Psychologically Speaking: You are normal

Welcome to menopause. Menopause occurs when a woman is without her period, or menses, for a full year.

Dear Dr. Batya, Six months ago, when we were away on a family vacation, I ended up in the emergency room. I awoke at 3 a.m. out of a deep sleep with the heavy feeling that someone just yelled "fire." My heart was racing and irregular and I felt absolutely panic-stricken, though I couldn't imagine what about. I was sweating profusely and was most uncomfortable. The doctors thought it was neither a heart attack nor a panic attack but sent me for cardiac and thyroid tests. I was shocked to discover that in the end they attributed it to menopause. Have you ever heard of this before? These symptoms really threw me. - W.L., Ra'anana Welcome to menopause. Menopause occurs when a woman is without her period, or menses, for a full year. It's actually perimenopause that results in more symptoms and, for many, it is not so welcomed. Perimenopause results in some women presenting themselves in my office wondering if they are "going crazy." Never having a prior history of depression, panic attacks or any medical concerns, they report that some days they are ready to bite off the heads of people who say something relatively innocuous. They also cry at the drop of a hat, get teary-eyed when they see a sad movie, may feel less energetic and less sexually interested or aroused. In addition they may experience many other symptoms, not the least of which may be sleep loss, confusion, dizziness, "power surges," hot flashes and some of the symptoms you describe. Some of these symptoms present with little warning and many are disconcerting. Talk about feeling unsettled and out of control! Add to it the fact that you may be dealing with your parents' aging issues (if you are lucky enough to have them still alive) or your own children who may have just started their own pubertal issues or, if older, may be close to leaving home. To top it all off you may be dealing with your own medical issues that come with simply being close to the "nifty fifties." Being part of the sandwich generation is no fun! Perimenopause, which may last a half decade or more, passes easily for some, may be slightly bothersome for others and for some may be a real nightmare. Once spoken about in hushed tones, the baby-boomer generation has made it quite acceptable to talk about it just about anywhere and anytime, as good health is considered a highly desired commodity. For those who suddenly turn red and drip like a tap, making the discussion public is a welcome relief. It has several components, and as a clinical psychologist I have become involved in providing behavioral and educative strategies for coping as well as in individual, couple and family therapy. As in other life-cycle events such as puberty, menstruation, marriage, childbirth and death, the more a woman knows and understands about her body, the easier it is to face the challenges she faces. Many women at various stages in their life joke about being "hormonally challenged." These little hormones are thought responsible for hot flashes, night and day sweats, palpitations, increased vulnerability to illness such as heart disease, osteoporosis, brain fuzziness, moodiness, sexual difficulties, memory loss, dry eyes, weight gain and insomnia. Feeling good about yourself and relationships as you go through the perimenopausal years can at times be particularly challenging but the following are given as a guide to help you get through: 1) Exercise is critical for your emotional well-being, as well as your bones and your weight. Start slowly and build up or add to your existing regimen but do something. The older you get, the harder it is to take weight off and now may be the time for real lifestyle changes. 2) Perimenopause is experienced differently by different people. One of the most difficult things to deal with can be the unpredictability. If you are having difficulties or are experiencing any unusual symptoms, make sure you get help. Recognize that depressive symptoms and menopause may overlap and that treatment for one may impact the other. Of the women I have seen, some have been using homeopathic remedies, some hormonal therapy and others a variety of other medications such as antidepressants. 3) Moodiness, insomnia and a variety of sexual difficulties can all be treated effectively. Don't sit on things waiting for "it" to get better. Seek help alone or as a couple so that you and your partner can work together to enable your relationship to be first rate. Decreasing your stress levels can decrease your symptoms. Make sure you take time out for yourself. 4) Be prepared. Whether it's to keep a change of clothes and a portable fan on hand for a hot flash or learning relaxation techniques when your heart goes "aflutter," there are lots of things you can do to make the moment easier. The good news is that symptoms eventually end and things return to "normal." 5) Get help to improve your "sleep hygiene" if fluctuating hormone levels and night sweats have you getting less sleep than you should. This may involve changing current sleep habits, reducing caffeine and a host of other simple tricks. 6) Have regular checkups and look after yourself. This is the only body you have and you owe it to yourself and your loved ones to take good care of it. Remember, like puberty, perimenopause is a natural process. It is neither an illness nor disease. The writer is a licensed clinical psychologist in private practice in Ra'anana.