With so much still left to learn about perimenopause, the emotional and physical symptoms that come with it can leave women feeling disconnected from themselves. Here’s how to approach the changes. 

As women, we’re constantly warned about the miseries of menopause. And while in recent years there has undoubtedly been more discussion in the public space about how we can support women during this age and stage of life – we’re told very little about perimenopause and more specifically, the rage that often accompanies it.

“For many women and people who menstruate, perimenopause is often the more challenging time to navigate than menopause,” says Traditional Chinese Medicine practitioner and founder of The Dao Health, Elizabeth Cullen. 

“This is due to perimenopause being an unpredictable time as the production of oestrogen gradually decreases contributing to both physical and emotional symptoms including irregular menstrual cycle, changes in menstrual blood flow, mood changes such as anger, anxiety and depression, physiological temperature changes such as hot flushes and night sweats, vaginal dryness and sleep disturbances.”

The first signs of perimenopause

While perimenopause can strike anytime, Cullen says, “symptoms typically begin when a woman is in her 40s and can last from one to 10 years – although timing can vary widely due to a number of factors including genetics, lifestyle and health conditions including surgical menopause.”
“A change in menstrual cycle regularity or the quality of a woman’s bleed will often be a first noticeable symptom,” says Cullen. “This is why tracking your cycle is so helpful so that you can become aware if irregularities begin.” 

But for many women, aside from changes to their menstrual cycle, it’s often a feeling of inexplicable rage that will initially give them pause to consider their ‘peri’ status with one study showing that for 70 per cent of women, irritability is their most common symptom.

Understanding perimenopause rage

To better comprehend where all this pent-up anger stems from, it’s first essential to understand the role oestrogen plays in our hormonal well-being. “From a Traditional Chinese Medicine (TCM) perspective, perimenopause is viewed through the lens of Qi, Blood and the harmonious balance of Yin and Yang,” explains Cullen.

“The ageing process for the female body is also governed by seven-year cycles, which reflect the depletion of Jing as we age with the natural progression of life. Kidney Jing, also known as our vital essence, is responsible for growth, development, reproduction and ageing. Declining Kidney Jing and Yin deficiency in TCM are correlated with decreasing oestrogen in the body.”

We also need to consider the challenges this particular age and stage of life brings more broadly. “I commonly hear from patients about the feeling of perimenopausal rage associated with a smaller window of tolerance,” says Cullen.

The silver lining of perimenopause

“One factor is certainly perimenopause as well as the lack of support whilst going through this significant transition in the body. But when treating women in this stage, we also need to check in on where they are on the priority list,” Cullen says. “Often, they are in the sandwich age where they are both looking after children as well as ageing parents – with their own health dropping by the wayside.”

The silver lining of all this overflowing fury, however, is that it often forces a woman to stop and pay attention to her body – and bring herself back up the priority list. 

“We know oestrogen has a significant impact on the brain which is currently being researched to fully comprehend the hormone’s responsibility on brain function in perimenopause and menopause,” says Cullen. “And the more we can learn and understand about the role of oestrogen on the brain’s function, the more we can do to manage these symptoms and improve women’s quality of life.”

How can we fight back and maintain our calm?

“Firstly, understand you are not alone in feeling rage or anger and there is support available to help manage the intensity and frequency of these emotions,” says Cullen. We also need to treat perimenopause with as much care, consideration and attention as we do preconception, pregnancy and postpartum. “We need to shift our approach to managing perimenopause and menopause symptoms at the time of onset and instead, prepare a decade prior to ensure as smooth of a transition as possible,” urges Cullen. “Preparing for perimenopause begins in our thirties in our sixth life cycle at 35.”

As with everything to do with our health and wellbeing, it’s also vital to use a multi-pronged, holistic approach – but some of Cullen’s top tips include:

• Making yourself one of your top priorities.
• Have an annual blood test to check all micronutrients are measuring optimally.
  Integrate Traditional Chinese Medicine.
• Move! Prepare your body to be the strongest it’s ever been leading into perimenopause with strength and resistance training to support bone density, movement and mental health.
• Reduce caffeine and alcohol as they are both warming in nature and can aggravate hot flushes and temperature imbalances. Reduce dependency on both a decade before for a smoother transition.

Every perimenopause experience is unique

There’s no question that everyone’s experience of perimenopause will be unique to them, but establishing a multidisciplinary team who are in your corner can help you feel better prepared to take on the physical symptoms – as well as the rage that accompanies it.

“If a patient is feeling uncontrollable or uncharacteristic rage it is important for a psychologist to be integrated into their care to navigate the perimenopausal period, which can affect mood, feelings and relationships. There is help available and you do not need to suffer alone,” says Cullen. 

And as women, we all need to be a little bit kinder to ourselves, too. “The unpredictable transition of perimenopasue and menopause deserve the space and respect as any other significant hormonal chapter in a woman’s life but unfortunately, in Western cultures this is just not the case,” Cullen says. 

“The three stages of menopause should not be underestimated and improved care and support throughout the transition should be a necessity accessible to all women.”

We couldn’t agree more.

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