Is perimenopause supposed to hurt??

I recently shared a house with a group of my lady colleagues; we had all gathered in a different city to study with one of our teachers, Eran Even, a very skilled herbalist who generously shares his insights.  It’s so great to have a weekend together…we get to gossip, share bits of our lives, and talk shop.  One of the many threads to our weekend conversation was PERIMENOPAUSE.  


This is not a surprise, because everywhere I turn there are posts, TikTok’s, memes, workshops, even classes on the subject.  And here I am, adding to the din with this blogpost.  As a group of practitioners, catching up in our shared house, we agreed that this is a necessary counterbalance for the general lack of conversation around this shared experience.  But over breakfasts, we also acknowledged that something is off about all this buzz.  


I’ll start by just describing what perimenopause is, so that we can better identify what it isn’t.  Perimenopause is a transition, a necessarily vague term describing the transition to the day that will be 1 year since your last bleed — menopause.  Just as you are not born a baby and then one day switch from a coo-ing, breast-feeding snuggle bug to a 13-year-old who wears a bra, this shift happens slowly, over a long time, with barely perceptible and perceptible shifts.  


Each season of life or of the year has its own unique expression.  The transition from perimenopause to menopause is analogous to Autumn, a time of harvest, a time to benefit from your earlier efforts, a time when the superfluous and dried up fall away, a time to select and collect the fruits that will soon go into deep storage.  The image here in Los Angeles might be a pomegranate tree -- as the leaves turn yellow and fall, the burgundy red fruit is heavy on the branches.  If picked at the right time and set aside for storage, the skin will dry taught over the seeds inside, which get juicier and sweeter as the outer skin shrivels.  

Southern California pomegranate harvest.


What does this mean in a human life?  This is a time of increasing wisdom and discernment.  The no-longer-necessary or no-longer-useful are shed, the beneficial fruits are cherished and accumulated.  As the menses slows and decreases, more blood (which houses our shen, or spirit) is stored in the body and can be put towards spiritual pursuits.  Instead of the outward thrust of energy of opening flowers and buzzing bees that occurs in summer, we turn more inward, bringing our sap and blood down into our roots.


Like all of life’s transition, this is another kind of miraculous change and one to be aware of, noticed, celebrated.  What was not quite sitting right with us practitioners is the confusion between what is common and what is normal.  So, for example, it is common for women to have fibroids that cause a lot of pain and heavy bleeding, but this is not normal.  We would never want to confuse these symptoms of pathology that occur during the period with the period.  Similarly, we observed, with all the current buzz around perimenopause, we are pathologizing a natural process.

It is important to know that hormonal changes can cause severe and debilitating mood or temperature changes, heart palpitations, or alarming increases in blood flow, for example.  While these symptoms may become more common during (peri)menopause, they are not normal.  Sometimes patients will say thing like, “since my perimenopause started,” when really what they mean is “since this troubling symptom started”. The distinction may seem subtle, but it is key to unlocking a longterm relationship to better health.


Typically, an unhealthy (peri)menopausal stage is the result of less intrusive symptoms or emotions that have gone unheeded, until finally, at this Autumn stage of life, every fiber of your being says “pay attention to me”!   Prioritize the precious, let the unnecessary fall away.


This is a great time of life to put your emotional and physical house in order.  Any efforts to use old strategies to push on through and tolerate the intolerable will no longer work.  Old traumas, pains, hurts, or sadness will no longer let you ignore them.  Instead they require that you feel them fully so that they can be expressed and stop exerting their influence on your body and mind. Similarly, difficult periods or postpartums that are left untreated can lead to more difficult perimenopausal symptoms.


In this post-Covid world, I would be remiss to not name Covid’s effects on normal hormonal fluctuations in the body.  I have seen in clinic that Covid can wreak havoc on a person’s hormones, causing difficult periods and unhealthy perimenopausal symptoms, among many other things.  Luckily, when diagnosing with a Chinese medical lens, we do not have to decide what causes what, only to understand the symptoms fully in order to be able to treat effectively.


Just as during a healthy menstrual cycle you might be more productive just after your period, be more outgoing during ovulation, more withdrawn and perhaps with some breast fullness before your cycle, it’s not that there are not perceptible changes during perimenopause.  I asked my own mother about peri/menopause and she described getting slightly warmer sometimes, but that it felt cozy.  I myself am noticing less predictable and scanty cycles, thinner skin, occasional mild night sweats, less tolerance for a glass of wine, and flabbier muscles, for example.  But also, for example, I feel strong, capable in my field, settled in with a rich social life, healthy, and more able to have difficult conversations.  


In other words, I, like many before and after me, am transitioning into becoming an elder.


If you are also in this stage of life and suffering from hormonal symptoms, something is wrong.  Mislabeling pathology as perimenopause may cause you to miss opportunities to get help with treatment.  As you may have guessed by now, this is something Traditional East Asian medicine practitioners are really good at treating.