Part I: Perimenopause and Menopause: An Introduction

First of a five part series

Recently, at Laura Marquit’s Joyful Movement Pilates studio in Fairfax, California, Laura and I gave a lecture followed by a short discussion about perimenopause and menopause and possible approaches to dealing with this natural transition.  Honestly, I felt honored and humbled that a dozen or so women came to hear us speak.  Several people who couldn’t attend wondered if I could pass along what I shared during the lecture.  Additionally, many women at the lecture asked some great questions and had great input.  I thought I’d follow up and recap here.  Please feel free to pass this information along and contact me with further questions and comments.  

But of course, a disclaimer first.  This is to serve as information only, please seek the care of a medical doctor for symptoms and concerns you may be experiencing.  This is in no way to serve as treatment of any disease or illness.  The following is for information only.   Now then….

There is so much information here, that I have broken it down into more readable chunks.  

First:  What are menopause and perimenopause?

What menopause is:

Menopause is when a woman has not had a menstrual period for a full year. The reproductive hormones that are responsible for producing menstruation–and creating life–are in decline leading up to the final period.  A woman is no longer fertile after menopause as the ovaries have stopped releasing eggs.  Generally, menopause occurs for women between the ages of 48 to 55, the average age for menopause is 51.  This seems to be the case across cultures and throughout the ages.  Menopause will occur if both a woman’s ovaries are removed, and menopause can be caused by some diseases, chemotherapy, and radiation. A woman will not be thrown into menopause if she keeps her ovaries but has her uterus removed.  If you undergo premature menopause, whether or not it’s medically induced, hormone replacement therapy or HRT is usually prescribed by an MD to ensure bone strength and for protection against heart disease.


Chinese medicine refers to menopause as the Second Spring….in other words, life without hormones.   Once we have reached menopause, we have transitioned into another stage of life: that of the wise woman.


In Chinese medicine, and in many other cultures, menopause is regarded as a milestone.  It is an opportunity for us if we consciously take advantage of it, that can result in some profound and fulfilling changes.  This may take some work in the form of some navel-gazing, asking some tough questions, reprioritizing, and maybe carrying out some surprising decisions and changes in our relationship dynamics with our new found state of mind.  Menopause  finds us less hormonally driven, there is a quiet, or perhaps less noise from the hormone “devil on our shoulder.”  The devil will have mellowed and the angel will have grown a little more assertive to create a hybrid of sorts…..a return of the carefree days of pre-pubescence polished with the patina of life.  All of life’s hard knocks, lessons, and experiences both good and bad resulting in personal growth and evolution.  You have become a pearl.

How does this transformation to a wise woman happen, you ask…

I’ll bet it’s a mix of the decline of the bonding, nurturing aspects of reproductive hormones and the payoff of personal growth that the years have given us the opportunity to weather.  Women who have tended to children and partners and less so to the world beyond their families often notice a shift.  They start to recognize the world beyond taking care of family or others, they want to engage with the greater world or try something new–priorities and emotions change as we hit midlife.  


Chris Everet blamed her divorce on menopause  I think she may be blaming perimenopause.  During this transitional time, did she find her voice?  Did she reflect upon what her life was and decide that it just wasn’t right? Did she do it mindfully?  According to the article, she has regrets in her process.  It’s the transition that is tough, not so much menopause itself.  (and yes, hot flashes and other annoying symptoms can last past the last period…I’ll get to that)


Perimenopause–the journey to and through menopause:


Menopause is not a disease, rather it is a natural state.  As a woman, if you live long enough, you outlive your ability to procreate.  Nature didn’t want us to begin mothering in our later years yet it doesn’t kill us off either.  We can live quite a healthy, long life post hormones if we take care of ourselves.  Perimenopause, with or without symptoms, is considered to be the few years before menopause.  This can be extremely rocky time for some and a breeze for others.   Symptoms such as hot flashes, night sweats, insomnia, mood swings, and more may occur.  Sometimes these symptoms can last beyond our last menstrual period.

Why do some women suffer so while others seem to get by so easily?  Well…let’s look at what’s happening first through a western medical lens.


Western medical:

When you start gliding towards menopause, your sex hormone supply is doled out in smaller and smaller amounts.  However, this is not necessarily a gradual coast, it can be a pretty jagged downward trend…this can create havoc in your body increasing “menopausal symptoms.” While the supply of hormones is declining your hormone receptor sites–the cells that are expecting to be receiving their hormone fix–haven’t dwindled in number nor do they demand any fewer hormones.  They are starving and they are letting you know–by creating symptoms.  In other words,  the dwindling supply, say of estrogen, cannot meet the demand of the still robust estrogen receptor sites.  These receptor sites are going through withdrawal and can throw up some pretty demanding requests to get their estrogen….hot flashes and night sweats to name a couple.  For some, these receptor sites don’t die off well after the last period.  


So, what makes it harder on some and easier for others?

Siddhartha Mukherjee used a wonderful analogy about individuals suffering from a disease. Basically, the disease is the “seed” and the “soil” is the disease’s host. This analogy explores the angle that manifestation of this particular disease is dependent on the “habitat” of the host.  

So, I’d like to give him credit for the analogy and riff off of it to explain Chinese medicine.  Every garden has soil, the quality of soil can vary between separate garden beds.  One garden bed may be well aerated, amended with great organic compost in just the right amounts, supplemented with great microbes provided by the manure of well-treated chickens, watered well, and ph checked then balanced.  An adjacent bed could be neglected, and still, another could be worthy of a Superfund site designation–you get the picture.  So, think of your body as its own garden bed independent of everyone else’s around you. Everyone’s individual garden bed is made up things we cannot change, such as genetics, family of origin dynamics, environmental exposures, and our past good and bad life choices–such as traumas, smoking, drinking, drugs, poor dietary choices, lack of exercise, hard living–or the opposite of all that.  Genetics and our past life experiences are mixed with what we are doing now:  food choices, exercise, stress levels, relationship dynamics, work life, life circumstances, etc.  This soil is the landscape of which menopause is played out upon.  Our “soil” can affect the way our body is capable of dealing with the “seed” of change–of menopause.  


This is what I love about Chinese medicine, it looks at the individual landscape and helps to rebalance the body that exhibits symptoms of menopause.  This I will get to later on….


Mukerjee, Siddhartha 9/11/17 New Yorker magazine article

images: Kathleen H Cutter and

Next up:   Now what to do about menopause…