Understanding Perimenopause and Menopause: What Therapists Need to Know
If you are a social worker, psychotherapist, counselor or other mental health clinician, here is what you need to know!
Perimenopause, which translates to “around menopause,” refers to the time period when women begin to experience symptoms leading up to menopause. Menopause is officially diagnosed after 12 consecutive months without a period. Perimenopause happens before menopause and is characterized by irregular menstrual cycles: very heavy, very long, shorter or skipped cycles, and many other symptoms. Perimenopause can last up to 8-10 years, and often begins in a woman’s mid-40s, and sometimes earlier. Many women experience a peak in perimenopause symptoms about 1-2 years before their menstrual cycle stops altogether.
Hormonal Changes during Perimenopause:
Perimenopause is characterized by fluctuating hormone levels, particularly estrogen, progesterone, and testosterone. Estrogen levels decline as menopause approaches, eventually leading to the absence of ovulation and menstruation. Follicle-stimulating hormone (FSH) and luteinizing hormone (LH), which regulate the menstrual cycle, also fluctuate during perimenopause, and contribute to irregular periods. Although tests like AMH (anti-mullerian hormone) can provide insights into ovarian reserve, accurately predicting the timing of menopause remains challenging through blood tests.
Physical Symptoms of Perimenopause:
Perimenopause can bring about a range of symptoms, although each woman’s experience can vary. Common symptoms include irregular periods, very heavy or skipped periods, hot flashes, night sweats, mood swings, weight gain, worsening PMS, difficulty sleeping, anxiety, difficulty with concentration and memory (known as “brain fog”), vaginal dryness, and dry skin. It’s important to note that not all women will experience all symptoms, and the severity can vary from person to person. Additionally, there may be racial and ethnic differences in symptom experiences, such as Black women experiencing more severe vasomotor symptoms, compared to Asian women.
Mental Health Symptoms:
For some women, the first sign of perimenopause is mood changes. Emotional sensitivity, depression, mood swings, obsessive worries, irritability, and rage can wreak havoc with relationships or daily functioning. Sometimes palpitations, panic attacks, or other physical symptoms of anxiety develop. Often, these symptoms can worsen insomnia, brain fog, and organizational skills. In fact, this may be a time when women first get diagnosed with ADHD because their executive functioning is more impaired. In addition, the impacts of identity changes and external stressors specific to this time of life (for example, experiencing the challenges of the “sandwich generation”) may also lead to mental health difficulties.
Navigating Perimenopause:
Navigating perimenopause can be challenging, but there are evidence-based options available that can be helpful. It’s also important to note that not all symptoms are always due to perimenopause. Other medical conditions, such as thyroid abnormalities, anemia, and medication side effects, may cause similar symptoms. For this reason, it is essential to talk to a healthcare provider for a thorough physical and mental health evaluation. While doctors may order tests to check hormone levels, it’s important to understand that hormones fluctuate significantly during perimenopause, making it difficult, and not usually useful, to provide a definitive diagnosis through hormone testing. A “diagnosis” of perimenopause is primarily based on age and the irregular menstrual symptoms someone is having.
There are many interventions that can help someone who is struggling with the symptoms of perimenopause. Menopause hormone therapy (MHT), formerly known as hormone replacement therapy (HRT), is a very good treatment option, especially for many women with significant hot flashes, night sweats, vaginal dryness, or urinary issues. For those not able to take hormonal therapies, other non-hormonal treatments can help with various symptoms. For women who have significant mental health issues prior to perimenopause and notice that their mood, anxiety or anger is much worse at this stage, antidepressant or anti-anxiety medications and talk therapy may be the most helpful approaches.
Perimenopause is a significant phase in a woman’s life, and understanding its intricacies is the first step towards maintaining optimal health and well-being. By seeking evidence-based options with expert healthcare professionals, women can navigate this transition with confidence and embrace the changes that come with it.
Every expert team of menopause healthcare providers should include a trained mental health clinician. BRIA Academy offers the Menopause Mental Health Provider Certification (MMHPC) virtual training program 4 times a year. For those who want advanced training, including access to a community of providers and case discussions, the MMHPC- Level 2 offers year-long training. To find out more, visit www.briaacademy.com
