October is World Menopause Awareness Month, and I'd like to discuss the important, but often overlooked, connection between stress and perimenopause.
Perimenopause, the transitional phase before menopause, typically begins in a woman’s 40s (but it can start earlier).
During this period, hormonal fluctuations, particularly in oestrogen and progesterone, can cause a range of physical and emotional symptoms.
Adding stress into the mix can amplify these symptoms, creating a challenging cycle for many women.
Let's look at how.
What is oestrogen?
Oestrogen is a hormone primarily responsible for regulating the female reproductive system and influencing mood, bone health and skin elasticity.
During perimenopause, oestrogen levels fluctuate wildly - they can increase to levels way higher than before perimenopause and decrease to really low levels in a matter of days.
These hormonal changes can lead to mood swings, anxiety and irritability, often catching women off guard. When stress is introduced, it can magnify these symptoms.
What is progesterone?
Progesterone is a hormone primarily involved in regulating the menstrual cycle and supporting pregnancy.
Whereas oestrogen is known to have an energising effect on us, progesterone has a calming effect.
As women enter perimenopause, progesterone levels start to decline more consistently than oestrogen.
The imbalance between fluctuating oestrogen and declining progesterone can contribute to irregular periods, mood swings and increased anxiety. Sleep quality is also reduced.
What is cortisol?
Stress triggers the release of cortisol, commonly known as the stress hormone.
Chronically elevated cortisol levels can disrupt the body's ability to handle perimenopausal hormone changes, compounding symptoms.
Women experiencing high levels of stress may report more severe hot flushes, increased sleep disturbances, and heightened emotional sensitivity.
Interestingly, perimenopause also affects the body’s stress response, making it more difficult to regulate cortisol. This creates a feedback loop where stress intensifies perimenopausal symptoms, and those symptoms, in turn, make it harder to manage stress.
How stress exacerbates perimenopausal symptoms
Sleep disturbances
Declining progesterone levels play a key role in sleep quality, as this hormone has a sedative effect.
Stress worsens this by raising cortisol levels, making restorative sleep even harder to achieve. The result is a cycle of insomnia, fatigue, and increased irritability.
Stress increases cortisol levels, making it harder to fall and stay asleep, which exacerbates existing disrupted sleep and leads to fatigue, irritability and a reduced ability to cope with daily challenges.
Mood swings
Both oestrogen and progesterone influence mood regulation, with oestrogen providing mood stabilisation and progesterone helping to reduce anxiety.
The hormonal imbalance during perimenopause can lead to emotional volatility.
Stress intensifies this, as elevated cortisol exacerbates anxiety, irritability, and even depression.
Cognitive effects
Oestrogen plays a role in cognitive function, which is why many women experience 'brain fog' during perimenopause.
Stress further impairs memory and focus, while declining progesterone can contribute to a sense of mental agitation. The combination of stress and hormonal changes can make tasks feel overwhelming or cause lapses in concentration.
Physical symptoms
Hot flushes and night sweats are common during perimenopause due to fluctuating oestrogen levels, and stress can trigger or worsen these episodes.
With both oestrogen and progesterone in flux, the body’s temperature regulation is more vulnerable, and stress-related cortisol spikes can make these symptoms more intense and frequent..
Emotional stress during perimenopause
Perimenopause occurs at a stage in life where many women are already facing a number of stressors, whether related to family, career or ageing.
For women in midlife, caregiving responsibilities for children or ageing parents can increase stress, while changes in career or personal goals may also contribute to feelings of uncertainty.
These external stressors, combined with the physical and emotional symptoms of perimenopause, create a multi-layered experience that can feel overwhelming.
Progesterone, with its calming properties, typically helps counterbalance stress, but as its levels drop, women may find themselves more susceptible to anxiety or emotional distress.
Meanwhile, fluctuating oestrogen can lead to heightened mood swings, which further intensify feelings of stress.
This combination of internal hormonal changes and external life pressures can create a perfect storm of emotional volatility.
Additionally, there are societal pressures around ageing. Perimenopause often brings visible signs of ageing, such as changes in skin and hair, which can add stress in a world that places a high value on youthfulness.
This external pressure to 'age gracefully' can make women feel anxious or self-conscious about the natural changes occurring in their bodies.
Workplace stress and performance
In the workplace, the cognitive and emotional changes linked to perimenopause can lead to decreased confidence and concerns about performance.
Many women worry about how their symptoms (such as forgetfulness or mood fluctuations) are perceived by colleagues or supervisors. This added layer of stress can further intensify symptoms, leading to a challenging cycle of emotional and professional strain.
Relationships and communication
Relationships, too, may be affected by stress during perimenopause. Emotional volatility or physical symptoms such as low libido can strain romantic partnerships, while mood swings and irritability may cause friction in relationships with family and friends.
The physical and emotional changes of perimenopause often require open communication and support from loved ones, but stress can sometimes make these conversations more difficult to initiate.
Conclusion
The connection between stress and perimenopause is intricate and multifaceted.
As hormonal changes disrupt emotional and physical wellbeing, stress can intensify symptoms, creating a difficult cycle.
Recognising these links during World Menopause Awareness Month is vital for promoting understanding, reducing stigma and fostering more supportive environments for women going through this transition.
By elevating this conversation, we can help women to feel more empowered as they navigate the challenges of perimenopause, both in terms of managing stress and acknowledging the broader societal pressures that they may face.
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Disclaimer
The information and advice I provided here is of a general nature and should never replace individual health or medical advice provided by your doctor or other healthcare professional involved in your care.
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