Hi, I’m Carol Covelli, a licensed psychotherapist specializing in helping women in midlife, experiencing perimenopause / menopause, anxiety and depression, AMA!

So, my wife is currently dealing with perimenopause. She just recently started seeing a mental health professional, and has been diagnosed with ADHD and an anxiety disorder.

Now I have been her safe space/outlet for irritability and bouts of anxiety for the span of our relationship. I'm pretty laid back and easy going and durable emotionally, so it's not a problem, or hasn't been in the past.

With the mood swings perimenopause has brought on, she's getting worse and it's becoming increasingly difficult to not respond back in kind.

Is there a technique or process by which I could let her know when it's getting too much without affecting her emotional state further?

Hello and thank you for reaching out. It sounds like you have been a tremendous support for your wife. I'm sorry that perimenopause has intensified her mood and that it has been more difficult for you to navigate. I am very glad to hear that she is seeing a mental health professional (I'm not sure if she is seeing a therapist or psychiatrist).

If she is seeing a therapist, do you think she would be at all open to having you sit in on a session? Not a couples session per se, but a session to discuss your concerns and work together with the therapist to identify actions, techniques or processes to manage when this situation occurs.

I assumed with my last paragraph that the situation isn't physical. If she is physically acting out, then if she is only seeing a therapist, she may need additional intervention from her GYN or to see a psychiatrist. If this is the case, I would also encourage you to see an individual therapist during this time as well.

If this is not the case, then maybe even seeing a couples therapist in addition to her therapy. You can always see an individual therapist as well.

I also wonder if she has negative experiences or trauma in her history that may be unresolved. This can contribute to how the physiological changes with perimenopause are affecting her mood.

Are there challenges women face during midlife that you feel are often overlooked?

That is a great question!! Thank you for asking! In my experience, there are many challenges that women in midlife face that are overlooked. The symptoms women feel during perimenopause and menopause are often overlooked or there is a "just deal with it" orientation. Some women very much struggle with perimenopause and menopause and can feel dismissed, sadly, even by medical professionals (I have had clients tell me). Along those lines, women are also feeling overlooked when they have symptoms of perimenopause and menopause and are not evaluated for other causes (i.e. hypothyroidism), that have similar symptoms.

I also feel people don't understand that many women in midlife are juggling caring for their children and their parents (i.e. the sandwich generation), as well as work, etc. Women are usually looked to care for their parents and sometimes even their spouses parents. It's alot of stress to do the hands-on care as well as finding the appropriate services.

Also, the care of women's sexual health in midlife does not receive the attention (on a macro level) that their male counterparts receive.

What do you think?

Could you elaborate more on what those symptoms are?

Sure! Do you mean symptoms of perimenopause? Symptoms include night sweats, hot flashes, irregular periods, heavy bleeding (please see a GYN about this, it can be an indicator of a more serious issue), fatigue, decrease or loss of libido, vaginal dryness, sleep disturbance (in addition to the night sweats), irritability, mood swings, anxiety, depression. This may not be the entire list and women may experience some, but not all of these symptoms. They also can have varying degrees of symptoms as well.

I used to be very mild tempered but recently due to hormonal changes I’ve become irritated very easily and experienced temper flares, something I haven’t had to deal with before. Are there some coping tools you’d suggest to keep my temper in check and not have over the top reactions to minor incidents?

I'm sorry to hear this is happening for you! Unfortunately, having mood shifts and irritability is common when the hormone shifts occur. I'm am glad you posted here. I see coping skills on two levels. The first are coping skills to help you in the moment when the irritability is occurring. The other are skills that are more life adjustments, to help lower the chances of getting to a place of irritability.

I would want to know for sure what your lifestyle is. Are you pushing yourself alot? Do you juggle multiple responsibilities? Do you typically take time out for yourself?

The best thing you can do in the moment of feeling those irritable feelings is to breathe. Take a long slow deep breath for 4 counts, hold for two and exhale for 4 and hold for 2. Repeat it one more time. This will help engage your parasympathetic nervous system (the calming response).

On a more lifestyle scale, taking a break, mindfulness, and meditation all can help. Taking a walk (for pleasure or fitness). It is also important to allow yourself a healthy outlet for irritability. Even journaling or just jotting down in the moment that you're feeling irritable.

Have you tried these before?

If you feel the mood swings are too much, I would encourage you to see your doctor or therapist to help.

My big sister (who is 12 years older than me) keeps telling me that when I hit menopause, I will lose my libido entirely. Yet I hear stories and accounts of people in their golden years having wonder sex lives (including my parents). She's kinda made me paranoid, because I'm 42, and my husband is six years younger than me. I hate the idea of losing my mojo when my ova supply runs out, as enjoying sex is a huge joy in my life, up there with huffing kittens, chocolate fondue and brand spanking new episodes of Doctor Who.

So is it true? Or is it more than hormones that dictate such things?

Not a doctor but I am a 54 year old woman and no, in my experience that's not true. We are still an everyday couple and so far "use it or lose it" seems more accurate.

I did always run pretty hot though except while nursing babies, which entirely tanked my libido. That did make me fear menopause but I seem to be through it and we are active and happy and at least once a day, it's been awesome not worrying about getting pregnant too.

Yes, so true!! It also sounds like you have a healthy relationship. Thank you for your response.

This is a great question and I love that you mentioned a few of the things you enjoy. There is truth in what your sister is saying. During perimenopause, hormones become dysregulated as they decrease with aging and as we are ending our ability to bear children.

There are options available with respect to hormone replacement therapy, bioidentical hormone replacement therapy, or even hormone-based cream to help with lubrication. When the time comes, a qualified doctor can evaluate and see if you are a candidate for any kind of hormone therapy.

Can other things dictate decrease libido? The quality of the relationship can contribute to this, too. If the hormones are decreasing and you don't have a healthy relationship or you're not happy in your relationship, your unhappiness can be intensified. Even a woman who isn't in perimenopause can be turned off if they no longer feel connected to their partner.

How do you help a woman cope with the idea of aging and no longer being "beautiful"? As I get older this is something I am really struggling with. What can I do to be more at peace with this?

Wow, what a great question! Much of figuring out how to cope with the idea of aging and feelings connected with the worry of no longer being seen as "beautiful" is understanding what one's perception of beauty is, and how the concept of beauty has been defined in one's life. How we individually define beauty is influenced by what we were "taught" (actively and passively) about beauty from the adults in our lives, our experiences, and possibly societal influences. There are some women feel they become more beautiful as they age because they feel more comfortable with who they are. Other women feel less beautiful with age because of the physical indications of aging (i.e. graying hair, fine lines, etc.). How to make peace with aging is difficult to answer in this forum because there isn't one definitive answer. Therapy would be a supportive space to explore and help you with your struggle.

Hello Carol, thanks for doing this AMA! I'm in my mid twenties, so not quite in the midlife stage, but what is some advice you would give to women my age about moving into this next part of life? What do you find are the biggest stressors women in their midlife are facing?

You provide a wonderful and well needed service, and its comforting to know there are resources like you available for when I get there.

Hello and thank you so much for your kind words! In fact, it is important when you are in your twenties to be looking to your next steps. Any advice I would provide would depend on your current circumstances and what you would like to seek advice about. Are you considering career choices? Dating/relationship issues? School? Looking to move out on your own? Without knowing the specifics, I would say that it is important to start looking at the things you want out of life. I find that it's in your twenties that one is shifting from what other adults expect of them and what they expect of themselves. It can be difficult to separate the two. Does that make sense?

In my opinion, the biggest stressors women in midlife face is that there are shifts in their lives. Their bodies, relationships, family dynamics, work, etc., and they are unable to take the space they need to make those shifts, because, well, you know, life just keeps going..

Hello I have recently read that undiagnosed spectrum conditions, such as autism, is now thought to account for a great deal of chronic anxiety and other struggles with mental health in girls and women. There is discussion and interest in how this may be intertwining with menopause in older women and contributing to their difficulties. Do you have experience of this in your training and work? If so, can you comment further?

Hello and thank you for your comment! Unfortunately, I don't have expertise with respect to autism spectrum disorders. However, I would be very interested in knowing where you read this information. The intertwining is fascinating to me. In the populations I work with (not autism), I see a correlation between the cumulative effects of mental health issues and struggles with perimenopause, menopause and midlife. I would imagine it would be similar, and would love to know more.

I'm not the OP on this question, but this study seems to point to the stress and mental anguish of women when they go undiagnosed. https://journals.sagepub.com/doi/full/10.1177/1362361319853442

I am going to read this later. Thank you so much for sharing!!

Hi Carol! Thanks for doing this!

I'll be 40 in a couple of months and have just, in the past year or so, come to remember/recognize/process the emotional trauma my parents put me through as a teenager.

How often would you say you experience other women going through this? Becuase it feels incredibly juvenile to be dealing with "mommy and daddy" issues at this age. Rationally, I realize that there is no right or wrong time to parse your emotions or past, but irrationally, it still just feels so silly and immature.

Thank you for being here and I'm sorry you have experienced trauma from your parents. When you ask about how often do I see women going through this, I'm going to read it as meaning trauma growing up/from their parents. Unfortunately, I see this more and more frequently. I understand when you say that it can feel silly and immature, but you are spot on when you said "there is no right or wrong time to parse your emotions or past." I can't speak specifically to what your experience is and can't provide specific advice, but seeing a therapist who specializes in childhood and/or complex trauma can help. In general, our experiences when we are children help our brains create the messages we tell ourselves, and patterns of behavior and relationships. If there is exposure to trauma, our minds can create patterns that no longer serve us once we are out of the traumatic situation. However, our brains don't realize we are out of the situation, even years later. It keeps responding as if you are still in that situation because that is what it knows to do to protect you. I hope I am answering your question properly. Am I? If a part of you feels now, at age 40, you are still caught in those patterns, I would definitely encourage you to see a trauma specialist.

I didn't "heal" until I started the process in my mind-30s. By 40 I have processed my parents affect on me. Wish I had done it sooner, but better late than never. When you grow up anti-mental health (family didn't believe it such type of therapy) how would you know to get help? Again, better late than never!

Thank you for contributing! It sounds like you've worked hard to process your experiences with your parents and growing up. I am so glad you are in a better place. You ask a great question and to be honest, that is a huge challenge mental health providers are constantly trying to overcome. There are many people who have been raised, and do not "believe in therapy." As a mental health provider, it saddens me that people who need and can benefit from getting help, are not amenable to therapy. Someone who is against therapy may never know to get help, or, may feel embarrassed, ashamed, or weak to look to get help. I think continuing to address the stigma on a societal level is what may help over time. For example, GenZ as a whole appears to be more open to therapy. I'm so happy that by 40 you are feeling good!

I feel like my anxiety is becoming more intense with every passing year. Is it common for women to get more anxiety as they age?

Thank you for your question! Yes, it can be possible, and there can be multiple factors that can cause anxiety to increase as we get older. Hormonal changes that coincide with menopause/perimenopuse are one factor that can contribute to anxiety (and increased anxiety), but it is not the only factor. Other potential contributing factors can relate to what you were taught about aging. Is aging an experience that just leads to death? Are there worries about being alone as you get older? Or, are you in an unhappy or unhealthy relationship and feel there are no other options? Are you dealing with health concerns or financial worries? If there are deeper emotional worries connected with aging, then it makes sense to feel anxiety about it.

Hi there, I started the change at 38 and am 48 now. I take progestin and estrogen and still have uncomfortable hot flashes in the middle of a meeting or just standing in line at the grocery store. It's just that there's SO much sweat that my under garments get soaked! People take notice and I feel embarrassed and frustrated that I lack (I feel helpless!) control over this. Is there anything else I can be doing to make myself more comfy?

Hello, thank you for sharing your experience here! I can imagine the discomfort and embarrassment you are experiencing. Have you spoken to your doctor about it? Does your doctor take periodic blood work to monitor your hormone levels? Hormone therapy should help with the intensity of the hot flashes. How are you managing your stress? I can understand the hot flashes you're experiencing, it must be very stressful. What I mean is on a day-to-day basis. Do you have any downtime?

What indicators do you see when it’s time to seek help from a therapist? What are some early signs or signs when someone is going through or struggling with midlife or perimenopause?

Wow, I love this question. If someone is experiencing signs and symptoms of a mental health issue, that is certainly time to see a therapist. Also, if someone is going through a stressor or needs support, that can be an indicator. For others, they may not be experiencing symptoms of a mental health issue, but want to speak to that independent third party to help them with a specific situation or for guidance.

Early signs when someone is going through or struggling with midlife or perimenopause usually connect with what is happening physically. Fluctuations in the menstrual cycle, fatigue, night sweats, and lowered libido are a few early indicators of perimenopause. These physical symptoms can bring out anxiety, depression, lowered stress tolerance, and even panic attacks. Midlife struggles can be solely connected to perimenopause or there can be additional struggles surrounding environmental and relational issues.

Carol, thank you for taking the time and effort to thoughtfully answer all these questions. It’s very much appreciated.

Thank you so much for your positive feedback!! :)

Hi Carol, is there anything peri menopausal women can do to help with memory loss? (If that’s actually a symptom which I’m hoping it is!) Thanks in advance!

Thank you for posting about memory issues! I haven't seen this asked yet. I do want to clarify, do you mean brain fog? Like, you walk into a room to get something and then forget what you came into the room for, is that correct? If so, then yes, that is an actual symptom. It can be a symptom of other issues as well (i.e. hypothyroidism). I encourage you to see your doctor and report what you're experiencing. Your doctor can potentially order blood work to make sure.

My wife is 41 years old, and I think she's premenopausal. Her period comes sometimes a week or two late or this past month she only had 13 days between cycles. she's having trouble concentrating and often has mood swings.

Are these all typical symptoms of premenopause? Anything she can do to feel more normal?

I appreciate your coming here to support your wife! Yes, her symptoms sound typical for perimenopause, but that is not to minimize what she is experiencing. I would encourage her to see her doctor to discuss possible options to help with the physiological symptoms. If she is someone who pushes herself, it can help to slow down or at least take moments to regroup and center herself. Trying to get sleep or some kind of restful moments during the day can help (even some deep breathing can help). She can also see a therapist to help develop coping skills and life adjustments to help with mood swings. A therapist may also be able to coordinate with her doctor in her care. Has she seen her doctor?

Hello and good day! I'm signed on and looking forward to answering your questions.

Hi Carol,

I'm in my mid 30s and I'm starting to feel like my body is just falling apart. Stuff hurts more, and injuries take longer to heal. It's both frustrating and scary to feel the physical changes. I know this is a little different from older women experiencing premenopause, but what mental health advice do you have for younger women coping with aging?

Hello and thank you for reaching out. Changes in our physical bodies as we get older can be disconcerting. I'm not a doctor and cannot say if what you're experiencing is normal and appropriate. But, it sounds like you're in quite a bit of discomfort. If you haven't done so, I would encourage you to see your doctor about what you're experiencing. Perhaps your doctor can investigate what is happening for you further. I hope this helps.

I had a subtotal hysterectomy (still have ovaries) at the end of 2017, I'm close to 40 now and am now going through perimenopause. What is your top recommendation for women dealing with mood swings, hot flashes, and everything else that goes along with midlife changes?

I appreciate you sharing your experience and I hope you are doing well. I would say the first thing to do is to report what you're experiencing to your doctor. Your doctor can talk to you about options that may help level off the symptoms you're experiencing. With respect to my expertise and experience, there is definitely a correlation between the intensity of what you're feeling and the experiences one has experienced up until, and including, the time of the start of perimenopause. What I mean is, for example, if you have had stressful experiences in your life and typically have held your feelings inside, or are hard on yourself, that may be harder to do once you reach perimenopause. This can feel disturbing because it feels like these ways of coping don't work anymore. If this feels like part of what you're experiencing, I would encourage you to speak to a therapist. Helping yourself on a psychological level, at least to me, is just as important as on a physical level. I hope this helps. What do you think?

Carol this is really helpful, I've been neglecting my self-care and assisting my aging parent has really been bringing up trauma from earlier in that relationship. Are there other people with your skillset out there? I would love to find someone in my West coast city to start therapy again. ❤️

Goodness, I would love to help you find someone out on the west coast! What state are you located in?

Washington! Seattle area would be great 😄

neglecting my self-care and assisting my aging parent has really been bringing up trauma from earlier in that relationship

I'll put some feelers out. I can't guarantee I can find someone, but I will do my best. Are you able to go out of network or private pay? Or, do you need to stay in network with your insurance? If so, then can you tell me who is your insurance (carrier and name of plan)? Feel free to DM me if you prefer.

Personally, BHRT changed my life 100% for the better. I had no idea how much chemistry affected who I was. In your experience, is this unusual? How much is mid life and how much is sheer chemistry?

Yes, BHRT can be a game changer, and I'm glad to hear that you are a candidate for BHRT. It's unfortunate that not everyone is. Your experience is not unusual. If the hormones can be regulated, I have seen it help many women. In my opinion, it is a combination of both. If the overall situation of the person in mid-life is stressful and negative, regulating the hormones biochemically may not change that. It really depends on the bigger picture. However, helping to regulate the chemistry can help her to have the energy and tolerance to make the environmental changes she may want to make.

I just recently turned 55, and have been in menopause for about 5 years now. I also have MDD and took a full round of TMS this summer. It didn't help. I actually felt worse. My main physical problem now is hair loss. It's getting very thin in the front and top. I was also asked by my Dr. if the hair loss started after my vaccines. It's been getting thinner for a couple of years now but seems to have really ramped up this year. I think that there might be multiple factors for the loss. Do you have any suggestions that might help this issue? It's not helping my self-esteem either. No one wants to be old, depressed, AND bald lol

Thank you for sharing your experience here. I'm sorry you felt worse after receiving TMS. Hair loss can be attributed to multiple issues, and I'm not a doctor, but am wondering if you have been evaluated for any thyroid issues?

Throughout your education, research, and experience, what is the most surprising/memorable thing you've discovered about depression and anxiety?

This is a great question! The most surprising/memorable thing I've discovered about depression and anxiety over my years of practicing is how many people are walking around in life feeling depressed and anxious and you would never know it. The game faces people feel they need to put to make it through the day or to not worry their loved ones, when they are suffering inside, is mind blowing to me. Also related to this, are how the vast majority of people I see feel that they are "not good enough," and how this harbors shame and having to keep that game face on. Thank you for asking!

What type of doctor or specialist is best to understand hormone balance in general? I don't know for sure but I just can tell something "isn't right " but my GP and OB don't seem to do much. I am in early 40s and feel a mess.

I'm glad to hear you are advocating for yourself, and not giving up when something doesn't feel right. Have you tried an endocrinologist?

I’m going through perimenopause early at 38…any advice for getting through the more emotional aspect of moving into this stage of life prematurely?

Thank you for sharing your experience here. The emotional aspect of perimenopause can be very intense, particularly when you experience perimenopause early and earlier than you would have anticipated. A lot of how I would answer that would depend on the emotions you are experiencing. Are you feeling sad or depressed about the window of having children becoming smaller? Are the emotions you're experiencing relating to feeling like you're aging because of perimenopause? Like, you're feeling older than you believe you should be at 38? I know I'm a therapist, but I highly recommend speaking to a therapist to help you through the emotions you're experiencing, particularly if you feel they are interfering with the quality of your life. In some instances, skills and coping mechanisms are invaluable. However, the sense I get from your post is that seeing a therapist would help you to process your feelings and what you are experiencing.

Holy crow! No one told me I would legit feel like garbage the rest of my life. I'm tired all of the time, sweat profusely and have different ailments every month. Hot flashes Night sweats General bodily temperature control issues (to the point of being debilitating) Throwing up most mornings Weakness Depression I can't take hormone replacement therapy due to cancer risks. Does it ever end? Is there a point when I'll feel good again? I took a nose dive, can I ever climb out of it?

Goodness, I'm so sorry you are experiencing these very intense symptoms! I understand that HRT is not an option, but can your doctor offer other non-hormone options to help with your nausea and vomiting, and depression? Has your doctor run a thorough panel to rule out any other potential issues? My understanding is that typically symptoms can abate once menopause is reached (one year without a period). Is that 100%? Not always. Have you spoken to a specialist in perimenopause/menopause? If you're in North America, you can try North American Menopause Society (NAMS) https://www.menopause.org/. There are good resources there and practitioners who have a specialization and/or training in helping women in menopause/perimenopause.

Have you seen women entering perimenopuse earlier than expected, like early 40’s? Anecdotally I’ve noticed an increase in perimenopause starting earlier than in the past, and wonder if there’s something to that.

Thank you for reaching out! Yes, I have seen this, and I have seen women in their 40s struggle to get validation for their symptoms because they were "only 40" or "too young" to be experiencing perimenopause. It's important for her to find a doctor that understands this.

You bring up an interesting point about perimenopause starting earlier. I wonder if there are any studies out there that verify that?

Hi Carol! Perhaps this question isn’t in your wheelhouse, but do you have any tips for minimizing the effects of pretty intense mood swings during PMS?

Hi there! I'm sorry to hear you're experiencing intense mood swings during PMS. Unfortunately, PMS is not exactly my wheelhouse, but would encourage you to speak with your doctor. Have you reached out to your doctor about the PMS you're experiencing?

What was your education and career path towards online psychotherapy like? My dream is to have my own practice and ideally for it to be online and i would appreciate any insight and advice you can offer!

Sure! It's great that you would like to be an online psychotherapist. It is very rewarding and very convenient to be able to work remotely. There are choices with respect to an education path, but all options require a Master's degree to be able to be eligible to be licensed to practice independently (private practice). You can receive a Master's in social work or a Master's in counseling, just make sure the program you attend is accredited. You can also pursue psychology but will need to attain your doctorate (PsyD) to have a private practice. You don't need a Bachelor's degree in psychology or social services to go for the Master's degree in social work or counseling. I'm not sure about psychology. Once you receive your Master's degree, you will need to take an initial licensing test (depending on the law where you live), then attain a certain amount of hours in the field under supervision. Once you get that, then you sit for another licensing exam. Once you pass that, you can open a private practice. Again, it depends on the law in your area, but that is the general gist. I hope this helps!

Thank you for doing this AMA, as I'm sure you know, there's so many women struggling.

I would like some information about SSRIs.

I turned 50 in Jan. After my husband's death from cancer in 2017 I went into peri.... I suspect the trauma and grief triggered it. I struggled with the ptsd-like grief and the peri symptoms and crippling anxiety on my own until 2019 when I started to see a therapist. She and my Nurse Pract. got me on Celexa and it was life changing. Not only did it eliminate the anxiety it toned down the hot flashes and night sweats to almost nothing. I went off of it at Christmas 2021 and the anxiety has not returned. I still over heat easily, but with way less intensity than before. Periods are still becoming more erratic. It's like the medication trained my brain to not over-react to stimulus.

I would like to know of similar acting SSRIs. Celexa worked great for me, but I understand that this kind of medication doesn't work for everyone and I think it would be valuable to know alternatives.

I also kind of dread the idea that peri is only taking a break now that I'm managing stress better, and it's going to come roaring back later. Am I right to worry?

Thank you for reaching out! It sounds like while taking the Celexa you were able to progress in therapy to where you didn't need to take Celexa any longer, that is great! Unfortunately, I'm not a doctor so medications are not my expertise. I do have some familiarity because many people I have seen take SSRIs, but not enough to make any kind of medication recommendation. It's also hard to say if your perimenopause symptoms will return. They might, but you also may have progressed more in your perimenopause and your body is settling. Again, it's hard to say. Do you feel comfortable reaching out to your nurse practitioner about other medications that can be helpful?

Are there any types of memory loss that happens in perimenopause? I have sincere concerns about my mother and want all my ducks in a row before I bring up my concerns. Few examples of memory hiccups. She will repeat herself. Even stuff if I told her that same day, she will repeat it back to me. Making plans. She will forget we made plans or the important logistics of said plans. Like whose vehicle we're taking what time we're leaving, or just completely forget we even made plans to do something together. Forget she gave something away. She gave me something and when I asked for it later she said she didn't know where it was. She had gave it to my brother and forgot she even text him that he can have it. There are other things but those are the most recent. But its mostly repeating herself.

Thank you for reaching out and sharing your experience. Memory issues or brain fog can occur during perimenopause, but can also be indicative of other potential health issues. Without knowing your mother specifically, it is hard to say. If possible, it would be helpful for your mother to see her doctor for a physical or evaluation.

What’s your favorite movie?

Considering most of the movies I have seen in the last (almost) 15 years were with my daughter, I would say Toy Story 2. What is yours? Thank you for asking!

My psychologist just told me that anxiety is only for immediate threats, and everything else is just worrying about the future. Any physical “anxiety” symptoms I have when I worry about the future he thinks are likely more related to my ADHD diagnosis. Is this true?

I appreciate your question because I love educating people about anxiety. Yes, people who have ADHD often also experience anxiety. What your psychologist is describing is the fight/flight/freeze/fawn response that gets triggered when there is an imminent threat. Everyone is equipped with this response, it is hard-wired into our brains from the "caveman days." When people have an anxiety disorder, this response gets triggered when there is no threat to our livelihood, but we FEEL like there is. It sounds like when you think about the future, this response is triggered, causing worry/anxiety. It's the same response, just without the T-Rex chasing us. Does that make sense?

I stopped HRT because I was concerned about the cancer risk. I have hot flushes hourly accompanied by nausea. The worst part is that I feel like I can’t concentrate while this is going on, so I lose 5 minutes or more per hour.

Is there a non-medication way to avoid this?

Thank you for reaching out! I understand your concern and am sorry to hear your symptoms have returned. I'm assuming you stopped HRT under the guidance of your doctor (?) and what you're experiencing is after having been off of HRT in this manner? If not, then please contact your doctor and inform the doctor that you have discontinued the HRT.

If what you're experiencing is having been off of HRT while under your doctor's care, then the focus would be on self-care. Unfortunately, because the hot flashes are part of your body's attempting to regulate itself physiologically it's challenging to avoid them occurring. If you're powering through the hot flashes, it can make them feel more intense. It can help to do the things you can find in a google search, such as keeping the room cool, or a fan nearby, staying hydrated, if you like mint or cucumber, and putting either of them in your water. But, taking those 5 minutes help to recenter yourself (if you can).

How do you distinguish between psychological/behavioral causes and hormonal/physical imbalances?

What sort of hormonal testing should woman who are experiencing struggles with midlife request from their GPs?

What resources, such as books or podcasts, do you find yourself recommending most often to women with midlife struggles?

Great questions! In order to get a clearer picture of what may be influencing a mental health issue or symptoms, I will do a thorough initial assessment. Oftentimes, it is in the assessment that I learn about experiences with perimenopause or an emphasis on not feeling physically well. Mental health struggles can cause physical problems, too. So, if I want a clearer picture of a client's physical status, I will encourage them to go for a physical and receive blood work.

I'm not a doctor and not necessarily aware of all the types of hormone tests available, but to know the status of one's sex hormones (progesterone, testosterone, estrogen), stress hormones (DHEA, cortisol), and to have a thyroid panel conducted (TSH, T4 and T3) would be a great start.

I am trying to find good resources for women. The North American Menopause Society has very good resources https://www.menopause.org/. Oftentimes, resources are sought for underlying issues or struggles (i.e. trauma, narcissistic parents, etc.).

How much of the depression do you think is from women regretting not having children?

Thank you for your post. Unfortunately, I am not aware of the specific research into your question. There are many many potential contributing factors to depression, and yes, regret for not having children can be a contributing factor for some women. However, I personally know many women who have not had children and are very happy with their decision.