The Wisdom of Menopause

by Christiane Northrup

  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.” I found a superb example of this culturally sanctioned unconsciousness about premenstrual syndrome (PMS) in a popular women’s magazine:

  I love PMS! It gives me so much perspective! It makes me cry in the supermarket aisle because they’re out of Calamata olives—a deliberate plot by the Stop & Shop stock boy to sabotage the new recipe I’m dying to try on my one day off! It makes me pick fights with my husband over incredibly important stuff—like the fact that he’s forgotten to put out my morning coffee cup alongside his, which is incredibly symbolic of something deeper, don’t you think? … And then, POOF! My period arrives and I wake up to a world that looks rosy. Gone is the pressure to get a divorce, send my kids to reform school, and move to another country. In fact, compared to how I felt the previous week, I feel pretty good indeed.1

  The writer goes on to explain that her PMS has only intensified as she has gotten older and that her OB-GYN has suggested that she go back on the pill, or try Prozac before her period. In other words, she needs to get “fixed.” But she’s ignoring potentially important messages from her body. 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. Every premenstrual issue that this writer blames on PMS is potentially related to a larger and deeper need that is not being met. The issues she raises may appear superficial or even silly at first glance. But if she was to be completely honest with herself, she would realize that the lack of olives at the grocery store and the fact that her husband doesn’t put out her coffee cup in the morning may be doorways to deeper needs that she has been ignoring: the need for more time off, a longing for the sensual satisfaction of cooking, a longing to be cherished daily by her husband. When these needs aren’t acknowledged, the body ends up screaming louder and louder to get our attention.

  By reducing her body’s signals to physical symptoms, the writer has bought into the dualistic belief system that pervades Western medicine. Her attitude—one that is all too common—is that troublesome hormones are a woman’s cross to bear, but with a variety of remedies and a sense of humor, they can be kept to a low roar, so they’re at least tolerable. Instead of seeing an opportunity for insight here, she has diminished and dismissed her inner guidance.

  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 actually 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.

  LEARNING TO RECOGNIZE AND

  HEED OUR WAKE-UP CALLS

  Whether you are in early perimenopause at thirty-five 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 elbows her every month to remind her 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, however. Most of us are too busy, and the discomfort isn’t that bad, after all. It’s easier to just ignore it. But the body is insistent!

  FIGURE 1: THE FIRST TWO WAKE-UP CALLS: PMS AND SAD

  PMS is to the monthly cycle as SAD is to the annual cycle. Both conditions respond to the same treatment while asking us to deepen our connection to our cyclic wisdom.

  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 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 underdiagnosed and undertreated 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. 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. If these issues aren’t resolved, they are very likely to resurface during the hormonal shifts of perimenopause.

  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 and despair 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. (Studies have also shown that light therapy helps depression in pregnancy.)2 But 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, given the effects of stress on hormone levels and blood sugar metabolism, it is clear 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. According to a 2010 study from the Netherlands of perimenopausal women, those who felt more negative emotions, specifically anger and sadness, also experienced an increase in pain.3 The more anger and sadness the women in the study felt, the more physical pain they experienced throughout the day. (The effect was especially strong in women who have fibromyalgia.) These symptoms are the body’s wisdom, pleading yet again that unresolved life issues be attended to. 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.

  Thus the average woman, blessed with approximately 480 menstrual periods and 40 seasonal cycles to bring her to the threshold of her 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? Is she scheduling pleasure into her daily life on purpose or putting herself last? 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 from our families 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.4

  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 a huge opportunity to break through culturally erected barriers, while shining a light on aspects of a woman’s life that need work. To resolve the situation, then, it is up to the individual woman to meet her body’s wisdom halfway.

  IS IT ME OR IS IT MY HORMONES?

  DEBUNKING THE MYTH OF RAGING HORMONES

  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 PMS and at midlife. But if there is an underlying susceptibility to distress in the first place, there is no doubt that hormonal swings will help bring that distress to the surface.

  Though hormone levels and mood do tend to fluctuate widely during our reproductive years, and even more widely still 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.5 In other words, it is not the hormone levels per se that are the 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. It is estimated that 27 percent of all women who experience agitation and depression during their periods, and 36 percent of all women who become depressed premenstrually, will be very sensitive to the hormonal changes that occur at menopause.6 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 forties—despite having been on full hormone replacement for over twenty years because they had undergone hysterectomies and removal of their ovaries while still in their twenties. Clearly, 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.

  ANATOMY OF MENOPAUSAL WISDOM

  Menopause combines the wisdom of the prior stages and brings it to a new level.

  Body Process Encoded Wisdom

  * * *

  MENSTRUAL CYCLE Cyclic intuitive wisdom and emotional recycling and processing

  PREGNANCY/FERTILITY Capacity to conceive an idea or a life with another, hold it, nurture it, and allow it to be born

  MENOPAUSE Passage into the wisdom years Capacity to be open to constant intuitive knowing Reseeding the community

  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, her devotion to cohesion and harmony within her world. 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.

  This fluctuation between inner and outer worlds and the way it is influenced by our hormones was revealed in a fascinating study done in the 1930s by a psychoanalyst and a physician. Therese Benedek, M.D., studied the psychotherapy records of patients, while Boris Rubenstein, M.D., studied the ovarian hormonal cycles of the same women. By looking only at a woman’s emotional state, Dr. Benedek was able to identify where she was in her menstrual cycle with incredible accuracy. The two doctors found that just before ovulation, when estrogen levels were at their highest, women’s emotions and behavior were directed toward the outer world. At ovulation, women were more relaxed and content and quite receptive to being cared for and loved by others. During the postovulatory and premenstrual phase, when progesterone is at its highest (and PMS symptoms are also at their peak), women were more likely to be focused on themselves and more involved in inward-directed activity.7

  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 nothing less than 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. One of my newsletter subscribers, Lucinda, describes the process eloquently.

  LUCINDA: Healing PMS

  PMS has been an issue for me that has severely limited my life, distorted my children’s experience of their mother, and made my husband’s life with me very scary. He insisted for years that an alien must take over my body when my hormones fluctuated in preparation for my menstrual cycle! Migraines were part of this pattern, too. I insisted that it was the “true ugly me” that surfaced at a
weakened time! One minute I would be rational and peacefully attending to my life tasks, the next I would be argumentative until war broke out!

  Then I would cry and feel like the worst person on the planet. This didn’t happen every month, but when it did it was on schedule, around the seventeenth day of my cycle. The consequence of this pattern was that I feared I was crazy, and I could not count on myself for normal planning of life events, making me an unreliable family member. While I longed for intimacy, I was too scary a person to approach. I was caught in the busy schedule of a working wife and mother and couldn’t figure out this problem in my life. I limped along, trying to appear normal to the outside world but becoming more and more exhausted.