​I recently had the privilege of being featured on Menopause Coach Kitty Anderson’s YouTube Channel, Create a Menopause Recovery in the video titled “Keisha Is a Black Woman Using HRT in the United States: Perimenopause Was Traumatic Without HRT!”

I responded to Kitty’s call for women of color to come forward and share their experiences of recovery from perimenopausal or menopausal symptoms, especially those who are using hormone replacement therapy (HRT). I actually encountered Kitty Anderson before; I enlisted her help to coach me through some continued challenges I was facing after I had started HRT months before. I even featured her on The Real Peri Meno blog in the post “Kitty Anderson: Menopause As a Social Justice Issue,”profiling her own journey as a menopausal woman who uses HRT herself and her experiences in becoming an expert on the topic.

My journey, from the process of realizing I was perimenopausal and not suffering from some other malady, and the maze I went through in navigating the medical system, is here on my blog on the post titled “Shocked By Perimenopause? I Was, Too.”

I wish more Black women (and women in general) would go public about their perimenopausal woes and the solutions that are working for them. While I am using HRT, I don’t expect ALL women to do so. But I do explore the reasons why Black women seem less likely to pursue HRT in “Why It Seems Like Black Women Don’t Use HRT.”  Using HRT is a highly personal decision, just like choosing to use any prescription medication is.

Please watch / listen to the interview in depth. Here are a few points I considered after the fact that I want to state for the record:

Choose the medical practitioner, healthcare professional or physician who works for and with you! Regardless of color, too. That healthcare advocate who opts to partner with you in your care may not look like you, sound like you or any in way be like you, but they may be exactly what you need at that moment – and as a permanent ally in your long-term care. The best doctors in this journey for me have been an older (60+) white woman and a younger white man. It was a Black gynecologist who really let me down, along with a slew of others.

Be prepared to pivot. No day in perimenopause is guaranteed to be the same. Your symptoms may be well controlled and absent one day, and then they might pipe up the next. That may not necessarily mean that you need to reinvent the wheel, but it does mean that a versatile mindset is more important now than perhaps it has ever been. As symptoms change during perimenopause, and as hormones choose to cause a commotion every now and again (even while on HRT), realize that dosages may change, you may need to add in new medications and you may need to drop things that no longer work for you.
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If you speak out about perimenopause, be prepared for . . . silence. When I went public about my perimenopause experience, I knew it was going to require being vulnerable. I didn’t know how people would react or what they would say. So far, in terms of my personal sphere, the response has largely been one of silence. No one I know personally is really asking any questions or sharing any of their experiences, but I know they are reading the material here, taking notes and considering options. I started this blog to help others, even as I continue to help myself in the background.

In online perimenopausal communities, two major camps or philosophies quickly emerge: women who are pro-pharma for the treatment of their symptoms and women who are on the naturopathic path. These two schools of thought each have their own merits, and many women, over time, end up combining modalities once they discover the mix that works best for them.
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But what about meditation? It’s often seen as a hocus-pocus, “woo-sah” hobby some people dismiss and make fun of. But when perimenopause strikes, even the most anti-holistic medicine women find themselves turning to it.

In the drive to delay prescribed medical interventions or to incorporate a holistic regimen as part of their perimenopausal game plan, some women meditate to restore a sense of calm to the process. There different types of meditation, such as transcendental meditation, concentrative meditation, mindfulness meditation or progressive relaxation. But meditation is generally defined as “a practice where an individual uses a technique, such as mindfulness, or focusing the mind on a particular object, thought or activity, to train attention and awareness, and achieve a mentally clear and emotionally calm and stable state.”

If the real world and social media are any indication of how perimenopausal women are using meditation, then it appears to be a tactic broadly adopted or, at least, tried. Women seem to use meditation for a number of reasons, many related to mood, as they try to calm anxiety or ease depression. Others test it as a way to relieve physical symptoms, like hot flashes, chills and heart palpitations. And, finally, some women use it as a new lifestyle practice to gain perspective, maintain optimism and boost emotional stability.

But, the real question may be, does it work? Does meditation help? Is it really doing anything?

Axing the Anxious State

It turns out that when it comes to feelings of panic or doom, meditation is a solid tool. According to the University of Washington’s School of Medicine, meditation calms the sympathetic nervous system. This is key because the sympathetic nervous system, when revved up, lends to sensations of fight or flight. They say, “[t]hrough meditation, you are essentially deactivating your sympathetic nervous system and turning on the parasympathetic branch. Initial studies have found that over time this practice can help reduce pain, depression, stress and anxiety.”

This is important, as panic attacks can show up for the first time during perimenopause, when fluctuating hormones take women on a rollercoaster ride. Symptoms of panic attacks include nausea or abdominal distress, chills, hot flushes, rapid heart rate, dizziness, sweating, shortness of breath, chest pain, trembling, sense of losing control, de-realization and a few more (as if these weren’t enough!).

In one study, 56 percent of women surveyed had never experienced panic symptoms prior to perimenopause, and one-third of study participants’ panic disorder symptoms went undiagnosed and untreated.

More than Meets the Mind

Meditation, even short-term stints at it, can have measurable benefits on health. One study from 2009 reported that just five days of meditation at 20 minutes per session improved “physiological reactions in heart rate, respiratory amplitude and skin conductance response.” Brain imaging even showed changes related to emotional regulation.

Additional studies have found that meditation has many other add-on benefits, including delaying brain aging, reducing ruminating thoughts, improving concentration and attention, and even assisting in recovery from substance abuse. Moreover, meditation has been associated with reduced blood pressure, decreased pain and strengthened immune system function.

Worth a Try?

Many of the benefits that meditation allegedly and empirically improves are the very same symptoms women need relief from during perimenopause. Less anxiety? Check. Better focused thinking? Absolutely. Reduced stress and lowered blood pressure? For sure. A regained sense of personal control? Yes.

The problem with meditation, however, may be that it requires a commitment. Sure, some people will feel a difference after just one session. But in order to sustain it, meditation must become a practice – that is, a habit or a routine aspect of daily living. Most sources suggest aiming for 20-30 minutes of meditation a day. Since it can be challenging for women to find that bit of undisrupted time, some suggested time frames to do it are:

• Early in the morning, before anyone or anything demands your attention
• After your workout, as part of your cool-down process
• During or after lunch, especially for those who work from home
• In the evening before bedtime, as everyone else in the house is winding down

How to Find Meditations?
Just as there are many types of yoga (yin, ashtanga, vinyasa, kundalini, and so forth), there are various styles of meditation. Generally two main themes emerge: guided meditation and unguided meditation. In a guided meditation, a speaker sets the tone and verbally walks you through imagery, ideas and themes to reflect and focus on. It may or may not be accompanied by music or nature sounds. In an unguided meditation, there is no one speaking, simply silence or perhaps some accompanying music or sounds to inspire and soothe you.

There are also various types of meditation, often by purpose or topic. Meditations are available on specific themes, like Christianity, relationships, finances, stress and more. And the great thing is, meditation can be obtained for free. A quick YouTube search will unearth more meditations than you’ll ever have time for.

While HeadSpace and Calm are meditation apps popularly used, they come at a cost. Free trials or restricted free access may be available, but the unpaid experience is rather limiting.

Meditations for Menopause

Would you believe it? Yes, there are actually meditations for menopause that some thoughtful creators have put together and made widely available. This isn’t a time to get too wrapped up in particulars though – these meditations are great for perimenopause, too.

Female Hormone Balancer Relaxation Meditation
Guided Meditation for Relieving Menopause Symptoms
Hormone Rebalance Hypnosis
Magical Menopause Full Hypnotherapy Session with Binaural Beats Frequencies
Women of Wisdom Menopause Guided Sleep Meditation

Anxiety and depression are common, though lesser talked about, symptoms of perimenopause and menopause. For the first time in their lives, women may begin feeling out of sorts, as if they can no longer function as they used to or take on the world with the same sort of ease and vigor they once did. They may feel distant, aloof and alone, and they might even stop enjoying things that once brought them incredible joy, inspiration and satisfaction.

To be blunt, many women begin to wonder if they are losing their minds.

Anxiety and depression that first manifest during perimenopause and menopause without any history of mental health conditions and may look and feel like typical anxiety and depression in other people, but the cause is not quite the same. Mental health concerns during perimenopause and menopause are truly, at the root, a symptom of hormonal dysfunction – primarily the withdrawal of estrogen (estradiol) and progesterone from a woman’s body during this phase of life.

To put it simply, erratic fluctuations of estrogen and progesterone throw the body into a topsy-turvy round of unpredictability. This erratic tailspin causes most of the well-known perimenopausal physical symptoms, such as night sweats, vaginal dryness, hot flashes, sore breasts, irregular menstrual cycles and much more. And it also causes first-time onsets of anxiety and depression. But why?
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The most credible and oft-cited hypothesis is that declining levels of estrogen lead to reduced levels of key brain neurotransmitters, especially serotonin, which is responsible for feelings of happiness and well-being. Serotonin is also connected to sleep, appetite and digestion. If or when estrogen starts to bottom out, it can have the opposite effect on cortisol, also known as the stress hormone, which begins to rise. A higher level of cortisol combined with a bottoming out of serotonin (which, in turn, came from low estrogen in the first place) leads to unpleasant and devastating mood symptoms, like anxiety or depression. As if these factors were not enough, production of melatonin, the sleep hormone, can dip by this age, too – amping up the insomnia associated with anxiety.

What Is Anxiety?

Some level of anxiety is normal in our lives and is simply part of being alive. But when minor daily worries torpedo into life-altering rumination and the inability to cope, that’s a sign that there may be more to it than routine everyday concerns.

Symptoms of anxiety include (but are not limited to) irritability, restlessness and hypervigilance, or a sense of being on guard. Women may feel they are trapped in a fight, flight or freeze mode. They may not be able to switch off their minds, no matter how much they want to relax and wish to sleep. Anxiety shows up in an inability to concentrate, too. Physical symptoms like heart palpitations, inner tremors, insomnia, shakiness and shivers may appear as well. Women find that when investigated through routine medical checkups, deeper-level testing and thorough bloodwork, no physiological anomalies show up related to, or that explain, these symptoms.

What Is Depression?

Depression is more than just having a bad day or feeling sad for a legitimate reason. Depression has emotional, physical and cognitive identifiers, including a loss of pleasure in activities, mood swings, excessive crying, insomnia or fitful sleep, loss of appetite, fatigue, changes in weight, social isolation, apathy and even suicidal ideation*. Studies show that women who’ve previously experienced post-partum depression or premenstrual dysphoric disorder (PMDD) are at greater risk / likelihood of experiencing a relapse of depression with the onset of perimenopause or menopause. Still, some women with a history of depression describe hormonal depression as feeling “different” from their prior depression and unresponsive to prior medications and methodologies.

* If you are feeling suicidal or thinking of harming yourself, please call the National Suicide Hotline at 800.273.8255 and get in touch with a friend, family member or trusted confidante.

What to Do

If anxiety or depression are new to you, you may have no idea where to turn or what to do. The first step is honestly acknowledging that there is an issue and that it’s not your fault. Though stigma still surrounds mental health issues, hormonal anxiety or depression has a true medical cause, which is assuring to some who may think of it as a personal weakness, personality flaw or “crutch they need to get over.” After all, more than 40 percent of those taking antidepressants in the U.S. are woman ages 45 and up – the very age range that corresponds to the onset of perimenopause and menopause.

Treatment plans should be individualized. What worked for a friend or relative may or may not work for you. A combination of lifestyle, naturopathic, hormonal and / or pharmaceutical treatments are options that have proven effective and given many women “their life back.”

While this is no substitute for official medical advice, treatments for perimenopausal anxiety or depression may include:

• Hormone Therapy
• Cognitive Behavioral Therapy (CBT) / Counseling
• Physical Movement – aerobic exercise, yoga, resistance training
• Lifestyle Changes – stress reduction, meditation, mindfulness
• Supplements
• Medications – SSRIs and other classes of antidepressants; other medications prescribed off label to treat insomnia, night sweats and anxiety *

*The decision to begin taking medication is a serious one that should be made with full, clear transparency about potential side effects, expected duration of treatment and discontinuation protocols, if applicable. Some suggest that initiating medications like antidepressants or benzodiazepines should be made with informed consent.