The menopausal transition is confusing to patients, in part, because the language used to describe this often decade-long transition is confusing.  The ovaries produce several hormones, but primarily estrogen and progesterone.  As the ovaries age, there is less predictable production of estrogen and progesterone, with many changes in periods and the development of symptoms that are troubling to many women. Generally, menopause (no periods for a full year) does not happen suddenly. Perimenopause is the time before menopause, and is divided into two stages.

Early Perimenopause sometimes begins in women in their 30s, but generally begins in the age group of 40 to 45, accompanied by a change in the menstrual cycle and the onset of some symptoms such as hot flashes.

Late Perimenopause typically occurs in women in their late 40s or early 50s.  Periods generally become much less frequent, and the symptoms of menopause that each woman may have experienced earlier begin to become more significant.

You, Jean, are in the early perimenopause stage. Since each woman is different, and menopause does occur in the early 40s in some women, this is just the right time for you to hone the lifelong skills you have used so successfully thus far to create a personal, marital, parental, and professional life that is different from the template given to you by your sister.  Here are some ideas to keep in mind.

1. Menopause is an inevitable and normal physiologic change that occurs in all women who are lucky enough to live this long. It is not a disease. The symptoms can be managed.
2. Fear is useless. This is the time in your life when you can use this period of uncertainty—accompanied by the memories of the poor choices your sister made during her menopausal transition, along with some very likely unpleasant physiologic and emotional symptoms that may accompany your menopause—as fuel for transformation and reinvention.
3. Create a new schedule that gives you some personal time. This is not the time for you to be the perfect wife, the perfect mother, and the perfect friend. Discuss this life stage with your husband and daughters in a positive way. Remind them that you are going to do all that you need to do for this period of time to avoid your sister’s choices and behavior. Husbands like yours, supportive life partners with sex as an important component of the relationship, will be grateful to be part of the solution instead of fearing the worst that they have heard from their fathers, their friends, and the television ads promoting all sorts of treatments for menopausal problems. A frank discussion about making the right choices in the menopausal transition and the belief that management of symptoms is certainly possible are great life lessons that mothers can give their daughters. A focus on the positive is so important. Thirty years from now your daughters will have the memory of your menopause to guide them through their transition. Explain to your husband and daughters that you will need their help with household management, if you don’t have their help already. Tell them that you will need fewer social responsibilities at times so that you can begin more self-care. Say no to committees and relationships that take your precious time from you and give little or nothing back. Spend time with older women who are positive role models for managing this life stage
4. Fix your sleep disorder. Use the time freed up from saying NO to find meditation and yoga classes. Daily exercise and small evening meals consumed earlier in the evening are helpful to better sleep. Avoid alcohol since it disrupts the sleep cycle. Find a short period of time for evening meditation practice, which will calm your brain before you sleep. Many people listen to meditation apps such as those produced by Dharma Seed. Three teachers recommended to us from this organization are Jack Kornfield, Sylvia Boorstein, and Tara Brach. You can listen before sleep and then again if you wake up, so you can return to sleep instead of engaging in battle with ruminating thoughts. Waking up rested gives everyone a real opportunity to have a more productive day.
5. Stop drinking completely for the next six months. Your sister’s life was terribly affected by alcohol, and there can be a genetic predisposition to alcohol overuse. In addition, nightly alcohol consumption has become such an expected part of life for women in your demographic that you may not be aware of how much you are drinking. Ask your husband and real friends to support this decision. Alcohol affects sleep in many negative ways, causing disrupted sleep and difficulty returning to sleep. In six months, you can decide about your relationship with alcohol and develop a more mindful approach to drinking.
6. Choose to eat mindfully at work. Eat frequently and consume small portions. Carbs and sugar consumption often affect energy, mood, and concentration.
7. Create small breaks throughout the day. Find time during lunch to walk outside and be fully present in the joy of this experience. Take breaks every 30 minutes, if possible, to stretch and breathe deeply for just two minutes. Certainly, take a breathing and stretching break every hour. This prevents muscle tension and poor posture and reminds you, even for this short period of time, that you have given yourself the gift of mindfulness.
8. Weight gain is more common as we age, and it often begins in mid-life. The truth is, we need to consume fewer calories and exercise more after 40. Alcohol, processed foods, mindless eating, overeating, excessive nighttime eating, constant socializing where food and drink are the lubricants, all contribute to the problem of middle-age weight gain. Some women don’t mind the increase in midlife weight gain or the change in body shape, but weight gain is also a medical problem for many. Mindfulness and choices that support the goals that are yours will prevent weight gain.
9. As you progress through the years of your menopausal transition there are many therapeutic choices available that you can discuss with a gynecologist who has an interest in the care of women in this life stage. For many women, this may include a period of hormone therapy. Each choice you make should be for a specific symptom, and each choice may have side effects that will inform your decision. Health-care providers must remain current, listen to their patients’ fears and symptoms, and work with patients to create the symptom management necessary for each woman for this period of life when she needs to feel and function at her best.

We at www.womensvoicesforchange.org believe that women can replace the old news that menopause defined women in only negative ways. We know that informed management of the menopausal transition offers women the opportunity to move into the next half of life with awareness of confidence based on  personal strengths and perhaps the planned pursuit of new life goals. We are a community where this message is delivered whenever there is news or whenever someone wants to know “how to get it right” once again