What Fresh Hell Is This?: Perimenopause, Menopause, Other Indignities, and You

As Rage Becomes Her author Soraya Chemaly said, One of the top three reasons women report getting angry is the lack of reciprocity in relationships. They feel taken for granted, uncared for, unloved, even as they’re providing care to parents, to children, to spouses, to friends, to coworkers to neighbors, whoever it may be. Being exhausted and fed up at the same time accumulates. I think a lot of the rage people feel is because for the entirety of their lives their needs were not being addressed or met fairly. But now, with the added stresses and exhaustion of this physical transition, that situation is not tenable. This—a lack of reciprocal care and attention—is not about hormones.

Radical selfcare is what’s going to get us through this kind of endlessly inane questioning of the validity of our existence, through menopause, and through all of the many other changes that are still yet to come.

Leaning into disappointment in our bodies can make it harder to live and take care of ourselves with injuries, chronic pain and illness, or other disabilities we may have.

If they don’t give you a seat at the table, bring a folding chair.” —Shirley Chisholm

Give less of a fuck. There’s a lot of talk from well-adjusted people on the other side of menopause about how they care a lot less about a lot more things than they did before. I believe this is often a survival skill picked up in perimenopause, one that likely kept them from yelling at other people and helped them carve out the time, space, and energy to care for themselves, often after a process of figuring out they gave way too many fucks to adequately deal with any of this.

No one considered the possibility that I might have been experiencing a hot flash paired with a panic attack, a notoriously common experience in perimenopause.

If we had it in our heads that feelings in menopause were the usual clichés—a certain kind of suburban prickliness or a trivial, surfacey sorrow—we’re likely to be surprised. We might not be expecting that “rages” can have a basis in very real anger and that our tears might spring from shame, self-loathing, hopelessness, or deep grief. A lot of managing our moods and mental health in menopausal transition is about making room for our feelings, very much including some that might scare us.

Approximately two million people go into perimenopause each year in the United States alone. Only a fraction of that number (around 15 percent) are diagnosed with breast cancer in the United States every year. Fewer people have heart attacks and strokes here annually than go into perimenopause. How do all of us—you, me, our mothers, healthcare providers, the ladies on The View—usually know so much less about something so much more common, something that will absolutely happen to everyone born with a uterus and ovaries in some way at some point, most often as an unavoidable part of the life cycle, than we do about things less common that are only, and frequently even avoidable, maybes?

Aida Manduley, LCSW, is a Latinx activist, trauma-focused clinician with a basis in liberation health and healing justice, and a human discotheque. They say, The biggest lie that we’re told—and I would say that this goes for everyone, just in different flavors—the lie that we’re told is that we have to do it by ourselves. No one does anything by themselves. Any person who says they got to where they are by themselves is lying, either actively lying or deeply misinformed and spouting a lie. Look, find me any famous person, find me any philosopher, find me any person who’s made it into the history books. A huge reason why they were able to is because they had people making their food and caring for their children, driving their cars, or horse buggies or whatever. None of these people did it by themselves. The fact that they got help was just erased. So now, other people think, “Oh, well, I gotta do it myself. This other person did it, so clearly, I gotta do it, too.” That’s not how it worked for them either. Actually, they got a lot of help.

Decreased cognitive flexibility, including difficulty or increased difficulty with attentiveness, focus, processing, and concentration. You might feel like your processing speed or your ability to problem-solve is decreasing. Learning can be or feel more difficult or slower to cement, especially in later perimenopause.

Having a bunch of arghful or superdemanding life stuff, all while our biochemistry is flying up and down like a haunted elevator or radically changing to a kind of hormonal makeup we haven’t had for more than a week at a time since we were kids—no shit that can have an impact on our mental health.

listen-and-validate-only (on their part) venting sessions for you;

One of the ways partners, family, housemates, or anyone else who’s a big part of daily life can support us is in accommodations, adaptations, or other changes we need in order to get through this or to adjust to the ways that we are just going to be different because of this from now on. That can be bigger things or little ones, but clear, tangible ways to help can go a long way for everyone and can be adapted for every age and ability.

I’m not going to tell you how to feel about or view perimenopause, menopause, and life after. That’s yours to feel. If we’re entitled to anything, having reached this stage of life or otherwise found ourselves here, it should be the right to own and contextualize our own experience of this.

Understanding, acceptance, and management (or not!) of your choosing really are the names of the game here: they are what’s actually doable and also won’t make you feel even shittier about yourself than perimenopause can make you feel already.

I didn’t know anything about perimenopause, including that I was in it, until I had already been in it for years, despite having an array of hallmark impacts: painful cystic acne, hot flashes, night sweats, anxiety, depression including a resurgence of my suicidality, menstrual changes, digestive issues, body-composition shifts, an increase in headaches and other kinds of pain, exhaustion, and some serious cognitive challenges.

With menopause, what’s considered “normal” vaginal pH changes from a 3.8–4.5 range to higher, usually between 5 and 6, the same level it usually is before puberty, too. That’s okay, but it can change our vulnerability to imbalances and infections.

As Menstruation and Menopause author Paula Weideger said in the 1970s, “The majority of doctors have an elevated opinion of their worth and an underdeveloped ability to respect their patients.

Have no shame ... as another woman friend of mine counseled with perfect sincerity and cheer: 'Just gain the 25 pounds. I really think I would not have survived menopause--AND the death of my mother--without having gained these 25 pounds.' [quoting Sandra Tsing Loh's 'The Madwoman in the Volvo']

[As in puberty,] There will be tears. And anger. And tragically unfortunate haircuts.

Messages we get about menopause more often tell us we must keep ourselves from much of what we want and need in this time. It's easy to get the idea that life in and after menopause is going to be little, dreary rituals of desperate maintenance and exacting control over food, exercise, the shape and size of our bodies, our skin, our intimate relationships, our sexuality, our leisure, our moods, robbing us of what pleasure we might have found in these things before.