Perimenopause anxiety is different than my regular old anxiety
Wow, new fun in middle age!
A few nights ago, I was so tired at 9 p.m. that I couldn’t keep my eyes open, which never happens. I’m usually up till midnight. And because it was unusual, I got so anxious that I didn’t sleep basically all night. Makes no sense, right? Well, that’s perimenopause anxiety for ya.
After sending out a few SOS texts in the morning, it turns out that I’m not alone in these exact kinds of paradoxical, hormonally induced sleep disruptions. That’s because this past year at 44, my “change of life” brought on a new kind of anxiety that feels different than my old anxiety, is harder to control, less mental, and, if possible, extra physical.
Not to brag, but I am an expert in my own anxiety. I’ve had it for nearly 40 years. Here’s what I wrote about my first anxiety attack for The Atlantic:
“The tropical storm whipped the palm fronds outside into a frenzy, while inside my elementary school, I was getting whipped into a frenzy, as well. I overheard someone say that if a hurricane hit, we’d all be under water. When I finally got home, my tiny, five-year-old body bolted through the house, ripped open the sliding glass doors and dragged everything from the backyard inside—my toys, even my brother’s toys. My panic knew no toy ownership, only that we were going to all be drowning any moment and all toys should be saved.”
Over the years, I’ve had plenty more, and I’ve found ways to kinda manage it, mainly with medication, avoiding triggers, OCD, and advice from a really great therapist.
No one, especially medical science, cares about middle aged women, so menopause is not studied enough. But we do know that most women experience increased anxiety while in perimenopause. Perimenopause is what people with ovaries go through leading up to menopause when your ovaries become useless. As they stop making estrogen, your periods start to change — usually some time in your 40s — and your hormones are a freaking mess, leading to a whole host of bizarre and concerning symptoms all over your body and in your mind. (This list recognizes some of the more bizarre ones that will probably trigger your health anxiety, as having some of them does mine!) Some are extreme and can even go on for the rest of your life.
It’s basically a second adolescence but with less zits. It can start at 50 or 35. It can last months or a decade. It’s different for everyone, so it’s hard to help each other through it.
Anyway, back to my old anxiety. It can start as a creeping sensation, like a heat rising up my neck, a flutter in my chest, or shaking in my arms. There’s usually a window where I convince myself that I don’t need to have this anxiety attack, and sometimes that works, but sometimes it doesn’t and I wait it out or take a low dose of a prescribed medication.
The old anxiety is horrible but familiar. It informs me a little bit about myself by showing me what I fear and what my vulnerabilities are. But this new anxiety brought on by the dying of my ovaries is both impersonal and horrible. It feels like something that is happening to my body instead of something I might have sway over.
It usually hits in the middle of the night — which is common. I wake up mid-panic attack or just before I start to have one. I lie there shivering, dizzy, and nauseated for about 30 minutes to an hour at 3 a.m. This will happen a few days in a row. And now that I’m not on a regular cycle, I never know when it’s coming. While on a strong birth control in my early 20s, I experienced the same kinds of night panics until I stopped taking the pill.
The one positive is that I can say to myself: I know this is a perimenopausal anxiety attack and not some kind of “mental weakness,” which is what they make you feel like anxiety is. But, in my experience, anxiety is not always triggered by something mental. Sometimes it’s just that the lighting is weird in a grocery store.
Discussions about perimenopause and anxiety are new. Doctors aren’t trained in it and they’re not informed on the finer points of hormone replacement therapy (HRT), which is basically the most helpful way of dealing with this. Yes, a few studies showed estrogen and progesterone HRT can increase your chance of breast cancer, but data is inconsistent. Also, HRT can decrease heart disease and osteoporosis risks, which increase with menopause. Either way, some people with a history of reproductive cancers will not be able to take hormones, but if you can, do it. This is a quality of life issue. I also hear now testosterone is being used for certain things like a desert-dry vagina.
My gyno claims I’m too young to be in perimenopause and says we can talk HRT once I have hot flashes, until then, she suggests birth control. I’m almost 45 with knowledge of my family history. Women of reproductive age are considered 15-44. IDK what she’s thinking, but I’m thinking I need a new doctor.
I’m in a group on Facebook with hundreds of thousands of women going through perimenopause, most are younger than I am. People in there echo my doctor’s disbelief. “I’m 46, how can I be missing periods?” This is it, baby. The time has come.
I’ve worked through my disbelief and grieved the passing of my reproductive years. My next steps are trying to get on the right meds, focusing on exercise, becoming more familiar with this new anxiety and the rotating roster of miserable symptoms, do the occasional acupuncture or massage, and I’m probably going to start an in-person perimenopause support group of just a bunch of clueless people who are also crawling out of their skin. LMK if you want to join.
Links:
This Gloria article is the best I’ve read with plain advice about perimenopause and birth control. Sign up for Gloria — it’s a must for anyone nearing or in middle age.
Emily Oster and Gillian Goddard also have a newsletter, Hot Flash, the subject of which seems obvious. Though they seem to call perimenopause “late-reproductive stage” in an introductory email. I’m calling it perimenopause.
I wrote about perimenopause for a Planned Parenthood blog, which was edited by their docs.