From the book "The Wisdom of Menopause: Creating Physical and Emotional Health and Healing During the Change," by Christiane Northrup, M.D. Copyright 2001 by Christiane Northrup, M.D. Published by arrangement with Bantam Books, an imprint of the Bantam Dell Publishing Group, a division of Random House, Inc.

A woman recently told me that when her mother was approaching the age of menopause, her father sat the whole family down and said, "Kids, your mother may be going through some changes now, and I want you to be prepared. Your uncle Ralph told me that when your aunt Carol went through the change, she threw a leg of lamb right out the window!"

Although this story fits beautifully into the stereotype of the "crazy" menopausal woman, it should not be overlooked that throwing the leg of lamb out the window may have been Aunt Carol's outward expression of the process going on within her soul: the reclaiming of self. Perhaps it was her way of saying how tired she was of waiting on her family, of signaling to them that she was past the cook/chauffeur/dishwasher stage of life.

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.

For many women, if not most, part of this reclamation process includes getting in touch with anger, and perhaps, blowing up at loved ones for the first time. The events that evoked anger are never new. What is new, however, is our willingness and energy to let that anger be acknowledged and expressed, both to ourselves and to others. This can be the first step toward much-needed change in our lives, change that is often long overdue.

Our Cultural Inheritance
Regardless of where you currently stand in your menstrual or perimenopausal transition, chances are you've inherited a few beliefs about your cycle that boil down to a variation of the following: "The issues that arise premenstrually have nothing to do with my actual life. They are strictly hormonal. My hormones exist in a universe that is completely separate from the rest of my life."

In fact, PMS and the escalation of symptoms that is so common during perimenopause are really our inner guidance system trying to get us to pay attention to the adjustments we need to make in our lives, adjustments that become particularly urgent during perimenopause.

If we don't pay attention to the issues that come up for us every month during the years when our periods are regular, our symptoms will escalate as we get older.

Our Brains Catch Fire at Menopause

Our brains actually begin to change at perimenopause. Like the rising heat in our bodies, our brains also become fired up! Sparked by the hormonal changes that are typical during the menopausal transition, a switch goes on that signals changes in our temporal lobes, the brain region associated with enhanced intuition. How this ultimately affects us depends to a large degree on how willing we are to make the changes in our lives that our hormones are urging us to make over the ten years or so of perimenopause.

There is ample scientific evidence of the brain changes that begin to take place at perimenopause. Differences in relative levels of estrogen and progesterone affect the temporal lobe and limbic areas of our brains, and we may find ourselves becoming irritable, anxious, emotionally volatile.

Though our culture leads us to believe that our mood swings are simply the result of raging hormones and do not have anything to do with our lives, there is solid evidence that repeated episodes of stress (due to relationship, children, and job situations you feel angry about or powerless over, for example) are behind many of the hormonal changes in the brain and body.

This means that if your life situation--whether at work or with children, your husband, your parents, or whatever--doesn't change, then unresolved emotional stress can exacerbate a perimenopausal hormone imbalance. In a normal premenopausal hormonal state it's much easier to overlook those aspects of your life that don't really work, just as you can overlook them more easily in the first half of your menstrual cycle--the time when you're more apt to feel upbeat and happy and able to shove difficult material under the rug. But that doesn't mean the problems aren't there.

Heeding the Wake-up Call

Whether you are in early perimenopause at 35 or standing at the threshold of menopause, your body's inner wisdom will attempt to catch your attention through four kinds of escalating physical and emotional wake-up calls.

Our First Wake-up Call: PMS

What happens if, during our childbearing years, we ignore our cyclic nature, disconnect from the body's wisdom, and attempt to function as though we were linear beings with the same drives, the same focus, and the same aptitudes day after day? Very often PMS happens. With its physical and emotional discomfort, PMS is one way a woman's body reminds her every month of the growing backlog of unresolved issues accumulating within her.

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.

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.

I like to think of the first half of our cycles as the time when we are both biologically and psychologically preparing to give birth to someone or something outside of ourselves. In the second half of our cycles, we prepare to give birth to ourselves. It is at this time that the more intuitive parts of our brain become activated, giving us feedback and guidance about the state of our inner lives.

A Direct Current of Wisdom

At midlife, the hormonal milieu that was present for only a few days each month during most of your reproductive years, the milieu that was designed to spur you on to reexamine your life just a little at a time, now gets stuck in the on position for weeks or months at a time. We go from an alternating current of inner wisdom to a direct current that remains on all the time after menopause is complete. During perimenopause, our brains make the change from one way of being to the other.

Biologically, at this stage of life you are programmed to withdraw from the outside world for a period of time and revisit your past. You need to be free of the distractions that come when you are focusing your mothering efforts solely on others. Perimenopause is a time when you are meant to mother yourself.

Perimenopause is a time when you are meant to mother yourself.

It may be no accident that the word "menopause" invites the association "pause from men." In truth, you are being urged, biologically, to pause from everyone in order to do important work on yourself. Perhaps as a result of this, one of the most common threads running through women's descriptions of how they feel during the menopausal transition is the longing for time alone, for a refuge that provides peace, quiet, and freedom from distractions and demands.

It's a wistful dream, seemingly out of reach in this busy age if multidirectional tugs-of-war. But those who have the yearning often believe that their uncomfortable menopausal symptoms would simply dissolve if only they had the luxury of shutting out the world so they could tune into the growth process occurring within themselves. This wistful dream is real. It comes from your soul. I've come to realize that you can trust it and believe in it--and that you must do its bidding.

Even if this dream seems out of reach, the simple truth is that every woman can

find refuge within her existing environment. Even if you can't charter a plane to a deserted island, odds are that if you acknowledge and validate your need for solitude, you can clear some time and find a private corner to which to retreat daily. You can insulate yourself from noise, telephones, and interaction with others. I encourage every woman to find a way to do this on whatever level is possible. When we commit to taking this first step, we have the chance to develop a newfound sense of ourselves and our life's purpose, which gives us an exhilarating sense of what is possible for us during the second half of our lives.

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