Perimenopause as Initiation: From “Make Baby” to “Make Wisdom”
If you believe the cultural conditioning, you may think of major hormonal transitions in a woman’s life – perimenopause and menopause – as an inconvenience to get through, burdensome, a problem to solve. You might be in the thick of perimenopause and wonder why you sometimes feel moody, bitchy, overwhelmed, irritable, fatigued, anxious, or one of dozens of other perimenopausal or menopausal symptoms. Perhaps you are experiencing grief about waning reproductive capacity, experienced as changes to or loss of your menstrual cycle. You may have gone to your doctor with a list of perimenopausal symptoms and been offered an antidepressant medication or the birth control pill, not the treatments that you want or need. You may feel fearful about the stack of chronic diseases that increase after 50 when you fall off the hormonal cliff. Maybe you are noticing that you’re bracing yourself, setting your jaw just to get through it all.
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But the cultural message of hormonal transition as a problem to fix entirely misses the point.
I want to offer an alternative, one that I have been exploring and deepening for the past several years now that I am personally in the fire of the perimenopausal transition.
When you view the perimenopausal transition into menopause as an archetypal process of spiritual education, psychic liberation, engagement, release, and re-imagining a new role, then an entirely new world of possibility opens. You realize that hormones are not programmed misery, but rather designed to transform us in positive ways.
I’m not talking about getting your crone on, because that image doesn’t work for me. If it works for you, great, enjoy. In my opinion, perimenopause (which can start as early as your mid-30s) is in need of major rebranding.
We are fortunate that we get to rewrite and reshape the experience of women after 40. We are in desperate need of it. Most women with perimenopausal or menopausal symptoms go to their doctor and do not get the information or treatment they need. The situation – the information, treatment, and gender gap – is totally unacceptable. The Women's Health Initiative was a major factor in the disinformation campaign that led to our current crisis in which 90% of women stopped their hormone replacement therapy, which led to accelerated aging and trouble getting the solutions they need.1 But this study was poorly designed, performed in the wrong age of women and with synthetic hormones that are risky, and finally overturned.2 As the Washington Post accurately described the situation: “No need to fear menopause hormone drugs, finds major women’s health study.”3 Amen.
Together, we are collectively creating a new narrative of the second half of life for women. Let’s roll up our sleeves and brainstorm a better way.
Perimenopause: An Archetypal Initiation
Initiation is a sequence of experiences, challenges, and sometimes rituals that guide you to a deeper process with spiritual truths and a new role. If we shift the current hormonal and biochemical process of perimenopause and menopause into a rite of passage, you could view the 100+ symptoms as a method of separating an initiate from their family, through irritability and maybe a sleep divorce, into a secluded camp with other initiates or women who are similarly suffering. Maybe all the symptoms are a way to guide you to the company of other women who are like minded and seeking meaning in what can be a rocky transition. It’s like a light switch that is going from off to on in terms of embodied wisdom, an energetic process. Together, we can re-define and emerge in a new role as wisdom keepers, no longer hamstrung and limited by the reproductive function.
I’m not the first person to describe hormonal transition as an initiation. Jean Shinoda Bolen, MD, a psychiatrist and Jungian analyst explores the “wise woman” archetype.4 She describes menopause, literally “meno” (blood) and “pause” (stop), as withholding of blood not to make a child as we did in our teens, twenties, and thirties, but withholding blood to make wisdom.
What wisdom exactly are we to make? As I plumb the depths of my own psychic structure, I see perimenopause as a time to examine the ways that my authentic self was adapted and mapped to a persona.
I’ve been working on the initiation model in my work guiding people into healing states of consciousness with psychedelic medicine. We need to unearth the story of who you needed to be to receive attention and love as a child. What emerges is a map of how your authentic self had to sacrifice authenticity in the service of connection that triggers symptoms. I see how many of my perimenopausal symptoms make sense when we look at this contracted self and how it splits from authentic self. Let me back up to explain.
A Universal Story
If you’ve read my books like Women Food and Hormones, or more recently, The Autoimmune Cure, you know that I like to offer my story as a guide for others. My goal is to help people learn how to be your own case study, known as an “n-of-1” experiment, with “n” being the study’s sample size—in this case, one. N-of-1 is a major tool of the work I do as a precision medicine physician. Put another way, you can serve as your own control and then perform experiments to find what personally works for you. That’s true for psychological experiments as well as medical experiments, including addressing your stress, sleep, blood sugar, trauma, brain fog, fatigue, joint pain, antibodies, and even bioidentical hormone therapy — all good tools for making hormonal transitions more graceful.
Like many of you, I have had a life of great joy and toxic stress. Now that we have survived the pandemic, it seems that most of us are in a similar boat. Trauma has become the norm.
As a child, my parents divorced when I was one year old. While overall my childhood was happy and supportive, it was also challenging as I negotiated life in a blended family. I felt I had to be a high achieving people-pleaser to receive attention. I became hyperindependent. That kicked off several decades of accommodation of my authentic self as I became an overachiever, type-A person, trying to do all the things for all the people in my life. Maybe you can relate.
Fast forward to my thirties, and I became the poster girl for the hormonal hot mess. I suffered from premenstrual syndrome, moodiness, borderline gestational diabetes followed by postpartum depression. I was stressed and overwhelmed, but still I continued to sacrifice authenticity for attachment. I hung onto ill-fitting jobs and relationships way too long. Still, I started my n-of-1 experiments to address my high cortisol, low thyroid function, and estrogen dominance. The experiments went remarkably well and I started to teach my patients how to perform them. I wrote about these experiments as protocols in my book, The Hormone Cure.
Right on the heels of giving birth to my second child, I entered perimenopausal chaos. In my forties, my periods got closer together and so heavy. My fibroids grew. I became anemic and pelvic pain worsened. My sex drive was missing in action. Sleep, always so sound, became unpredictable. I craved more refined carbohydrates and used food to try to change my emotional state. My persona grew, my soul languished, and my belly fat increased. I developed prediabetes.
All together, I’ve had about 20 years of ongoing perimenopausal transition. It seems that I still have more lessons to learn, so the universe has provided ample opportunity for growth. Now in my fifties, I noticed the symptoms of the final stages of perimenopause: less ability to focus, more brain fog, memory changes, loss of muscle mass, and more conflict in my relationships, at least the ones that rely on my persona. As both of my daughters left home for college, I regrouped, deconstructed, and reconstructed the architecture of my life to become more aligned with my authentic self.
The Lesson
Beginning at 50, I finally started to speak my truth. I no longer retreat to my cognitive structures (“solve it with my head not my heart”) or simply dissociate. I am more embodied and willing to have difficult conversations when needed.
In this, my hormones have led the way and served as a forcing function.
Think of it as the Hormonal Initiation. I got schooled by my hormones, and if you want, you can too. I feel like they have set the stage to give me exactly the growth opportunities that I’ve needed at every stage of my life.
Maybe you’ve heard the idea that your mess is your message. Well, when your hormones are a mess, that’s a message to listen to. Hormones are designed to transform.
Now I see hormonal transition as a beautiful process that shapes who we are. You may be pulled through a process of engagement and disengagement. You will ascend and descend. You may at times feel like you might die, and then minutes to hours later, feel reborn. The point is that hormone transition is an initiation, pulling you to a healing state of consciousness. A changing of the guard.
Menopause is not a problem or dead end. It’s a biochemical initiation. And there are no shortcuts to initiation.
The only way is to go inward and understand who you are, physiologically and psychologically, and come out the other side changed, wiser.
If you resist that change – if you just think it’s simply a problem to solve or suffer through – then you are also resisting the person the universe is asking you to become.
Welcome to the initiation of perimenopause and menopause as you shift from reproduction to wisdom. I am so glad you are here. If you want more support and for me to take you by the hand, consider joining our Rise mentorship or come to one of our upcoming retreats. Together, we are closing the knowledge, treatment, and gender health gap for women over 40, and offering a new way of being that is more authentic and true.
Footnotes
1Sara Szal Gottfried, The Hormone Cure (New York, Scribner, 2014).
2Manson JE, et al. The Women’s Health Initiative Randomized Trials and Clinical Practice: A Review. JAMA. 2024;331(20):1748–1760, https://pubmed.ncbi.nlm.nih.gov/38691368/.
3https://www.washingtonpost.com/wellness/2024/05/01/menopause-hormones-hrt-safety-whi/, accessed October 26, 2024.
4Jean Shinoda Bolen, Goddesses in Everywoman (New York, HarperOne, 2009).