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EMOTIONAL WELLBEING

Dial Down the Hormonal Stress of Perimenopause

How to keep your female hormones in check as you come face-to-face with stress from perimenopause.



"The limbic system is kind of going—and this is my clinical term—bananas." —Dr. Sheryl Green

Certain hallmarks of perimenopause—say, hot flashes and their close associates in thermoregulatory anarchy, the night sweats—are self-evident. But there’s another one that can be harder to discern, especially when set against the backdrop of a once-in-a-lifetime pandemic: stress.

Fortunately, to seek relief, you don’t need to know how much of what you’re experiencing is specifically perimenopausal stress, and how much is due to everything else.

"There are definitely biological influences that contribute, and there are also environmental influences,” says Sheryl Green, PhD, an assistant professor at McMaster University in Hamilton, Ontario, a clinical health psychologist at the affiliated Women’s Health Concerns Clinic, a coauthor of The Cognitive-Behavioral Workbook for Menopause and a Phenology Scientific Advisor. “How much is biological versus environmental? We don't really know, and it doesn’t really matter, because the treatments are equally effective, whether the stress is 70% environmental and 30% biological, or vice versa.”

Women gripping head

What are the biological contributors to menopause stress?

The limbic system, which is your brain’s emotion regulation center, “is used to having a nice, regular dose of hormones day to day, month to month,” explains Dr. Green. “During the reproductive years, we have a predictable level of estrogen and progesterone fluctuation across the menstrual cycle.”

So even if that cycle involves some heightened stress and anxiety, they’re finite and largely calculable. We can, as Dr. Green notes, safely assume that “our hormones will get back to a level that helps regulate those emotions again.”

“Then, when perimenopause occurs, there’s a sudden unpredictability to those hormonal fluctuations, which can be extreme in addition to being irregular,” explains Dr. Green. “So the limbic system is kind of going—and this is my clinical term—bananas.” Exacerbating any resulting biological stress is the sheer not knowing: “You can’t predict whether you’re in for a challenging few days—or months,” says Dr. Green.

Another issue? The elevated cortisol levels that tend to coincide with peri-menopause. While research into the specifics is ongoing, there’s little doubt that an increase in the so-called stress female hormone might put some sort of dent in your overall equanimity.

What are the other factors to perimenopause stress?

Sleep deprivation is a biggie—whether it’s the result of night sweats or happening all on its own (alas, fitful sleep is another common byproduct of stress). Either way, less sleep generally equals increased stress.

Another big one? For anyone who’s wanted a child and hasn’t yet managed to have one, there’s the particular now-or-never stress of perimenopause. Even if you’re considering interventions that don’t technically require regular menstrual periods (or periods at all), ye olde biological clock turns downright deafening as it winds down. In fact, plenty of women who have had kids still find the clock’s erratic last gasps stressful: “This is a very specific stressor,” says Dr. Green. “Approaching the point where we're not able to reproduce anymore has a significant emotional impact for a number of women, and can lead to not only stress, but also higher anxiety and depressive symptoms—if not full-blown depression.”

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So how can you manage all of those female hormones?

In Dr. Green’s extensive experience of working with women, Cognitive Behavioral Therapy (CBT) has proven particularly effective. For anyone unfamiliar with the treatment, it aims—per the American Psychological Association—to help people recognize where distortions in thinking patterns are creating problems; to reevaluate and change course accordingly, and to problem-solve through difficult situations.

As for how that translates to perimenopause: “Let's say a woman is in the middle of her workday, has an important meeting coming up and she’s already starting to feel a little sweaty. Then this woman thinks to herself, ‘If I go in and start to sweat, what if they think there's something wrong with me? They're going to think I'm incompetent. This is going to be awful.’ Now we’ve triggered anxiety,” Dr. Green says. “So, we’re actually escalating the hot flash.” Dr. Green has seen plenty of patients who would then skip the meeting.

“In CBT, we would tackle those behaviors as well as the thoughts, starting with the actual likelihood of someone seeing that we’re having a hot flash (pretty low).” But what if anyone does? “Let’s de-catastrophize. And let’s come up with some more helpful responses, from placing hands on a cold water bottle to slipping shoes off under a table.”

Of course, your doctor may suggest medication, too, and there’s no reason you can’t try both approaches at once: “About half of the women who are coming to me for a psychological and behavioral treatment of these symptoms are also treating them with medications, from hormone therapy to antidepressants,” says Dr. Green. “That combination may well produce the best outcome.”

You can also try a holistic approach, focusing on your own nutrition, sleep, exercise and overall wellness. Don't feel like you have to go through this alone: chatting one-on-one with a Phenology Coach in the Phenology App, who are Registered Dietitians trained in menopause- and midlife-related topics, can be helpful. Phenology Coaches can answer your wellness-related questions.

You can also talk to your healthcare provider about the benefits of naturally-powerful ingredients in supplements. For example, saffron and genistein is a combo that, consumed as part of a daily regimen as in this daily supplement routine, can reduce stress and anxiety, support positive mood and better sleep, and reduce frequency and duration of hot flashes.


Rafaela Marcus
Rafaela Marcus has spent most of her career in magazines, sometimes in the Glamour/Cosmo/Allure universe, sometimes in the National Geographic Traveler/Conde Nast Traveler/Travel + Leisure universe. After 25 years in New York, she now lives in Los Angeles.