The one where we start talking about perimenopause
I am in perimenopause and have been educating myself about it. The more I learn about it the more I find myself working with it clinically and educating women about the (MANY!) symptoms that can be attributed to perimenopause (seriously, itchy ears?!). And then (because I’m also human) I find myself struggling with the very things that I talk with women about every day. Like so many of us, one of the symptoms I have been struggling with is weight gain – the “meno belly” as it is being called. There is a biological reason why we put on extra weight in perimenopause. Our bodies are building reserves for when we are older and more vulnerable to illnesses. Your body naturally wants to build a bit of padding to protect from falls and fight disease. So now I have this vision of my fat cells clinging to every cookie I eat for dear life in case I need it when I’m 80.
I understand this from a physiological perspective, and firmly believe that all bodies can be strong and are beautiful at any size, and I admit that I still feel unhappy when my favorite pants don’t fit. I struggle with this, and many women I know in this phase of life have had a similar experience. My food intake and activity levels haven’t changed much in the past year but yesterday I stepped on the scale (I’m really not sure why – just checking in?) and saw a number that surprised me. I found myself cycling through all the stories of “What’s wrong with you? You’ve let yourself go. You need to eat better, be more active, give up sugar, cut back on carbs.” The emotions were just right there towering over me — the disappointment, the frustration with myself. And then I felt guilty for having self-judgment because I teach women about unrealistic standards of “beauty” that don’t take into account real human bodies, that are body and fat shaming, problematic standards that don’t age with us, and outdated notions of “health.”
I had been having this conversation with a woman earlier this week- noticing and naming those thoughts, the emotions, those stories that women have heard for years. I am the first to admit that it is much easier to be the clinician in this conversation - to be curious about those stories - to see where they came from and how they got embedded in us.
Those of us who are in perimenopause now were in our very impressionable youth during the “Can you pinch an inch?” campaign to sell more Special K cereal. The very best way to sell products is to make us believe that there is a problem (or something wrong with us) and that the product for sale is the solution. That’s it. In the 80s and 90s we were sold lots of stories about how to lose weight and be thin. A bowl of Special K for two meals a day, the ThighMaster, Jazzercise!, diet pills, and exercise VHS tapes you could order from TV commercials. We were consumed with it. Fat was the enemy so we ate sugar laden foods, then carbs were the enemy so we gave those up too. We watched our mothers buy diet books and diet bars and shakes. All the while we were seeing ads for weight loss camps in the back of Teen magazine as our bodies were starting to change and we were putting on weight, growing boobs, and getting hips (as we were supposed to!). You may have gone from trying Margaret’s (Are you there, God?) “We must, we must, we must increase our bust!” to being preoccupied with an expanding waistline. And now fast forward four decades and our bodies are once again changing in ways that they are biologically wired to do and we still have those commercials, those stories, all the words that our mothers and grandmothers muttered to themselves about being fat and needing to diet embedded in us like splinters that go too deep. I can still smell a freshly opened can of Tab as I type this.
This is a challenging time. There are so many changes occurring — physically throughout the entire body, mentally, and emotionally. It is so much more than hot flashes and irregular periods. There are also the added layers of stressors, responsibilities, and expectations with which we are dealing on top of the hormone stuff. Whatever changes you are experiencing in your body, it can feel difficult when there is a change from what your own baseline has been. The flipside of the challenges is that this can also be a very freeing time. I hear many women say that they care a lot less about what others think now and they are finally ready to focus on what matters most to them.
I frequently see the meme online begging Judy Blume to write a book about Margaret in menopause. I would buy that book. I would love to help write that book. We are finally starting to talk about perimenopause and menopause. I’m learning and I’m struggling and I am finding my own resolve to focus on what is healthy for my body and my mind. Our bodies and brains need the nourishment of whole healthy foods. We need protein, fiber, and essential nutrients – not more gimmicks and marketing schemes. We need to move our bodies and build strength so that we are less likely to be frail and break our hips when we are elderly and still trying to Bust A Move or Strike A Pose. “Strong not skinny” is the new mantra we are seeing. Even when we know this intellectually it can be difficult to fully embrace it.
We need to acknowledge that we are up against decades of clever marketing and stories about problems and deficiencies that are now a part of our wiring. Those messages are still out there and finding their way to the algorithms that are always near you. Many of us have partners who have also been immersed in the same media: women who are expected to look younger and are criticized for showing their age, the filters on images, hair dyes, wrinkle creams, the unrealistic industry beauty standards. So not only are we dealing with all of this in our bodies, we might also be trying to get a partner to understand something that we don’t even fully understand (including why we are just so tired!).
We are also up against the last two decades of news and doctors telling us that taking estrogen will increase our chance of breast cancer. Scientists and (some) health care providers now have a much better understanding of the complex set of data from which this belief arose and how news sources ran with that headline and broke the story before physicians were fully informed and prepared to respond to patients. We now know that hormone replacement therapy (HRT) can significantly help most women be healthier and suffer much less. There are some women for whom there may be increased risks and therefore it’s important to find a practitioner who understands the latest research on HRT and can help you make informed decisions about your care. And we are dealing with increased risk of breast, ovarian, and other cancers as we age regardless of whether we do HRT. Please do your regular recommended screenings!
So how do we move forward in perimenopause? (Cue shooting star and “the more you know” PSA music). There has always been and always will be a lot of misinformation, and ineffective or unnecessary supplements and diet plans for sale (and some supplements that really do help). Educate yourself with reputable information. The Menopause Society (https://menopause.org/) is a great place to start. There is science backed information on the website and a directory of physical and mental health providers who can support you through this stage of life.
There are some gynecologists who have written books and have been on lots of podcasts, write blogs, and have social media. Dr. Jen Gunter (https://drjengunter.com/) and Dr. Mary Claire Haver (https://thepauselife.com/) are two of the best known currently. I have read Dr. Gunter’s Menopause Manifesto and Dr. Haver’s The New Menopause. I recommend both books.
You’ll find me in the directory on Menopause.org. I’m not the only option, and I am an option for a psychologist who understands the symptoms of perimenopause and is doing the work to research, understand, and cope with the many changes (both physical and emotional) that are occurring. I also help women take a look at their lives, the stories they have come to believe, and examine if those stories still fit or if it’s time to rewrite some of them. If you are interested in working with me, click the “schedule a free consultation” button on any page of my website: https://jennifermieschphd.com/. I am able to work with clients in many but not all US states and territories.
Take care of yourself, stay informed, empower yourself to decide what is best for you at this phase of life, and seek support from a provider who is knowledgeable of peer-reviewed science. Please don’t rely on tik-tok or instagram trends. And stay tuned to The Being Enough Blog for more on the great perimenopause adventure…
-Jennifer Miesch, Ph.D.
Licensed Psychologist and author of The Being Enough Blog
https://jennifermieschphd.com/blog
A blog post is not a substitute for mental health therapy. This blog is not intended to diagnose or treat any physical or mental health conditions.
