Dear Perimenopause… F*** You

peri: Dear Perimenopause, fuck you. Respectfully. Actually, no. Disrespectfully. Because I have some questions, and quite frankly, I would like to speak to upper management. First of all, who invited you? Because I don't remember signing up for this. I don't remember receiving a notification. I didn't get an email, and I checked my junk folder. A calendar invite, or even one of those annoying little reminders that tells you your subscription is about to renew. You just showed up. And apparently you've decided that we're going to live together now. Excuse me. I have three children. I have a career. I teach, I write, I host this podcast, I have bills to pay, responsibilities to manage, and a whole life that was already doing the absolute most. And now you want to come in here and start rearranging the furniture? And by furniture, I mean my brain, my emotions, my sleep. My body and apparently my entire nervous system. Ma'am, I'm a millennial. I thought I had a little more time before my hormones decided to start a group project without my consent. But here we are. One minute I'm perfectly fine. The next minute I'm anxious for absolutely no reason. My ears are ringing. I can't remember what I walked into the kitchen for. I feel exhausted, irritated. Or just moving particles. And the scariest part? I feel like I'm gonna die sometimes. Not metaphorically. Not because something particularly stressful happened. Just this overwhelming sensation that something is terribly wrong. And I'm sitting there thinking, what the actual fuck is happening to me? So yes, dear Perimenopause, fuck you. But now that I've gotten that off my chest, we need to have a serious conversation. Because I know I'm not the only woman who has felt this way. And I know there are women listening right now who have been frightened by changes in their bodies, their emotions, and their minds, without realizing that the menopause transition might be part of the picture. And there are partners listening who are wondering what happened to the woman they know and love. So today, we're talking about it the anxiety, the brain fog, the physical symptoms, the changes in intimacy. The relationships, the racial disparities, the science, the things we know, the things we don't, and the things nobody bothered to explain to us. And we're going to laugh. Because quite frankly, if I don't laugh about some of this, I might scream. Welcome back to Rooted in Rising with Dr. Carmela Maxell. Today, we're getting personal. And Perimenopause, you're officially on notice. And before we get into this conversation, I want to make something very clear. This episode is not just for women. Gentlemen, don't you dare turn this off. Because I know some of you saw the title and thought, this isn't for me. Wrong. This is absolutely for you. If you have a wife, a girlfriend, a mother, a sister, a daughter, a friend, a coworker, or literally know a woman who exists on this planet, you need to understand this. And frankly, I think we've done society a tremendous disservice by treating menopause and perimenopause as women's issues that women should figure out amongst themselves. Why? Why are we teaching girls about puberty but barely preparing them for what happens decades later? Why do we teach boys about testosterone and reproduction, but rarely explain what happens when the woman in their lives experience significant hormonal changes? Why are we treating something that affects approximately half the population as though it's some obscure medical phenomenon? And let me say something else. You don't have to personally experience something to have a responsibility to understand it. Men, you don't have to experience perimenopause to be compassionate about it. Partners, you don't have to understand every hormonal fluctuation to recognize when someone you love is struggling. Employers, You don't have to experience hot flashes or brain fog to recognize that workplace environments should support people through different stages of life. And parents, we should be having age-appropriate conversations with our children about how bodies change throughout adulthood. Because perimenopause doesn't just affect the person experiencing it. It can affect relationships, families, workplaces, intimacy, communication, mental health. And how we understand aging. I want us to stop treating menopause education like some secret women's club where you only get the password after your first hot flash. That's ridiculous. And honestly, if more people understood what was happening physiologically, perhaps fewer women would have to explain themselves while they're already exhausted, anxious, and trying to remember where they put their damn keys. So whether you're experiencing perimenopause yourself, supporting someone who is, Or simply trying to become a more informed human being, welcome. Pull up a chair. We're all learning something today. One, I thought something was wrong with me. Before we go any further, I want to give you a quick disclaimer. I have a doctorate in clinical psychology, and I'm a professional in mental health, but I am not a medical doctor. I am not an OBGYN, an endocrinologist, or menopause specialist. I'm sharing my lived experience, my perspective as a mental health professional, and research that can help us understand this transition. This episode is for education and conversation. It isn't medical advice, and it isn't a substitute for a healthcare professional evaluating your individual symptoms. And I want to emphasize something else. Not every symptom a woman experiences in her late 30s, 40s, or 50s is caused by hormones. Sometimes something else is happening, and those symptoms deserve proper attention. Okay, now that we've established that. Let me tell you why this episode matters so much to me. When I first started experiencing these changes, I genuinely thought something was wrong with me. And I don't mean that in a casual way. I mean I was terrified. I would experience anxiety that seemed to come out of absolutely nowhere. Now, I understand anxiety. I've spent years studying human behavior, working in mental health, and helping people understand the relationship between thoughts, emotions, and physiological responses. I know what a stress response is. I understand the sympathetic nervous system. I understand what happens when our bodies perceive a threat. But understanding anxiety academically and experiencing unexplained anxiety in your own body are two very different things. Because I couldn't always identify a trigger. There wasn't necessarily an argument. There wasn't always a stressful situation. Sometimes I was just existing. And suddenly there was this overwhelming sense of dread. Like something bad was about to happen. Like I was going to die. And let me tell you something. When your body starts sending you signals that feel frightening, you don't necessarily sit there and calmly think, perhaps this is a fluctuation in my reproductive hormones. No. You think, do I need to go to the hospital? You wonder whether something is wrong with your heart, your brain, or your nervous system. And because at the time I wasn't even forty, perimenopause wasn't the first thing that came to mind. I didn't think I was old enough. Which brings me to one of the biggest reasons I wanted to record this episode. How many women are experiencing symptoms they don't understand because nobody ever told them when these changes could begin? How many are sitting in doctors' offices feeling dismissed? How many are questioning their mental health? How many are being told they're just stressed when what they really need is a comprehensive conversation about their health? And how many are being told everything is hormonal when something else needs medical attention? Both of those things can happen, and neither is acceptable. I want women to understand that their experiences deserve to be taken seriously. Even when the explanation isn't immediately obvious. Because there's something particularly frightening about feeling unfamiliar to yourself. It's not just the anxiety, it's the loss of certainty. The feeling that your body used to operate according to a set of rules, and now somebody has changed the rules without telling you. And suddenly you're trying to figure out how to function in a body that doesn't always feel like the one you recognize. That can take an enormous psychological toll. Two. Wait, I thought this happened at fifty. Can we talk about the age thing for a minute? Because I think a lot of us grew up with a very particular image of menopause. We pictured a woman in her fifties. Maybe she was having hot flashes. Maybe she was fanning herself dramatically. Maybe she was irritated with her husband. And that was pretty much the extent of our education. Nobody really explained that menopause isn't usually one sudden event. It's a transition. And perimenopause is the period leading up to menopause, when ovariant hormone production becomes more variable and menstrual cycles may begin changing. Menopause itself is typically identified after 12 consecutive months without a menstrual period, when there isn't another medical explanation. The average age of natural menopause in the United States is around 51. But the transition can begin years earlier. Most commonly, it begins in the 40s. Some women experience changes earlier, although symptoms before age 40 warrant careful evaluation rather than an automatic assumption that they're experiencing typical perimenopause. And that's an important distinction. Because we're hearing more women in their 30s talking about symptoms they associate with perimenopause. But are women actually entering perimenopause earlier? Or are we finally talking about symptoms that previous generations didn't have the vocabulary information or permission to discuss? Those are different questions. And we don't have enough evidence to confidently say that perimenopause is universally beginning earlier in today's generation. What we do know is that reproductive aging varies. Genetics matter. Smoking can affect the timing of menopause. Certain medical treatments and health conditions can affect ovarian function. And chronic stress, while enormously important to overall health, should not automatically be blamed for causing early menopause. There's also a condition called primary ovarian insufficiency, which can occur before age forty and requires medical evaluation. It isn't simply another name for ordinary perimenopause. So if you're in your 30s and experiencing menstrual changes or symptoms that concern you, please don't dismiss them. But don't assume the answer before you've had an appropriate evaluation either. I think we owe women something better than two extremes. We shouldn't tell them that they're too young to be experiencing hormonal changes. And we shouldn't tell every woman who feels tired, anxious, or forgetful that she's definitely in perimenopause. We need curiosity. We need good science. And we need healthcare professionals who are willing to listen. Because I can tell you from personal experience that being frightened by symptoms you don't understand is exhausting enough. You shouldn't also have to fight to be heard. Now I want to talk about estrogen. Because when I started learning more about what estrogen actually does in the body, I had a moment where I thought, wait a damn minute, you mean to tell me this hormone isn't just responsible for my menstrual cycle? It's involved in what? Because growing up, most of us learned about estrogen in the context of puberty, reproduction, and pregnancy. And that's important. But that is nowhere near the whole story. Estrogen is involved in an extraordinary number of physiological processes throughout the body. And here's where I get to nerd out a little bit, because I teach about the brain. We have estrogen receptors in multiple areas of the brain, including regions involved in memory, emotional processing, and temperature regulation. Estrogen also interacts with neurotransmitter systems, including serotonin and dopamine, which play roles in mood, motivation, and cognition. Now that doesn't mean estrogen controls every emotion or that every change in mood is caused by hormones. But it does mean that changing estrogen levels can have effects that extend well beyond the reproductive system. And here's where it gets even more interesting. Estrogen helps regulate bone remodeling. It influences blood vessel function. It affects vaginal and urinary tissues. It contributes to skin physiology. And it interacts with metabolic processes throughout the body. So when we talk about perimenopause, we're not talking about one little hormone changing in one isolated part of the body. We're talking about changes in a hormonal system that interacts with multiple organs and biological processes. And here's the part that I wish someone had explained to me years ago. During perimenopause, estrogen doesn't simply decline in one nice, predictable straight line. no. That would apparently be too convenient. Estrogen levels can fluctuate considerably. Sometimes they're higher, sometimes they're lower. And those changes occur alongside shifts in progesterone and other reproductive hormones. So imagine your body trying to adapt to a hormonal environment that is becoming increasingly unpredictable. Now, to be scientifically accurate, Those fluctuations don't explain every symptom and they don't affect every woman in the same way. But they can contribute to some of the physical and psychological experiences associated with the menopause transition. Which brings me back to my original complaint. Why the hell weren't we taught this? Why did I spend so much of my life thinking estrogen was primarily about periods and pregnancy when it has important functions in so many other systems? Why did nobody explain that changes in reproductive hormones could intersect with sleep, cognition, mood, sexual health, and physical comfort? And why are we still having conversations where women feel like they have to justify symptoms that deserve thoughtful evaluation? Because when you understand how widely estrogen acts throughout the body, it becomes easier to understand why this transition can feel so significant. Not because estrogen is responsible for every fiber of our existence, but because it interacts with so many of the systems that help us function every single day. And sometimes the psychological impact of those changes can be just as significant as the physical impact. Think about it. If you're not sleeping well, your concentration may suffer. If your concentration suffers, your confidence may suffer. If you're experiencing discomfort during intimacy, Your relationships may be affected. If you're experiencing unexplained physical sensations, your anxiety may increase. And suddenly, something that people casually describe as just hormones is influencing how you experience your everyday life. That's why we need to stop minimizing this transition. Because it isn't just about period stopping. It's about understanding a complex biological process and how it intersects with a woman's psychological, physical, and social well-being. And I want every woman listening to remember something. You are not simply a collection of hormones. You are a whole person. And your health care should reflect that. Now, speaking of the brain, let's talk about what happens when you walk into a room and suddenly have absolutely no idea why you're there. Because apparently, my brain has decided to start taking unscheduled vacations. Part three, my brain has left the building. Now, let's talk about the brain fog. Because this one, this one is personally offensive. I teach about the brain. I spend a significant amount of my professional life reading, writing, explaining complex ideas, remembering details, and making decisions. So imagine my frustration when I suddenly can't remember a word that I have used approximately 400 times in my life. I'm standing there thinking, the thing. The thing with the thing? What thing? I don't know. That's the problem. Or I walk into a room, look around, and wonder why the hell I'm there. Was I getting my phone? Was I looking for my keys? Was I coming in here to yell at somebody? Honestly, all three are possibilities. And yes, everybody forgets things sometimes. But when you start noticing changes in your own attention, concentration, or memory, it can be unsettling. Especially when your identity is connected to being capable, organized, and intellectually sharp. Here's what I want people to understand. The menopause transition can be associated with subjective cognitive difficulties, including problems with attention, working memory, and verbal recall. And sleep disruption, anxiety. Depression and stress can make those difficulties feel even worse. But experiencing brain fog does not automatically mean you're developing dementia. And it also doesn't mean that every memory problem should be attributed to hormones. Persistent or progressive cognitive changes deserve an appropriate assessment. From mental health perspective though, I want to explore something deeper. What happens to your confidence when you stop trusting your own brain? Think about that. What happens when you've spent your entire adult life being the person who remembers everything? The appointments, the birthdays, the deadlines, the grocery lists, the children's schedules, the work responsibilities. And suddenly you feel like your brain is buffering. You might become frustrated. You might become embarrassed. You might begin second guessing yourself. And that frustration can become its own source of anxiety. Now you're anxious about forgetting. And because you're anxious, your attention gets worse. And because your attention gets worse, you're even more worried. It's a miserable little feedback loop. And I want to remind women listening that cognitive efficiency is not the same thing as intelligence. Having trouble retrieving a word does not erase your education. Having a difficult day does not erase your accomplishments. Needing to write something down does not mean you're suddenly incompetent. Sometimes we need support, strategies, rest, or treatment. And sometimes we need to stop treating every moment of reduced productivity as a personal failure. Your worth is not measured by how flawlessly your brain performs on a Tuesday afternoon. Even if your brain has apparently decided that Tuesday afternoon is an optional event. Health conversation, we're not having enough. I want to spend some time here because this is where my professional background and personal experience intersect. When people think about perimenopause, they often think about hot flashes. But the psychological experience can be much broader. Some women report increased anxiety, some experience irritability, some experience mood fluctuations or depressive symptoms. Some feel emotionally overwhelmed in ways they haven't experienced before. And some women go through the transition without significant mental health symptoms at all. That's important to acknowledge. We're not all having the same experience. But research has identified the menopause transition as a period of increased vulnerability to depressive symptoms for some women, particularly those with prior depression or other risk factors. Anxiety symptoms can also occur during this period, although the relationship between hormone changes and anxiety is complicated. Sleep, stress, physical symptoms, existing mental health conditions, and life circumstances all matter. And I want to talk about sleep. Because I don't think we give sleep enough credit for how dramatically it can affect our psychological functioning. When you're not sleeping well, everything becomes harder. Your frustration tolerance can decrease. Your concentration suffers. Your emotional regulation becomes more difficult. You might feel more reactive, less patient, and more overwhelmed. Now imagine experiencing that while managing work, children, aging parents, relationships, financial responsibilities, and everything else that comes with adulthood. And somebody tells you to just relax. really? Relax? Why didn't I think of that? Thank you so much. Problem solved. I'm being sarcastic, obviously. But that's how dismissive some of the advice can feel. And there's another piece of this I want to acknowledge. Sometimes women are experiencing legitimate psychological distress and feel ashamed because they believe they should be able to manage it. Especially women who are used to being the strong ones, the caregivers, the problem solvers, the people everyone calls when something goes wrong. And suddenly they're the ones who need help. That can be difficult. But asking for help doesn't diminish your strength. And having a physiological contributor to anxiety or depression doesn't mean the emotional experience isn't real. It is real. It deserves attention. And there are evidence-based approaches to managing symptoms, whether that involves psychotherapy, addressing sleep difficulties, medication when appropriate. Treatment of menopausal symptoms or a combination of strategies. No woman should have to simply endure severe psychological distress because somebody told her it's a normal part of aging. Normal transitions can still require support, and that's a message I want every woman listening to remember. Five. My body is doing things I did not authorize. Now let's discuss the physical side, because apparently periminopause looked at the emotional chaos and said, you know what this needs? More features. Hmm. Let's talk about the symptoms people commonly associate with the transition. Hot flashes, night sweats, changes in menstrual cycles, sleep disturbances, vaginal dryness. Discomfort during intimacy, changes in sexual desire. And for some women, changes in mood, concentration, and energy. There are also symptoms women discuss that are less specific. For me, one of those experiences had been ringing in my ears. Tinnitus. And sometimes I just feel bleh. That's the scientific term I'm using today. Bluh. Not necessarily sick. Not necessarily sad, just not quite myself. And I want to be careful here. Tinnitus can have many causes, including hearing-related conditions and medication effects. Researchers are studying possible relationships with hormonal changes, but ringing in the ears is not a reliable way to identify perimenopause. The same goes for fatigue, dizziness, palpitations, and other nonspecific symptoms. Those experiences deserve medical evaluation when appropriate. And I think this is part of the problem with how we discuss women's health. Sometimes everything is dismissed as stress. Other times, everything is dismissed as hormones. But women are whole people. We can experience hormonal changes and have other medical conditions. We can experience anxiety and have legitimate physical symptoms. We can be exhausted because we're not sleeping. And we can have a health condition that contributes to fatigue. The goal isn't to find one explanation that conveniently covers everything. The goal is to understand what's actually happening. And that's why I believe symptom tracking, asking questions, and building a relationship with a healthcare professional who takes your concerns seriously are so important. Because when you know more about what's happening in your body, you can begin to make informed decisions. And that knowledge can reduce some of the fear that comes with uncertainty. Not all of it, but some of it. And sometimes that makes a tremendous difference. Part 6. Black women, women of color, and the price of being overlooked. Now this part of the conversation is especially important to me. Because when we talk about women's health, we have a very basic question to ask. Which women are we talking about? Whose experiences have shaped the research? Whose symptoms are believed? Who gets access to knowledgeable healthcare professionals? And who is expected to keep functioning despite significant symptoms? One of the most important studies of the menopause transition is the study of women's health across the nation, often called SWAN. This longitudinal study has followed women from multiple racial and ethnic backgrounds and has helped researchers understand differences in the menopause experience. And some of the findings deserve serious attention. In one major analysis, black women who experienced frequent hot flashes and night sweats reported a median symptom duration of approximately 10.1 years. 10.1 years. For non-Hispanic white women, the median was approximately 6.5 years. For Hispanic women, approximately 8.9 years. Now, these numbers describe the duration of frequent vasomotor symptoms among women in the study. They do not mean that every black woman experiences a decade of symptoms, but the difference is substantial, and it raises important questions about why certain groups experience a greater burden. Another review of SWAN findings reported that black women reach their final menstrual period approximately eight and a half months earlier on average than white women in the cohort. Researchers also identify disparities in sleep, depressive symptoms, and access to treatment. And here's where I want us to be thoughtful. These differences are not proof that race itself is a biological cause. Race is not a hormone. We have to consider the role of chronic stress, discrimination, socioeconomic conditions, healthcare access, environmental exposures, and other factors that can influence health over a lifetime. And we also have to acknowledge that these relationships are complex and not completely understood. As a black and Filipino woman, I think about how often women of color are expected to be resilient. We're praised for being strong. We're praised for enduring. We're praised for taking care of everybody. But sometimes I wonder whether all that praise has made it harder for people to recognize when we are suffering. Because being strong does not mean you don't experience pain. And resilience should never become an excuse for inadequate care. We should not have to demonstrate extraordinary distress before someone takes our symptoms seriously. We should not have to become experts in our own conditions just to be heard. And we should not have to accept untreated symptoms as the price of being a woman. I also want to be careful not to lump all women of color into one category. Black, Latina, Asian, Indigenous, Pacific Islander, and multiracial women do not necessarily experience the menopause transition in the same way. Even within those groups, experiences vary tremendously. And some communities remain underrepresented in research. So when I talk about inclusion, I'm not asking researchers to simply add a few women of color to a study. I'm asking whether we're asking the right questions about their experiences in the first place. Because good health care should reflect the diversity of the people receiving it. And every woman deserves to be a part of that conversation. Part seven to the men and partners listening, this part is for you. Okay, gentlemen, partners, spouses, significant others, come a little closer. Because I need to talk to you for a minute. And no, you're not in trouble. Well, not necessarily. But if you love a woman who is navigating perimenopause, I want you to understand something. She may be experiencing changes that she doesn't fully understand herself. And sometimes those changes can affect the way she sleeps, feels, communicates, and experiences intimacy. That doesn't mean every disagreement is hormonal. It doesn't mean she's suddenly incapable of making decisions. And it certainly doesn't mean you get to dismiss her feelings by saying, is it your hormones again? Please don't do that. Seriously, don't. Because I promise you, that is probably not the helpful con contribution you think it is. What might be helpful? Listening, asking questions, being patient, learning about the transition instead of expecting her to explain everything while she's experiencing it. And understanding that support doesn't always mean trying to fix something. Sometimes it means saying, I know you've been having a difficult time. What would help you feel supported? That's it. That's a beautiful question. And I want to talk about intimacy, because this is another area where misunderstandings can develop. Changes in estrogen can contribute to vaginal dryness and discomfort during sex. Sleep disruption, emotional distress, relationship dynamics, medications, and other factors can affect sexual desire. And sometimes a woman may still want intimacy, but her body isn't responding the way it used to. That can be frustrating, it can be embarrassing, it can affect confidence, and it can create tension if a partner interprets those changes as rejection. So to the partners listening, please hear me. A change in sexual desire is not automatically a reflection of how attractive you are. Pain during sex is not something a woman should be expected to tolerate to protect someone else's feelings. And physical affection should not always come with the expectation that it has to lead to intercourse. Sometimes she may want to be held. Sometimes she may want to cuddle. Sometimes she may want physical closeness without any additional expectations. And sometimes she may want sex. The point is that you communicate. You don't assume. You don't pressure. And you don't turn a complicated physical experience into a referendum on whether she loves you. Now, ladies, I want to speak to us too. Our partners cannot read our minds. I know. Inconvenient. Very unfortunate. But true. Sometimes we have to tell them what we're experiencing. Not because we owe them every detail of our bodies, but because healthy relationships require communication. You can say I'm having a difficult day and I don't fully understand why. You can say, I want to be close to you, but I'm uncomfortable physically. You can say, I need patience, not solutions right now. And partners, you can say, I don't completely understand this, but I want to. That's a good place to begin. Because this transition may be happening in one person's body, but its effects can be felt throughout a relationship. And navigating it together can make a meaningful difference. Eight, we need to talk about sex, aging, and identity. There's something else I want to discuss, and this is the part that doesn't always get enough attention. Perimenopause can bring up questions about identity, about femininity, about attractiveness, about aging, about what it means to feel desirable. And I think our culture makes it unnecessarily difficult. Women are constantly receiving contradictory messages. We're supposed to age gracefully, but we're not supposed to look older. We're supposed to embrace our bodies, but we're also supposed to maintain a particular appearance. We're supposed to be confident, but not too confident. Sexual, but not too sexual. Youthful, but somehow wise and mature at the same time. It's exhausting. And then when your body starts changing and suddenly you're trying to figure out how to feel comfortable in your own skin while society continues to tell you what that skin is supposed to look like, I want to challenge that. Because a woman's desirability does not have an expiration date. Her sexuality does not disappear because she's approaching menopause. Her value is not determined by whether she can become pregnant, and her identity is not limited to what her reproductive system is doing. I also want to acknowledge that some women experience grief during this transition. Grief for their younger bodies, grief about fertility, grief about the passage of time, grief about the realization that they're entering a different chapter of life, and other women experience relief, freedom, a sense of possibility. Some experience both, and all of those responses deserve room. We don't have to force women to celebrate every aspect of aging. And we don't have to frame aging as a tragedy. We can acknowledge that change is complicated. That we can be grateful to be alive and still be frustrated by what our bodies are doing. That we can feel beautiful and still struggle with confidence. That we can love our partners and still experience changes in intimacy. That we can embrace getting older without pretending every part of it is wonderful. Because being human means holding more than one truth at a time. And sometimes the truth is that you're grateful for your life, but you'd also like your hormones to stop acting like they've joined a reality television show. Part nine, what we can actually do. Now I don't want to spend this entire episode talking about everything that can go wrong without discussing what support can look like. Because women deserve options. And the first step is often finding a healthcare professional who understands menopause and is willing to evaluate symptoms thoughtfully. There are evidence based treatments for many menopause related symptoms. For some women, Systemic hormone therapy may be appropriate for bothersome hot flashes and night sweats. For vaginal dryness and certain urinary or sexual symptoms, local vaginal estrogen and other treatments may help. There are also non-hormonal options. And for women experiencing significant anxiety, depression, insomnia, or other psychological symptoms, mental health treatment can be an important part of care. But there isn't one universal treatment plan. And hormone therapy isn't automatically the answer to every symptom. In particular, the evidence for using hormone therapy specifically to treat anxiety disorders or prevent cognitive decline is limited. Treatment decisions depend on individual medical history, risks, symptoms, and goals. I also want to mention something about products marketed as natural or bioidentical. Those terms can sound reassuring, but natural doesn't automatically mean safer. And compounded hormone preparations doesn't necessarily have the same evidence, regulatory oversight, or dose inconsistency as FDA-approved products. That's why informed conversations with qualified healthcare professionals are essential. Beyond medical treatment, there are practical things we can do to support our well-being. We can take sleep seriously. We can engage in physical activity that supports our health and strength. We can pay attention to nutrition. We can make time for meaningful relationships. We can seek psychological support when we need it. We can learn to recognize when stress is becoming unmanageable. And we can stop expecting ourselves to function at maximum capacity every single day. Because that last one, I think a lot of us need to hear it. Especially women who are used to accomplishing everything. You don't have to earn the right to rest. You don't have to wait until you're completely depleted. And you don't have to prove how much you can endure. Sometimes taking care of yourself means making an appointment. Sometimes it means asking your partner for help. Sometimes it means saying no. And sometimes it means acknowledging that you are not feeling like yourself and giving that experience the attention it deserves. That's not weakness. That's self-awareness. Now I want to return to something that has been bothering me throughout this experience. Why didn't I know more? Not just as a woman, but as someone who has spent years studying human behavior in the brain. Why was I so unprepared for the possibility that this transition could affect my psychological well-being? And I know I'm not alone in asking that question. For generations, menopause has often been discussed quietly, sometimes as a joke, sometimes as an embarrassing inevitability, sometimes as something women were simply expected to tolerate. And while menopause research has existed for decades, public education and healthcare experiences have not always kept pace with the evidence. We've learned a great deal through longitudinal studies and improvements in clinical research. But important gaps remain, particularly around mental health, racial disparities, individualized treatment, and the experiences of younger women. And I think one of the most important things we can do is talk about it openly, not just among women. With our partners, with our daughters, with our sons, with our friends, with healthcare professionals. Because understanding reproductive aging should not be some secret knowledge that women acquire only after something frightening happens to them. It should be a part of basic health education. And I would love to see a world where a woman in her late thirties who experiences unexplained symptoms doesn't immediately feel isolated or ashamed. Where she knows what questions to ask, where she understands that perimenopause may be one possibility among several, where she can access appropriate evaluation without being dismissed, and where she doesn't have to spend months wondering whether she's losing her mind. That's what I wish I had known. And that's why we were having this conversation. So, dear Perimanipause, it's me again. We've had some time to talk, and I want you to know something. I still don't particularly like you. I don't like the unexpected anxiety. I don't like forgetting what I was saying halfway through a sentence. I don't like feeling strange in my own body. I don't like being exhausted for reasons I can't always explain. And I definitely don't like the moments when I feel frightened by sensations I don't understand. But I'm learning. I'm learning that my body deserves curiosity instead of criticism. I'm learning that asking questions is not a sign of weakness. I'm learning that I can understand a great deal about mental health and still experience moments when I need help understanding my own. And I'm learning that growing older doesn't mean becoming less of myself. It means entering a different chapter. One that I didn't necessarily ask for. One that I'm still figuring out. But one that I intend to navigate with as much information, humor, honesty, and self-compassion as I can manage. And to every woman listening who has felt scared, confused, exhausted, or unlike herself, I want you to know something. You deserve to be heard. You deserve to be taken seriously. You deserve accurate information. You deserve appropriate health care. You deserve intimacy that feels safe and comfortable. You deserve relationships where your experiences are respected. And you deserve the freedom to say that something is difficult without being told you're overreacting. To the partners listening, thank you for being a part of this conversation. Keep asking questions. Keep learning. And remember that sometimes the most loving thing you can do is believe someone when they tell you they're struggling. And to the women who are navigating this transition while raising children, managing careers, caring for family members, and trying to maintain some sense of themselves, I see you. Not because I have every answer, but because I'm figuring some of this out too. And maybe that's the most important thing I can offer today. Not a perfect explanation. Not a miracle solution. Just an honest conversation and a reminder that none of us should have to navigate this in silence. So, dear Perimenopause, you may have arrived without an invitation. You may have disrupted the schedule. You may have rearranged some furniture. But you do not get to define who I am. And you certainly don't get to write the rest of my story. I'll take it from here. And to everyone listening, Thank you for spending this time with me on Rooted in Rising with Dr. Carmela Maxwell. Remember to stay rooted in who you are and keep rising into who you're becoming, even when your hormones are acting like absolute assholes. I'll see you next Tuesday. And until then, take care of yourselves. You deserve it.