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.

Externally and internally, this period is a mirror image of adolescence, a time when our bodies and brains were also going through major hormonal shifts that gave us the energy to attempt to individuate and become the person we were meant to be. At menopause we pick up where we left off in adolescence. It is now time to finish the job.

It should be no surprise, then, that research has documented that those women who experience uncomfortable--even severe--symptoms of PMS are often the same women who have a tumultuous perimenopause, with physical and emotional symptoms that become increasingly impossible to ignore.

As a woman makes the transition to the second half of her life, she finds herself in a struggle not only with her own aversion to conflict and confrontation, but also with the culture's view of how women "should" be. The body's inner wisdom gets its last, best chance of breaking through culturally erected barriers, while shining a light on aspects of a woman's life that need work. To resolve the situation, it is up to the individual woman to meet her body's wisdom halfway.

Debunking the Myth of Raging Hormones

Though hormone levels and mood do tend to fluctuate widely during our reproductive years, and even more widely during our perimenopausal years, research has failed to show any appreciable differences between the hormone levels of those women who suffer from PMS-like symptoms and those who don't.

What has been well documented, however, is that the brains of women who suffer the most from PMS-like symptoms are more susceptible to the effects of fluctuating hormone levels. In other words, it is not the hormone levels per se that are the problem; it is the particular combination of a woman's hormone levels and her pre-existing brain chemistry, along with her life situation, that results in her symptoms. It is estimated that 27 percent of all women who become depressed premenstrually will be very sensitive to the hormonal changes that occur at menopause.

Though we tend to blame perimenopausal symptoms on hormonal shifts in the body, their origins are far more complex. Several women in my practice, for example, have experienced symptoms such as hot flashes and mood swings in their later 40s--despite having been on full hormone replacement for over 20 years as a result of hysterectomies and removal of their ovaries while in their 20s. Changes in reproductive hormones alone do not account for these symptoms. They are signals from our mind and body that we have reached a new developmental stage--an opportunity for healing and growth.

Moving Inward

Until midlife, it is characteristic for a woman's energies to be focused on caring for others. She is encouraged to do so, in part, by the hormones that drive her menstrual cycles--the hormones that foster her instincts for nurturing. But for two or three days each month, just before or during our periods, there is a hormonal interlude when the veil between our conscious and unconscious selves is thinner and the voice of our souls beckons to us, subtly reminding us of our own passions, our own needs, which cannot and should not always be subsumed to the needs of those we love.

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