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We Answer Your Questions About Perimenopause

RACHEL MARTIN, HOST:

Imagine a physical condition that creates dramatic temperature changes in your body. You feel anxious, lethargic. You might lose your sex drive. You may even become severely depressed. Now imagine this condition affects more than half of all people. You'd think you'd hear a lot about it, right? This is reality for every single woman. And since the dawn of time, menopause has just not been a topic for polite company, let alone public discussion, which is why this scene from the award-winning Amazon series "Fleabag" got so much attention. Here is Kristin Scott Thomas with Phoebe Waller-Bridge.

(SOUNDBITE OF TV SHOW, "FLEABAG")

KRISTIN SCOTT THOMAS: (As Belinda) We have pain on a cycle for years and years and years. And then just when you feel you are making peace with it all, what happens? The menopause comes. The [expletive] menopause comes.

MARTIN: All this week, we've been talking about the connection between women's mental health and key reproductive shifts that happen over our lifetimes. Today, we're wrapping up the series with questions from you. To help answer those questions, I talked with Dr. JoAnn Pinkerton. She leads the Midlife Health Division at the University of Virginia Medical Center. And she's the former director of the North American Menopause Society. She explained that estrogen, which is one of the key hormones for women's reproductive development, fluctuates in the years leading up to menopause. Those years are called perimenopause. And that fluctuation in estrogen could have an emotional and psychological impact. Our first question to Dr. Pinkerton came from 55-year-old Gail Alcorn (ph) from Thousand Oaks, Calif.

GAIL ALCORN: Could menopause be contributing to higher levels of sort of general anxiety? And if so, is there anything special you would recommend to help with that?

JOANN PINKERTON: So the menopause transition is a time when you have both physical and psychological changes. In fact, some women don't have any hot flashes. They only have anxiety. So the first thing is to figure out, you know, is it bothersome enough that you need treatment? And then it also depends whether it's mild, and we can handle it with lifestyle changes, you know, such as mindfulness, more rest, more exercise, more sleep, whether you've got stressors that you need some cognitive therapy with or counseling or whether you actually need medication such as either hormone therapy or a low-dose antidepressant or both.

MARTIN: It's so interesting that you say that you might not even get the the hot flash that we all know to be synonymous with the change. It could just be anxiety or, in some people's case, really severe levels of depression. I want to play a question now from Dee Livingston (ph). She's 53. She's from San Antonio, Texas. And she shared with us her very intimate struggles that she's had to face since going through perimenopause.

DEE LIVINGSTON: My question about menopause is, how much is it going to change me psychologically? - because of what's happening to me physiologically. Since I started going through changes, I've lost all desire or motivation. I feel like I'm kind of mentally neutered, if that makes sense. I don't know. Am I always going to feel kind of like this? Is this a process that takes a few months or a few years? What can be recommended to help this limiting feeling?

MARTIN: What do you think?

PINKERTON: You know, while some people feel like they don't have as much energy or they're not sleeping as well, it sounds like it's much more serious. It's really affecting her daily life and her activities. And so, you know, if symptoms are persisting that severe for two weeks or longer, it may actually be a depression. Some women are more prone to have a depression when they are postpartum or when they're perimenopausal and particularly if they've ever had a depression before. So I would definitely see someone to kind of see how much of this is hormonal, how much of this is life's stresses and whether or not there's some therapy or medications that - or even supplements that might make her feel better. Perimenopause is a limited time. It's usually five to 10 years. And there is something called postmenopausal zest, when you start finally feeling good again. And we'd like to get her to that.

MARTIN: You referenced the light at the end of the tunnel, the postmenopausal zest, I think you called it.

PINKERTON: Yes.

MARTIN: Is that what you said?

PINKERTON: Yes, postmenopausal zest.

MARTIN: Say more about what that is. I think a lot of people will want to hear how you can start to see that, what it looks like.

PINKERTON: If you recognize that perimenopause is a tough time for women with all the hormonal fluctuations and also a tough time of life when you've got potentially work expectations, home expectations, family, social - and it all kind of hits at once. And then if we get through that and if you're taking care of yourself, all of a sudden, you start to say, wow, I feel really good again. I feel like I am a postmenopausal woman who can now take on the world.

MARTIN: So much of this is being able to communicate what's happening with you. Let me play some tape. This is from 54-year-old Kimberly Cohen (ph) of Memphis, Tenn.

KIMBERLY COHEN: What are some communication techniques or resources I can use and share with my loved ones to help explain the emotional rollercoaster I am riding and get the support I need from them?

PINKERTON: You know, if you try not to tell people that you're going through perimenopause, it's going to be more difficult at work and at home. And, in fact, opening up the lines of communication is really important - to be able to say, I'm more irritable. I'm not sleeping as well. It is important to communicate it, but then it's also important to make sure you take care of yourself - that you get enough sleep, that you exercise and that you recognize that it's a more vulnerable time. And then if it's causing issues where sex drive is low, you know, thinking about maybe being more creative about sex, maybe even thinking about counseling if that's an issue. But these emotional changes are real for families and for people at work.

MARTIN: Dr. JoAnn Pinkerton - she leads the Midlife Health Division at the University of Virginia Medical Center. Thank you so much.

PINKERTON: Thank you.

MARTIN: That was the last installment in our series exploring how women's mental health can be affected by pivotal reproductive shifts throughout our lives. You can listen to the other stories that we have done this week at npr.org.

(SOUNDBITE OF TV SHOW, "FLEABAG")

SCOTT THOMAS: The menopause comes. The [expletive] menopause comes. And it is the most wonderful [expletive] thing in the world. And, yes, your entire pelvic floor crumbles, and you get [expletive] hot and no one cares. But then you're free.

(SOUNDBITE OF SONG, "THINK")

ARETHA FRANKLIN: (Singing) 'Cause freedom...

UNIDENTIFIED SINGERS: (Singing) Freedom.

FRANKLIN: (Singing) ...Stands for freedom... Transcript provided by NPR, Copyright NPR.