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

Perimenopause - or the period of transition into menopause - can be a time of great upheaval when it comes to the physical, mental, and social aspects of life.

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]:

Menopause symptoms include hot flushes heavy periods night sweats support counselling psychologist Joanne Collyer in Subiaco Perth

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.

Increased stress irritability mood swings and anger in menopause during midlife with extra responsibilities sandwich generation caring for children and parents. Seek tips and help from counselling psychologist Joanne Collyer in Subiaco Perth

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]

Coming to terms with grief and loss of youth and fertility not having children, feeling trapped and coping with anger and rage at others in menopause during midlife with extra responsibilities. Seek tips and help from counselling psychologist Joanne

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.

Psychological risk factors for perinatal depression and anxiety

Pregnancy is a time of great change and adjustment, and mental health issues can emerge. Read on to learn more about psychological risk factors for perinatal depression and anxiety.

PSYCHOLOGICAL RISK FACTORS FOR PERINATAL DEPRESSION + ANXIETY

By Joyce Chong (updated 26 April 2018)

Pregnancy and parenthood are times of great change and, with that, adjustment beckons. From changes to your body, your health, finances, potentially house/city/country, shifts to family dynamics, and also changing identity, it's no wonder that difficulties adjusting to this period of change may emerge. It's also during this time that we may see anxiety and depression emerge, or intensify should these be pre-existing conditions.

In our work as clinical psychologists with pregnant women and new mothers, we thought we'd highlight some of the psychological risk factors we often see that can negative affect mental health.

1. A history of depression or anxiety

Having a pre-existing history of depression or anxiety can make you more susceptible to developing perinatal depression or anxiety. It's therefore especially important to working on boosting your wellbeing and mental health as early on as possible so that you're prepared for the changes that lie ahead.

2. Negative thinking styles

We're all prone to negative thinking styles at any stage of our lives. During pregnancy and following birth, some common ones we see include:

Emotional reasoning (e.g. “If I feel anxious it must mean that I’m not that confident.”),
Black and white thinking (e.g. believing it’s either perfect or completely ruined),
Catastrophising (e.g. believing that forgetting one thing will lead to a disastrous impact on your unborn child), and
Mind reading (e.g. “They will think I’m so incompetent!”).

3. Perfectionism

Perfectionism can rear its ugly head at any time in the pregnancy, birthing, and parenting process, and it can make it difficult to adjust to change. From having the perfect pregnancy, to the perfect birth plan, to being the perfect parent with the perfect baby...are you putting too much pressure on things that are likely beyond your control?

4. A tendency to engage in social comparison

A tendency to engage in social comparison. We’ve previously blogged here about how social comparisons can hurt your self esteem and pregnancy and parenthood provides a new arena for social comparison.

From comparing your pregnancy body to what you see on Instagram, to assessing your parenting skills against those of other new mums, to gauging your child's milestones against others in playgroup - the potential for feeling anxious and depressed is heightened.

5. Unrealistic expectations

Unrealistic expectations present challenges for pregnancy and parenthood, and they underpin problematic (clinical) perfectionism. Examples of where unrealistic expectations trip us up include:

Expecting to glow throughout pregnancy with only a tiny bump, when the reality is that you're ridden with nausea and swollen ankles for much of the pregnancy.
Expecting to instinctively know what to do after you've given birth, when it's only your first time holding an infant.
Expecting things to go according to your birth plan, only to end up with a completely opposite experience due to complications.
Expecting to breastfeed when, in reality it isn’t possible due to problems latching, or illness.

With such unrealistic and potentially unattainable expectations, is it any wonder that your mind sets yourself up to feel like a failure?

6. Difficulties adjusting to change

Pregnancy and becoming a parent is a time of great change, and with that comes adjustment. It helps to adjust expectations regarding how much disruption there will be to life and to routines, how significant an impact it will have on productivity levels, and how it will impact on stress and mood levels.

For example, if you're used to ticking of item after item on your To Do list and streamlining your workflow, it may come as a rude shock to discover your main achievement for the day becomes leaving the house before lunchtime.

Do the above signs look familiar?

Not sure if you or someone might need help? A useful screening tool used by many health professionals is the Edinburgh Postnatal Depression Scale which you can take it here.

Much can be done to support expectant or new mums with Perinatal Depression and Anxiety, but things can't change unless the first step is taken. A good starting point is to talk to your GP, obstetrician, or psychologist. If you'd like to work with us to build skills to help navigate this period of significant change, then contact us to make an individual appointment.

Excellent resources can also be found at Beyond Blue and also Perinatal Depression and Anxiety Australia.

What about fathers and partners?

Perhaps it is telling that we don’t see as many expectant or new fathers in comparison to expectant mothers because it is the mothers who experience the more visible changes.

However, first-time fathers are also going through a period of great change, moving from what was once a nice twosome shifts to the focus being solely on a third new little being. Whilst this can be an absolutely joyous event, there's no denying that there may be financial stress, a diminished social life, impacted relationships, changes to quality of life, and even importance for fathers in ranking within the household.

Men can also experience Perinatal Depression and Anxiety, with similar risk factors as those for women. Perinatal Depression and Anxiety Australia has put together an excellent resource which you can find here, as has Beyond Blue here.

It may also be helpful for expectant fathers to talk to others who have been through the same process to understand what emotional changes may occur. For first-hand accounts of other fathers’ experiences, have a look at the Black Dog Institute here.

Alternatively, consider speaking to a mental health professional (like us!) about preparing psychologically for the upcoming changes, particularly if the psychological risk factors are present.

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AUTHOR: Dr Joyce Chong

Dr Joyce Chong is a Clinical Psychologist with around 20 years’ experience in the field of psychology. She has a real passion for integrating scientific research and clinical experience to translate evidence-based treatment into practical tips for better wellbeing, mental health, and performance. She is also the author of our books Planet Burnout and My Happy Place.

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