We’re talking menopause, without the sales pitch. With this new 19th newsletter, you’ll feel less alone and more informed as you navigate this season of life. Subscribe today.

The average age of menopause in the United States is 51. The average age of perimenopause onset — when your hormones start fluctuating in preparation for the end of ovulation — is 10 years before menopause, or 41 … or, exactly how old I am right now. 

This newsletter? It’s for me too. 

One thing I have been thinking a lot about is how this phase of life isn’t only about reckoning with physical symptoms. Managing these physical symptoms can also be a kind of wake-up call about the kind of relationship you have with your own mental health. 

Cue the expert

That’s why I wanted to talk to Harita Raja, a board-certified psychiatrist who specializes in women’s health in addition to working as a clinical instructor at Georgetown University Hospital. When she started out in private practice, most of her patients had just had their first babies and were navigating postpartum mental health. And now, they’re still with her as they navigate perimenopause and beyond. 

She hears a common refrain from those patients: “I thought I was going crazy.” 

Part of the problem? How good these women have gotten at white-knuckling their mental health. After all, if you’ve been told that your period can’t actually be *that* bad or that everyone gets the “baby blues” after pregnancy, you’ve probably internalized that the impact that your reproductive health has on your mental health is either not a real problem or is something to be dealt with privately. 

This can all come to a head during perimenopause, Raja said. 

“The impact of that is significant, both internally and externally,” she said of these decades of dealing with difficult feelings by pretending everything is normal. “Internally, you’re increasing your cortisol, anxiety and depression may lead to a more chronic mental health condition. And externally, they’re not showing up the best way they can. A lot of women who are going to show up [seeking help] when they’ve hit rock bottom and then we tell them, ‘Oh it’s just because you’re aging.’ They trust the medical system and that’s it — it’s over. There’s nothing left to do.”

Raja said she sees a lot of women who come to her after experiencing decades of being told, “It’s all in your head,” had symptoms dismissed and have kept pushing through. 

The reality, Raja said, is that “they’re not pushing through very well.” She points to recent research in the United Kingdom showing more middle-aged women leaving the workforce and to the New York Times’ coverage of what they dubbed “the power pause” — or women leaving the workforce at the seeming apex of their careers. 

“All these women leaving work during midlife, during perimenopause — it’s not a coincidence, right? It’s because they are struggling and they have no way to get around it. We need to support women during this time.”

Raja is a menopause-certified mental health provider through The Menopause Society. She prescribes hormones in her practice, something she says “probably less than 1 percent” of psychiatrists do. That said, she stresses that hormones are just one tool in the toolbox. Not all symptoms warrant the same kinds of treatment, and not all treatments are hormones.

So, what does it all mean?

Raja’s words left me wondering what it means to think of perimenopause as a kind of wake-up call for taking back control over our own mental health outcomes. 

At her practice in Bethesda, Maryland, Raja started a group for South Asian women to come together and talk about their mental and physical health at midlife. They do a Zumba class together and then they talk. So often, she hears from people about the barriers that exist to talking about hard things. Raja said it’s nice for these women to be in community with others from a shared background — especially as they often discuss how most of their families didn’t talk about menopause and how they are processing that today.

That’s a common story, from folks from all different types of backgrounds. “In my culture, we just didn’t talk about this” is a sentence I have heard so many times now — enough that I am curious about if this is one of the great unifiers of the experience of entering middle age: a shared feeling of not having been prepared by the cultures and communities you come from for a stage of life that is about not having children. 

Is this something you have experienced in your communities — or do you feel the opposite? For a future edition, I’d love to hear about how you have or have not discussed menopause with your family and friends. 

My goal with this newsletter is to make a space to have these conversations out in the open — for people dealing with perimenopause and menopause to freely feel angry when they need to, to swap tips about night sweats when they need to, to laugh at themselves when they need to, and to feel empowered and emboldened by the confidence that comes with arriving at midlife all the time. 

Speaking of which — next week: We’re talking about night sweats. (Have a great tip for how you manage them? Please share them with me so I can add them to the list of tips I’ll include in the next edition.) 

I can’t wait to keep having this conversation with you. 

I almost forgot! 

At the end of each newsletter, I’ll share something menopause-related that I saw around the internet this week. Please share your internet finds with me, too!  

I am a huge fan of musician Neko Case and have been listening nonstop to her album that came out last week, “Neon Grey Midnight Green.” I’m also a huge fan of the way she’s been talking about menopause while doing press around this album. This quote from her recent profile in Pitchfork is really making me have so many feelings right now! 

“When I was younger, I thought people my age were really old, that your body doesn’t work anymore, that you’re done by then. It’s absolutely not true. I love seeing people around me, especially the women I know, changing the narrative of what it means to be 50 and older, or even 40 and older. Menopause is like adolescence. All your chemicals change and you don’t recognize yourself for a while, but then you come out of it with more self-confidence and less capacity for bullshit. It’s so freeing. There’s so much more room in your brain to do other things that you wanted to do. So there’s part of me that wants to tell people how great it is to be 54 years old.”