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Everything from unbalanced nutrition to unresolved relationships can disrupt the normal hormonal milieu, wreaking physical and emotional havoc during the childbearing years. Ignoring these early, relatively gentle nudges month after month sets her up for sharper and more urgent messages. Inconvenient as they are, these pains are our allies, begging us to look up and see what's not working in our lives. Often we don't. Most of us are too busy, and the discomfort isn't all that bad. It's easier to ignore it. But the body is insistent!

A Poignant Wake-up Call:
Postpartum Depression

It is well documented that women who have significant PMS are also more apt to suffer from postpartum depression in the first days or weeks after giving birth. Or sometimes those who suffer from postpartum depression will go on to develop PMS when their menstrual cycles resume. Because new mothers often feel far too vulnerable to complain, postpartum depression is under-diagnosed and under-treated in our culture, even though between 10 and 15 percent of all women experience some form of mood disorder following childbirth, ranging from major depression to anxiety disorders such as panic attacks.

It may be no accident that the word "menopause" invites the association "pause from men."

As with all illness, there are genetic, environmental, and nutritional factors that are associated with postpartum depression. But it is also true that postpartum depression is often a sign from a mother's inner wisdom that she isn't getting the support and help she needs at this time, and that certain areas of her life, especially her relationships with one or both parents or with her partner, require some attention.

An Annual Wake-up Call: SAD
If the monthly messages go unheeded, a woman's body may send a louder wake-up call on a yearly basis, in the form of seasonal affective disorder, or SAD. It begins with an intensification of the symptoms of PMS during the autumn and winter of the year, when the days are shortest and darkness dominates. Eventually it can evolve into full-blown depression during the time of year when daylight is abbreviated.

It is well known that providing two hours of full-spectrum artificial light in the evening, to trick the body into thinking the days are longer, can reverse the weight gain, depression, carbohydrate craving, social withdrawal, fatigue, and irritability of SAD. But studies have shown that without continued use of the artificial lights, the symptoms return the following autumn unless the wake-up call is heeded. The link between PMS and SAD is a profound example of how women's wisdom is simultaneously encoded into both our monthly cycles and the annual cycle of the seasons.

Perimenopause: The Mother of
All Wake-up Calls

For many women perimenopause can be, as one of my patients described it, "PMS times ten"--and this is particularly the case for those who, for one reason or another, hit the snooze button instead of heeding their monthly and seasonal wake-up calls.

This is not to discount the direct physical effects of changing hormone levels. However, it is a safe bet that any uncomfortable symptoms that reveal themselves during times of hormonal shift will be magnified and prolonged if a woman is carrying a heavy load of emotional baggage. Throughout a woman's childbearing years, a kind of "debt account" is established where existing and future issues accumulate, compounding interest with each passing month that the debt goes unpaid.

For many women perimenopause can be, as one of my patients described it, "PMS times ten."

Thus the average woman, blessed with approximately 480 menstrual periods and 40 seasonal cycles to bring her to the threshold of menopause, gets about 500 progress reports. How is her physical health and nutrition? How are her emotions? What's happening in her relationships and her career? There have been approximately 500 opportunities to resolve those issues or sweep them under the rug.

At perimenopause the process escalates. The earnest, straightforward inner self, which has tried for years to get our attention, makes one final hormonally mediated attempt to get us to deal with our accumulated needs, wants, and desires. This is likely to turn into a period of great emotional turmoil, as each woman struggles to make a new life, one that can accommodate her emerging self.
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