist can help you to clarify your concerns and help you find a way forward by:

a. Understanding the changes you’re experiencing, and to assist you with adjustment and acceptance of the transition into a new phase of your life.

b. Coping with juggling multiple responsibilities. Your psychologist can help you identify stressors and formulate a plan of attack, drawing on a range of problem-solving skills including time management, assertive communication, and shifting unhelpful mindsets. They can also help you with increasing self-compassion.

c. Coping with grief and loss of identity due to ending one phase of life and starting the next, and adjusting to this great change in your life. As part of this, work with your psychologist on improving self-esteem, redefining meaning in life if you are feeling lost, and building optimism for the future ahead of you.

d. Improving emotion regulation and mental health through helpful self-talk, reducing irritability, improving communication to support healthy relationships, as well as helping you with mindfulness and grounding techniques.

e. Improving communication and relationships with partners, children, and more generally with friends and colleagues. Partner relationships and parenting relationships come into sharp focus at this time, and a psychologist can support you to build better communication and relating skills.

f. Supporting healthy habits. Adopting healthy lifestyle habits - from exercising, to sleeping well, to reducing alcohol - is often easier said than done. Lifestyle procrastination is very real, and your psychologist can help you maintain your goals for exercise, sleep nutrition, and other forms of self-care.