Perimenopause and Menopause

Exuberance is Beauty

~ William Blake

All my life I have had a dream that I would live in a house with a long winding driveway lined with oak trees.  In my early forties I bought thirty acres of bare land in the South Island of New Zealand with no water, electricity, septic system or house.  Over a period of seven years the task of building a house and putting in the infrastructure of power, electricity, fencing and a water recycling system was all consuming.  Once the house was built my first priority was to plant shelterbelts so that my horses and the sheep that grazed my land would have protection from the elements.  Later, with the help of friends and students, large sections of landscaping and native habitat were planted.  An extensive vegetable garden was created with raised beds and a small orchard to provide fresh produce.  Little by little as areas of plantings matured the farm began to feel like home.  Yet in my mind, one of the most urgent projects was to plant a long line of Algerian oak trees along my drive.  This involved digging deep holes, driving supporting stakes, and tying each sapling to secure it against the strong prevailing winds.

I had been warned that while this particular species of oak could weather drought and strong winds, it would also take several years before the tree would lay down a strong taproot.  It will seem, I was told, as if nothing is happening, or that the tree has died.  I was warned not to make the mistake of cutting down in impatience these slow growing trees.  Only when the taproot was firmly established would the tree begin to thicken through the trunk and extend its energy into its branches.  It did seem forever before the delicate saplings started to look like full fledged trees, and now as I walk down the drive the branches are almost long enough to form a shade canopy. The larger and more mature my oak trees become the more beautiful they are to me.

Now in my early fifties, on days when I linger a little too long in front of the mirror, noting the changes that time has etched on my own face and body, I call forth the image of two trees: the delicate sapling and the mature oak. When I seek comfort and refuge it is under the boughs of a long-lived tree; its bark thick and creased with weather; its branches offering shelter from both heat and cold, and its fully formed majestic structure an inspiration even in the depths of winter.  We would think it folly to want a sapling never to mature into a tree, yet how differently we view our own aging?

There is much to be learned from the intelligence of Mother Nature.  For if we can learn to see our own maturation process with the same sense of satisfaction, we can move into our elder years with dignity and pride. We can learn to see that maturity has its own incredible beauty worthy of admiration. For just as the sapling becomes strong through surviving the buffets of the elements we also come to maturity having learned lessons from our mistakes as well as from our achievements.  If we can gather the resources we have gained from our experiences we can move into “the change” able to reap the fullest harvest from our lives and able to be a harvest for all who come within our domain.

Perimenopause (the years leading up to the cessation of menstruation), menopause and post-menopause are years of a women’s life that can be fulfilling and rich with potential.  Unfortunately, this is rarely the way Western women view the transition

The Misconstruction of Menopause

Over a decade ago a group of women approached me during a Yoga intensive inquiring as to whether I would be willing to lead a discussion on Yoga, aging and spirituality.  That evening about twenty women of all ages gathered to share their experiences, questions and stories and the impressions of that gathering remain indelibly etched in my memory.  As the evening progressed I was disturbed to hear the overwhelmingly negative stories the older women shared about their experience of going through menopause.  Turning to the younger women they cautioned: “You won’t understand (how bad it is) until you’ve experienced it.”  More than one woman related that the experience of emotional instability, lack of sleep and debilitating hot flashes caused her to consider taking her life.  There were few words spoken about the positive side of aging apart from one cryptic comment about “the alternative.”  This was not to be the only occasion that I heard women speak in such a disheartening manner about menopause.  While there was no doubt in my mind that these women had had a very difficult time during their menopause, it concerned me that the younger women present (myself included) were being set up to expect menopause as an inevitably terrible experience much as one women might relate the pain of her own difficult childbirth to another.  Having myself been fortunate to have a healthy, regular and mostly pain-free menstruation history through adapting my Yoga practice and life style during my moon cycle, I was determined that my transition into menopause might be different.

Like many women, in my late forties my menses began to change, becoming lighter and spaced a little closer together.  Although I noticed some degeneration of my vision during this time, I remained otherwise symptom-free and my energy levels were excellent.  Then one night a few months after my fiftieth birthday I awoke feeling a little hot and flushed.  This episode was really quite mild compared to the stories of drenched sheets related to me by friends and students.  My reaction, however, was anything but mild. I  felt panic stricken that this was happening to me, doyenne of over thirty years of Yoga practice!  Even though these mild hot flashes were not happening during the day and were not even strong enough to significantly disturb my sleep, I observed a dreadful feeling of fearfulness and to my surprise . . . an emotion that took some time to put my finger on . . . shame.  As I observed my thoughts and feelings, I realized that I equated menopause not just with the cessation of my menses, but the cessation of my being a woman.  It seemed to me that these symptoms were the harbinger of decline, decrepitude and the end of my attractiveness, sexiness and worth as a feminine entity.  But was this really how I felt about myself?  Or an idea that had been implanted over a long period of time through the osmotic process of cultural conditioning?  Clearly, my emotional reaction to menopause was far more damaging than the actual experience of it.  When I objectively assessed myself, I felt that I had never been stronger or more balanced in my physical body; my energy levels on the whole were exceptional and I felt more mentally and emotionally skillful than at any other time in my life.  Why then the intense fearfulness?

I believe that I am not alone in my initial reaction to this change.  From the moment we are born female we are conditioned to believe that our ultimate worth is inextricably linked to our physical form and our sexual desirability.  This emphasis has only become more extreme for the present generation of girls who sadly are being divested of the sweetness and innocence of their childhoods through the disturbing pressure of early sexualization.  The idealized physical forms that we are exposed to on billboards, in magazines, on television and now over the internet, consist of faces and bodies that have been so cosmetically altered and digitally manipulated that they bear little resemblance to every day women. Viewed with more discerning eyes these radically altered visages seem like grotesque flash-frozen caricatures of youth.  If you were to sit on a busy city street and carefully observe the women you see around you it is unlikely you will see anyone that looks remotely like these images. And yet these images have become deeply embedded in the collective female psyche as “real.”

Even more damaging and insidious is the unrelenting media bombardment urging women to spend her time, energy and hard-earned money on fighting the “ravages of age,” as if aging, and by aging I mean a chronological advancement of the years, were something that anyone, man or woman, could or would want to prevent.  We can no longer buy sunscreen to avoid life threatening skin cancer; we now purchase “age shield” and “age proof daily defense moisturizer.”  And even though recent randomized control trials show that the benefits of hormone replacement therapy are less than previously thought and the risks—especially of invasive breast cancer, coronary artery disease, dementia, stroke and other life threatening diseases—are greater(1), many women may feel compelled to take HRT for cosmetic rather than medical reasons. Unfortunately the jury is still out as to whether the latest rage; bioidentical hormone replacement is any safer in the long term(2).  I respect any women’s educated choice to take medical measures if her menopausal symptoms are making her life a living misery.  There are certainly instances where short-term use of hormone replacement when supervised by a knowledgeable health practitioner is an intelligent and compassionate option.  However, the most basic truth is that our bodies are going through a perfectly natural process of transition—not a medical condition or a disease. Becoming addicted to hormone replacement therapy may delay this transition indefinitely, which is born out when women go off hormone replacement and their symptoms return, sometimes even more dramatically than before medical intervention.

Embodying Fitness on all Levels

How can we assist our bodies to go through this transition gracefully?  For the bigger story as to how we can move through menopause with ease may have less to do with medically altering the fluctuation of particular hormones and more to do with creating optimal health; not only physical health but mental, emotional and spiritual “fitness” that will stand us in good stead during this powerful time.  A time in many respects that is no less bumpy and unfamiliar than puberty, yet no one considers puberty a medical condition requiring drug treatment.  Through improving all levels of our fitness we create an environment where the body has the resources it needs to find it’s own neuroendocrine balance.  For it is not just a matter of how much of any given hormone one has in the body but how the hormone receptors work and whether the orchestration of our hormonal symphony is creating discordant or harmonious music.  This is not just a question pertaining to menopause but is relevant to preventing illness and disease as well as increasing longevity at all stages of life.

Solutions to creating optimal health are rarely to be found in quick-fix drugs, isolated nutrients or sachets of freeze dried antioxidants.  Rather, basic and simple life style changes such as getting adequate rest, reducing excessive work and stress loads, taking sufficient pleasurable and preferably weight-bearing exercise, having harmonious and life enhancing relationships, doing meaningful work, eating nutrient-rich natural whole foods, and addressing preexisting health problems such as obesity, smoking, or alcohol addiction, not only give us a better chance of having an easeful menopause they give us a better chance of remaining fully functional into our later years.  While each of these aspects of health is outside the scope of this little article, I encourage you to consider some of the simple and more obvious life style changes you can make that would support your optimal health and well being. Paradoxically it is often common sense life style changes such as eating and sleeping at regular times that make the most difference to our overall health.  Yet these simple changes can seem far more challenging because they call into question the fundamental way in which we live our lives.

​​It is also worth considering the possibility that the severity of symptoms that many women experience during this time relate to imbalances within her overall health and lifestyle that existed long before menopause but are no longer tolerable within the new hormonal fluctuation that is taking place.  After years of bull dozing her way through “to do” lists, many women wake up one morning realizing that they not only have less “push” than they had in their thirties and forties, they no longer want to push themselves to live in an unnatural rhythm of relentless activity and pressurized productivity. I believe it is this profound yearning to return to a rhythm that is in sync with her deepest feminine nature that impels women to make dramatic shifts during this time.  I am struck by the sheer number of women in their forties and fifties who arrive at my Yoga retreats having recently jettisoned exhausting corporate careers, empty marriages, and unhealthy life styles, seeking instead a way of living that is in harmony with their natures and aligned with their personal values.

Fear of Aging and Menopausal Experience

While it is important to consider how preexisting unhealthy habits and life style choices may be creating less than conducive conditions for a smooth menopause, it can be even more crucial for a woman to look closely at her thoughts and feelings about aging and how this is affecting her sense of self.  One of the questions that I have both as a woman and as someone who has practiced Yoga for almost forty years is whether deep-seated fearfulness and insecurity about aging fuels an ongoing state of chronic sympathetic arousal.  It’s no surprise that we are experiencing a pandemic in postmodern societies of chronic stress in which our very body chemistry is altered with high levels of stress hormones.  This has been widely researched by the medical and alternative health community and the jury is in that it is not good for us.  But what is less obvious is the pernicious way in which a women’s self worth can be eroded by the toxic messages she receives about aging.  I do not think we can underestimate the detrimental effect of living in a culture that degrades, disregards and disrespects older and elder members of its community.

In cultures where elders are respected, valued and continue to play an active role within the community, aging is celebrated rather than feared(3).  Growing older in these cultures is experienced as a time of harvest, fruition and abundance and for many, an increase in social status.  In modern industrialized countries, however, women over the age of forty often describe themselves as “invisible”, no longer acknowledged or appreciated as persons of value.  So while it is not difficult to extrapolate that high stress levels caused through factors such as lack of sleep and poor diet undoubtedly contribute to extreme menopausal symptoms, I am suggesting that stress is two pronged.  Stress can come from more objective sources such as overworking but it can also come from mental and emotional negative self-talk that is happening in the substratum of awareness eroding the foundation of a women’s psyche.  Regardless of the source of stress, chronic sympathetic arousal is not a bodily environment in which the neuroendocrine system can function in a balanced way.

What is sympathetic arousal and what happens when this becomes an ongoing experience rather than a momentary reaction to a perceived threat?  Fear is the basic building block of the stress response, which is activated to ensure our survival.  The crack of the branch, the shadow seen from the corner of our eye or the vibration underfoot all alert us to the presence of a predator or imminent danger.  In reaction, the body readies itself to fight (defend) or take flight (flee), flooding the body with adrenaline and redirecting blood flow from the internal organs to the external layers of musculature.  This diversion of blood flow is key to understanding why living in a high stress state undermines health.  Each organ in your body has it’s own blood supply and each organ must nourish itself before it can do it’s unique job in concert with all the other internal organs and bodily systems. When we are chronically in a state of red alert the organs do not receive this nourishment and they become depleted, unable to do their jobs efficiently.

When bombs are being dropped and all residents have moved into bomb shelters for protection, all normal production ceases: food is not harvested or transported, the supermarket shelves are empty and garbage remains on the street.  Similarly, when our bodies are under siege, important bodily processes are suspended or altered.  Processes such as digestion and assimilation of our food as well as prompt removal of waste are impacted. Inflammation sets in.  A chronic arousal of the sympathetic nervous system, in short, creates ideal conditions for disease.  Additionally, when fear is experienced as a subtle, ongoing subconscious event with no particular source that we can pinpoint our feelings and thoughts about menopause may ultimately affect our experience of menopause.  Consider this.  A study by Suzanne Woodward and Robert Freedman showed that slow, deep breathing alone would result in a significant reduction in menopausal hot flashes(4).  In a pilot study prior to their own research, progressive muscle relaxation exercises and slow, deep breathing reduced the incidence of hot flashes by an impressive 50 percent(5).  More recent research by Erik Peper and Katherine Gibney at San Francisco State University led them to “strongly recommend that effortless diaphragmatic breathing be taught as the first step to reduce hot flashes and PMS symptoms”(6).

Enter Restorative Yoga

One of the reasons that Restorative Yoga can be so helpful during the potentially topsy-turvy time of menopause is that restful supported Yoga postures held for longer timings could begin to dismantle chronic states of sympathetic arousal and literally reset the balance between the sympathetic and parasympathetic nervous system. Redirecting blood flow from the superficial layers of the body back to the internal organs helps to support the internal organs to do their jobs such as filtering blood, balancing hormone levels, activating strong immune responses, digesting and assimilating nutrients and removing toxic waste products from the tissues so that they can be excreted regularly from the body. This not only ameliorates many of the symptoms of menopause, it builds stronger health.  And it doesn’t take long for this re-balancing act to reap rewards.  In as little as a few days or a week of eating a healthy diet and getting sufficient deep rest I see women on Yoga retreats start to bounce back. Many arrive looking bloated, uncomfortable and exhausted yet after a week of daily Yoga practice depart the retreat center looking and feeling svelte and energized.  As one retreat participant related: “I was amazed by the body's ability to naturally heal itself when surrounded in an environment of peace and tranquility combined with the support of women and the practice of Yoga . . . it's one of the best investments I've made.”  But you don’t have to go on a Yoga retreat to feel better: you can create your own “retreat-like” conditions at home through doing regular practice.

The second reason why Restorative Yoga practice can be so healing is that it allows women time to enter a deep state of relaxation and calm where she can perceive that part of her that is all enduring. . . her spirit.  In this silent place she can begin to restore a sense of her intrinsic worth; the part of her that remains eternally youthful and vibrant regardless of whether there are wrinkles on her face or her waistline has thickened.  Learning to shift her identification away from the impermanent and changing physical body towards the eternal identity of her spirit gives women an internally derived sense of self that can not be taken away from her through circumstance or through aging.

The third reason why Restorative Yoga and practices such as sitting meditation and Yoga Nidra(7) can be beneficial is that by creating a deliberately simplified space we can heighten our perception both of the content of our thoughts and emotions as well as the pristine field of awareness that lies just beneath the surface.  When we learn to practice detachment we start to see that both pleasure and pain are transitory experiences.  If we are occasionally buffeted by uncomfortable symptoms such as night sweats or unstable emotions, we can use these practices to witness the maelstrom of changing physical sensations, feelings, thoughts, and emotions for what they are: transient experiences.  We can learn to view “the change” from the part of ourselves that is unchanging. In this way it is possible to find stable ground even when we feel shaky.

Although thus far I have been fortunate in only experiencing several 3-4 week episodes of nocturnal hot flashes and sleep disruption, I have observed a phenomenon that may be of usefulness to other women.  Although always sensitive, my body is now a veritable Geiger counter for stress.  Whenever I notice myself feeling rushed and hurried, I can literally feel an instantaneous chemical change in my body.  When watching an emotionally disturbing news report on television, my heart begins to pound and stress chemicals flood my system so that my skin tingles.  I can literally feel my blood move to the surface of the body creating a strange and disquieting sensation.  Drinking red wine has never been agreeable to my body, but now the moment I take a sip I can feel my entire body recoil from a substance that it now registers as poison.  When I spend time with someone whose company I do not enjoy the precursor symptoms of irritable bowel syndrome begin to simmer just under the surface.  In short, all of the triggers that throughout my life have shown themselves to be non-conducive to my health are now illuminated immediately by the heightened sensitivity brought about through perimenopause.  I see this is as a powerful and positive change in which anything: animal, vegetable or mineral that is not supportive to my well-being is immediately brought to my attention.  I suspect that many women experience heightened sensory perception at this time, which they can use to aid their discernment in making choices.  Rather than viewing this heightened sensitivity as a downer we can choose to view it as an invaluable tool of awareness.

The transition into the second half of our life can be an opportunity or it can be an obstacle. Menopause has the potential to be a powerful experience in which we as women become more sensitive and adept in perceiving subtler resonant fields of physical, energetic, mental, emotional and spiritual phenomena, within ourselves and around us. In short, we have an opportunity to purify our perceptions and to live our lives at a higher resolution. For women being initiated into elder hood this high-resolution living offers a more satisfying experience of life.  It is also a way of living that casts a light around her so that she may be an inspiration and guide for others.

© Donna Farhi 2018

Sacred Self-Care: A Women’s Yoga & Ayurveda Retreat, May 25-June 1, 2019, is now open for registration​.


​Resources

  1. Humphries, K.H. & Gill, S. (2003) Risks and benefits of hormone replacement therapy: The evidence speaks. Canadian Medical Association Journal, 168 (8), 10001-10.
  2.  “Oprah’s “Crazy Talk”–– Bioidentical Hormones–– Helpful or Harmful? (Part 2), Byron J Richards, board Certified Clinical Nutritionist.
  3. For an exceptional explication on the cultures in which longevity is a norm read Healthy at 100 by John Robbins.
  4. R.R. Freedman, and S. Woodward, “Behavioral treatment of menopausal hot flushes: evaluation by ambulatory monitorings. American Journal of Obstetric and Gynecology, 167 (2) 1992: 257-78
  5. L. M. Germaine, and R.R. Freedman, “Behavioral treatment of menopausal hot flushes: evaluation by objective methods.” Journal of Consulting Clinical Psychology, 52 (1984): 1,072-79.
  6. Gibney, HK. & Peper, E. (2003). Taking control: Strategies to reduce hot flashes and premenstrual mood swings. Biofeedback, 31 (3), 20-24.
  7. Yoga Nidra is an ancient Tantric practice in which the physical body moves into a deep state of relaxation akin to sleep yet the consciousness remains awake to acknowledge this unbounded blissful experience as true Self.

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