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Michelle Hirsch, LCSW

Clinician's Corner

Menopause, Moods, and Life Transitions
By Michelle Hirsch, LCSW

Is it hot in here, or is it just me? I think I have CRS Syndrome (Can’t remember squat). Are you a real pain in the rear or am I just having another mood swing?

Do any of these statements ring a bell? For many women experiencing perimenopause and menopause, these are real symptoms of menopause.

According to Dr. Christiane Northrup, M.D., author of The Wisdom of Menopause, “The fluctuating hormone levels that most women experience during perimenopause and during menopause do not, in and of themselves, cause the distressing emotional and psychological symptoms (such as anger and depression) that so many women suffer with in PMS and at midlife. In other words, it is not the hormone levels per se that are the entire problem, rather, it is the particular combination of a woman’s hormone levels and her preexisting brain chemistry along with her life situation, that results in her symptoms.”

During the transitional period of perimenopause into menopause there are several symptoms that many, though not all women, experience. Hot flashes, or as some refer to them, “power surges,” are the most common perimenopausal symptom in our culture. Seventy to eighty-five percent of women experience hot flashes. Night sweats are also a continuum of hot flashes, often occurring between 3 and 4 a.m.

Insomnia can also occur if night sweats and hot flashes awaken some women on a regular basis. Anxiety can contribute to insomnia if too many issues or intrusive thoughts occur when trying to fall asleep. Another common symptom is heart palpitations. According to Dr. Northrup, they are the result of imbalances between the sympathetic and parasympathetic nervous systems and are often related to fear or anxiety. 

Migraine headaches and breast swelling and tenderness are also symptoms of perimenopause and menopause. Migraines tend to occur when both estrogen and progesterone levels fall dramatically, usually a day or two before your period. Breast swelling (although your partner may not complain) and breast tenderness can also occur just before your period. This seems to occur more often when a woman experiences estrogen dominance.

Hold on ladies, we have only begun the list. Next, are heavy and sometimes erratic periods. Estrogen levels are often elevated and when progesterone levels are too low, heavy periods may occur. Hormonal changes also contribute to irregular and erratic periods.

Mood swings and forgetfulness appear to be two of the most frustrating symptoms for most women. Obviously, mood swings and the increase in dark, negative moods, is hormonally influenced. Forgetfulness, or, as I call it “Can’t remember Squat” or CRS syndrome, is a normal symptom that many women experience as our hormones change and our brains rewire. Sometimes memory problems during midlife can also be due to so many external demands on our limited time.

Loss of sexual desire can sometimes occur during perimenopause because some women experience a drop in their testosterone levels. For other women, loss of sexual desire can be related to the lack of estrogen or thinning of the vaginal tissue. Lack of estrogen can also contribute to vaginal dryness and/or painful intercourse.

Although identifying all of these symptoms can certainly be overwhelming and sometimes depressing, these are natural and normal occurrences during midlife. In my practice as a psychotherapist, one of the first issues I address with my clients is that these symptoms are normal. I emphasize that they are not going crazy when their memory fades or that they are to blame for their mood swings. 

We also address relationship issues, especially when they are noticing a loss of sexual desire. It is important that we separate menopausal issues from problematic relationship issues.

Another area that is often addressed in therapy sessions relates to grief and loss issues. Many women are experiencing the empty-nest syndrome. They have often defined themselves in terms of being a caregiver of children and their husbands. These roles often change after the children are gone and returning to couplehood is sometimes uncomfortable and awkward. This is especially true if children have been the main focus in their relationship.

This also may be a time when women begin to explore new career avenues or other interests that have been delayed because of the focus on childrearing. For those women who have not had children, this appears to be a time for self-reflection and redefinition of themselves.

Even though women experience a variety of uncomfortable physical and emotional symptoms during perimenopause and menopause, this can be a wonderful time for self discovery, creativity, wisdom, redefinition and the opportunity to share their experiences with other women who are having similar experiences.

Michelle Hirsch, LCSW, practices at the Brookfield location of Cornerstone Counseling Services. She can be reached at 262-542-3255 ext. 222.


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