Menopause and Why I Feel Crazy
If you're in your forties or fifties and feel like a stranger to yourself — rage out of nowhere, tears at commercials, sleep destroyed, anxiety arriving for the first time in your life — you are not losing it. You are most likely in perimenopause, and almost no one prepared you for what it would actually feel like.
By Jamie Ruth, LPCC · Licensed Professional Clinical Counselor (Minnesota)
Perimenopause starts earlier than you think
Perimenopause — the years of hormonal upheaval leading to menopause — typically begins in the early-to-mid forties, sometimes late thirties, and can last four to ten years. Menopause itself is just one day: the twelve-month anniversary of your last period. Everything before it is perimenopause, and that's where most of the symptoms live.
Estrogen is a brain hormone
Estrogen affects serotonin, dopamine, sleep regulation, memory, and the stress response. When it starts fluctuating wildly — not just declining — the brain reacts. New-onset anxiety, panic attacks, depression, rage, brain fog, word-finding problems, intrusive thoughts, and insomnia in midlife are very often hormonal, not psychiatric. They are also very often misdiagnosed.
The symptom list is long
Hot flashes and night sweats are the famous ones, but the full list includes: insomnia, joint pain, heart palpitations, dizziness, dry skin, hair changes, weight redistribution, low libido, vaginal dryness, frequent UTIs, irregular and heavier periods, migraines, tinnitus, and the cognitive symptoms above. If something new and weird started in your forties, put perimenopause on the list of suspects.
You were not warned because medicine failed women
After a 2002 study was widely misreported, an entire generation of doctors stopped prescribing hormone therapy and stopped learning about menopause. Most current OB-GYNs receive minimal menopause training. If your doctor tells you it's just stress, you need a better doctor — ideally one certified by the Menopause Society (find one at menopause.org).
Hormone therapy has been reassessed
Current evidence shows that for most healthy women under sixty or within ten years of menopause, hormone therapy is safe and significantly improves symptoms, sleep, mood, bone density, and cardiovascular outcomes. It is not for everyone — talk to a menopause-trained provider — but the blanket fear most women were taught is no longer supported by the evidence.
What helps alongside (or instead of) HRT
Strength training (non-negotiable — you are losing muscle and bone), protein at every meal, prioritizing sleep, reducing alcohol (which gets dramatically harder to process in midlife), SSRIs for mood when needed, vaginal estrogen for genitourinary symptoms (extremely safe and life-changing), CBT for insomnia, and therapy to grieve the identity shifts of this stage.
There is a self on the other side
Postmenopausal women report some of the highest life satisfaction of any life stage. The hormonal storm does end. Many women describe a clarity, directness, and freedom from the people-pleasing of earlier decades. You're not losing yourself. You are being reorganized — and the next version is often more honest, more whole, and harder to push around.