In recent years, a burgeoning field of study has hypothesized a connection between adverse childhood events, also known as ACEs, and a more difficult menopause transition.

An ACE could be one of various circumstances, including physical, sexual or emotional abuse, physical and emotional neglect, and parental separation and divorce. In “Researchers Find Link between Childhood Trauma, Recent Abuse and More Severe Menopause Symptoms,” Madison Okuno, a Mayo Clinic researcher, said: “We found that women with a history of abuse, whether in childhood or recent, are more likely than women without these histories to experience more severe menopausal symptoms and more psychological symptoms.”

In their research, the Mayo Clinic studied more than 1,600 women between the ages of 40-65. Nearly 60 percent of research participants reported having endured a prior ACE. Similarly, researchers at the Perelman School of Medicine at the University of Pennsylvania found that “trauma and stress in the teen years increases the risk of depression during menopause.” Teen girls who had experienced traumatic events during childhood or adolescence were more at risk for perimenopausal depression: “In particular, women who experienced their first traumatic event in their teens are especially susceptible to depression during perimenopause, even if they had never previously had depression.”

Past Trauma Leading to Future Health Implications

To what extent are these women more apt to experience depression? More than two times as likely when compared to women who either experienced such events much earlier in life (as infants or toddlers), or never at all. The Penn State team determined that the timing of such events is a critical window into the significant and long-lasting effects on brain development, particularly in the areas responsible for emotions, mood and memory.

Penn State studied the women participants for a long time – 16 years. Each participant was assessed regularly for cognition and mood, and blood samples were collected to determine hormone levels routinely. Approximately 22 percent had experienced one ACE, and almost 40 percent had gone through two or more adverse childhood events. And most of the adverse events occurred before puberty.

Of these women, almost 21 percent experienced depression for the first time during perimenopause, while 22.4 percent were diagnosed with depression before perimenopause started: “Notably, women who reported two or more ACEs after the onset of puberty were 2.3 times more likely to have their first experience of clinical depression during perimenopause, compared to those who did not experience any ACEs.”

Sadly, ACEs Are Common Events
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The most commonly reported ACEs were parental separation or divorce, emotional abuse, and living with an alcoholic or someone with another substance abuse disorder.

Unfortunately, adverse childhood events may seem like an outlier, but they are much more common than many would like to believe. According to the Crimes Against Children Research Center, 20 percent of all girls are victims of child sexual abuse, and during the course of their lifetime, 28 percent of all 14-17 year-olds (male and female) have been sexually victimized. Those most vulnerable to child sexual abuse are between 7-13 years old.

Then, beyond sexual abuse, are these sobering stats, which illuminate other potential types of adverse childhood events:

• 14.4 percent of U.S. children are in poverty (Children’s Defense Fund)
• 10.5 percent of all U.S. households experience food insecurity, or not having enough food to eat (USDA)
• 2.7 million children in the U.S. have a parent who is incarcerated (National Institute of Corrections)
• 424,000 U.S. children are in foster care (Children’s Rights)
• Hundreds of thousands of children experience stress and sadness due to racism, sexism, lookism (being appraised by one’s appearance and conformity to prevailing beauty standards) and homophobia (life experience)

Why Now, If Not Then?

This is a logical question: If the groundwork for mental-emotional challenges was laid during childhood or adolescence, why does it wait to crop up when women are in midlife?

Given these emerging and new insights into the role of ACEs on future risk of perimenopausal depression, and the role of ACEs on brain development, I have a few of my own thoughts about why this happens to some women:

• The relative predictability of hormones, even with monthly cycles, before the onset of perimenopause help to “shield” a woman from succumbing to the more drastic and unpredictable hormonal highs and lows of perimenopause. By the time perimenopause starts, her body and brain might have already been treading water for quite some time – coping well on the outside with not much resilience left inside.
• Women with ACEs are already more biochemically compromised than women who haven’t endured any ACEs. Perimenopause is akin to taking the brakes off the car; the “wheels” of a woman’s physiology (her brain and its neurotransmitters, her neuroendocrine system and its chemicals) can no longer hold it all in check; there are just too many moving parts at once, and prior coping mechanisms are inadequate.
• Women at this stage of life are already under major stress – financial obligations, career demands, childrearing, maturing marriages, new health diagnoses, aging parents, dying friends or relatives. In the context of also having had ACEs, the added stress of the hormonal hijinks of perimenopause just proves too much.

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What to Do About It?

The past cannot be scrubbed clean and deleted. Women at this phase of life often have some housekeeping to do, and this is true even for those with no ACE history. During a woman’s 40s and 50s, she may be in a new state of flux, and anecdotally, this is a time when women begin making some critical life changes. They take an inventory of their past, present and future, and may start to redesign and revise life according to her terms. This may look like:

• Pivoting careers, perhaps going from a high-stress corporate role to a less stressful consulting job
• Returning to school to retrain to do something else, or learn something new to ignite a hobby or passion
• No longer doing disproportionate amounts of cooking, housework or the emotional labor involved in keeping a household or family going
• Getting a pet for added emotional support and as a comforting companion
• Discontinuation of micromanaging her children, including their activities, classwork, homework, grades, extracurricular activities or social lives
• Taking up new self-care practices, like meditation, yoga or regular exercise
• Increasing reliance on and active practice of her faith, whatever that may be

At the same time, these personal changes are not always enough, especially for women battling moderate to severe perimenopausal depression or anxiety, with a history of ACEs. In such cases, it is advised that they seek the help of a healthcare professional to consider therapy and other interventions.
 

​Midlife brings about many changes in a woman’s life – the maturation or ending of marriages, the stride or disruption of careers and the emergence into adulthood of their children, just as their senior parents may begin to show serious indications of true aging and decline.

As if these dichotomies weren’t enough, then enters weight. As women enter their mid-30s+, some begin to realize they must take intentional steps to preserve their health. The habits of their teens and 20s no longer serve them, and they assume all kinds of practices to stem weight gain and lose size. Yet many find that despite all their efforts, including clean eating and exercise, weight loss proves more challenging and fluctuates throughout the month.

But why? What factors drive the sometimes wild changes in a woman’s weight all within the same 30 days, even with steadfast practices to stay in shape?

It turns out that it’s not entirely women’s fault. Some of it is purely out of their control.

It’s hormonal, to a large extent.

Throughout life, women contend with hormonal shifts, swings and changes. Think of puberty. Consider the menstrual cycle. Then there’s pregnancy, postpartum and, now, perimenopause.

According to a professor at Michigan State University, women’s appetites unconsciously rise as they prepare for the possibility of pregnancy, even during perimenopause when women are still capable of conceiving: “Each month, the female body undergoes a menstrual cycle marked by changes in the hormones estrogen and progesterone. Monthly fluctuations in hormones cause women to increase the amount of food they eat and also causes emotional eating, which is the tendency to over consume in response to negative emotions.”

The shift in hormones that happens during perimenopause – usually a woman’s 30s to 40s – can play a part, too. Less estrogen can lead to more visceral fat in the abdominal area, and this is a common complaint of perimenopausal women – that they gain a spare tire they never had before, and it’s harder to lose than ever.

It's also a matter of what you eat and drink.

Aside from premenstrual indications, a woman’s weight can go up and down by as much as five pounds within 24 hours. In such cases, the explanation is usually attributable to water weight and sodium. Cutting back on salty foods and consuming foods high in potassium and magnesium can blunt the impact of sodium.

A casual scientific experiment in which several women tracked their weight over the course of a month is pretty interesting. Even with various levels of exercise, and a mix of “clean” diets to so-so, less disciplined eating, all the women’s weights changed over the course of 30 days.

Alcohol can also cause bloating and impose a state of dehydration that makes the body hold onto weight. This can cause puffiness in the face, the waist and elsewhere. Aside from the aesthetic effects, too much alcohol consumption can lead to a state of inflammation in the body, of which weight retention is a symptom.

Additionally, many people – when enjoying a glass of wine or a cocktail – don’t consider the caloric impact of this indulgence: A regular, 12 oz. beer contains 153 calories, and a small glass of wine (five ounces) clocks in at 125 calories. Many drinkers have more than one drink in a sitting – say, two beers while watching the game or a glass of wine followed by a mixed drink while enjoying a night on the town. Drinking on a regular basis (several days a week) while eating regular meals, snacking and drinking other high-calorie beverages, like frozen coffee drinks or fruit juices, can stack on the calories fast.

It’s about your activity level, too.

Exercise and strenuous activity rev up the heartrate, boost the metabolism and lead to perspiration. Exercise routinely, and you’ll drop water weight more consistently. And you’ll also reap the benefits of calorie burn, too.

According to Harvard Health, during a 30-minute workout of the following activities, a 155-pound person burns 108 calories when weightlifting, 144 calories from water aerobics, 144 calories during hatha yoga, 198 calories doing low-impact aerobics, 216 calories on a stepper machine, 324 calories on an elliptical machine and 360 calories doing step aerobics.

Metabolism with age may play a role.

It’s been said time and time again that metabolism slows with age. According to science, much of this has to do with the loss of muscle mass with age, not just getting older by default. Beginning around 30 years old, lean muscle mass starts to decline unless the person takes action to prevent it through weight bearing exercise and strength training. Researchers estimate that people lose 3-5 percent of muscle mass each decade if they don’t stay active. With less muscle mass, you burn fewer calories. And the weight you gain will be based on fat, not putting on muscle.

Despite this, recent studies published in the year 2021 reveal that metabolism and age don’t necessarily go hand in hand. Researchers found that between the ages of 20-60, metabolism actually didn’t change. Instead, it slowed down after the age of 60 by about 0.7 percent every year.
This evidence shows that the adage of metabolism getting sluggish with age is an unproven maxim. Instead the weight gain is attributable to a loss of lean mass and a reduction in physical activity, leading to weight gain.

Medications that help with conditions but can harm what the scale says.

Some people never needed any medications on a sustained basis until midlife hit.

Unfortunately, some of the medications women are apt to begin taking in their 40s and beyond can be associated with weight gain. Almost 25 percent of women in their 40s and 50s are on antidepressants, and many drugs in this class have been connected to weight gain.  Frequently, the antidepressants themselves do not cause weight gain, but they can induce an increase in appetite that leads to more eating.

Aside from antidepressants, there are other medications connected with poundage. They include steroids, which are used for arthritis, asthma, lupus and other health conditions, and antihistamines, commonly used for allergies. Meds for epilepsy and nerve pain, like Lyrica, and beta blockers, which are prescribed for hypertension and anxiety, can also lead to weight gain.

Moving forward

Weight gain at midlife as a woman is a complex thing. As you can see, there are various clues and causes for it, from monthly hormonal changes beyond one’s control to lifestyle factors that are in one’s sphere of influence.

Some strategies for coping with age-related body changes include adopting a wellness-focused lifestyle that prioritizes feeling good more than fitting into a socially acceptable model of beauty. Developing this mindset doesn’t mean foregoing exercise and sound nutrition for French fries and sugar binges, but it does acknowledge that doing well by one’s body turns the focuses to maximizing its function for the long haul vs. short-term gains in unhealthily obtained weight loss.

Other methods include becoming even more cognizant of diet and exercise if you’re on medications associated with weight gain. Taking a drug that heightens appetite is not necessarily carte blanche to eat whatever, whenever. Rather it can be a sign to be that much more disciplined because an increase in desire to eat due to a medication doesn’t mean the body physiologically needs more food to fuel it.

With age comes change, as most of us can attest. Change in our lives, change in the world, change in our spouses and children, and change in our philosophies, ideals and goals. This can be a time to be more forgiving and tolerant of those changes, holding a mirror of acceptance and goodwill to ourselves as much as we extend that to others.

“God, grant me the serenity to accept the things I cannot change, the courage to change the things I can and the wisdom to know the difference.”

If you're reading this, chances are you're middle-aged and may not even realize it.

​Perimenopause frequently strikes women in their prime, at the midlife point, just as they are in their 30s or 40s and life is starting to settle and make more sense.

Gone are the late-night escapades at the bar or club. And we’re often past the point of aimless dating, financially indulgent shopping or being way too undisciplined with our nutrition and fitness.

By their late 30s or early 40s, many women are rather settled in their line of paid employment or staying busy in the home, with spouses, children, hobbies, many obligations and perhaps some volunteer or civic commitments in the community or neighborhood.

At the same time, however, there is a reluctance to imagine that by 35 or 40, someone has reached midlife. The 40-something or 50-something year-old woman today typically does not engender the same image of women the same age from half a century ago. They don’t look, act or present like our grandmothers, great-grandmothers or great aunts, if we’re fortunate enough to have seen them alive.

Today we seem younger, more youthful. We see women like Nicole Murphy, Angela Bassett, Cindy Crawford and Elizabeth Hurley and feel certain that the needle has moved in the other direction – away from aging and toward a sort of suspended state of beauty, potential and timelessness. Indeed, “What Age Is Considered Old Nowadays?” shows that as time marches on and people live longer, ideas about what constitutes being elderly or middle-aged continue to shift.

But the truth is that, from your mid-30s through your mid-50s, you are middle aged. In the United States, the average life expectancy is 77.3 years. Half of 77.3 is 38.65. But what your “midpoint” is, is in part influenced by your demographics. For Black Americans, the life expectancy is 71.8. For Hispanics, it’s 78.8. Note that life expectancy fell across most groups as of 2020, due in part to the pandemic.
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If you reach the halfway point of your projected life expectancy, then that is the point at which one reaches the midlife category. This is true even for the Millennials, the generation covered so extensively by the media. The oldest members of the Millennial generation are now in their late 30s and early 40s, and Millennials themselves agree that middle age occurs between 35-50 years old.

Midlife Produces Health Changes, Including Perimenopause

This age range is also when common health problems start to pop up. The most frequent chronic illnesses in middle age are high blood pressure, high cholesterol, arthritis, heart disease and depression. This time of life is when people may notice their blood pressure creeping up, their knees sounding like a band warm-up and their ability to perform athletically declining. And, yes, this is also when women start to experience the warning signals of a menopause that may be 10-15 years away.

The 30s and 40s is when women may begin to have night sweats, hot flashes or strange menstrual changes (like a cycle that seems lighter than usual, longer than typical or heavier than normal). They may notice changes in their emotional state, feeling on edge for no reason or tearful for all the wrong reasons.

Even though these women may look youthful, in shape and “good for their age,” they are, in fact, possibly entering that critical perimenopausal stage. Perimenopause is certainly a midlife phenomenon, a flag signaling declining reproductive capacity and hormonal changes that affect entire body systems.

At the same time, there is a paradox in this situation: Women who are experiencing a range of perimenopausal symptoms right on time for their 30s or 40s may be told by their doctors that they are too young to be experiencing perimenopause. This leads to all sorts of problems, including delayed treatment, denial of coverage (by insurance) for certain treatments, a compromised quality of life and, at worst, misdiagnoses and treatments for conditions women don’t even have.

It’s Okay to Be Middle-Aged

The idea of being perimenopausal catches some women by surprise. Many just cannot believe it and will not admit to it. Even if they have every textbook symptom at 45 years old, some women simply refuse to attribute their condition to perimenopause or aging. Ridiculously, some find more peace in thinking they have a thyroid problem or an autoimmune disease than being in the symptomatic twilight years before official menopause.

It’s hard to blame them. In a society where many doctors are under-educated or miseducated about perimenopause and when it happens, and in a culture that prioritizes youth above all, it can be hard to wrap one’s mind around aging and the reality of mortality.

As more women, like actress Gabrielle Union, come clean about perimenopause and change notions of what middle age looks like, maybe things will change.

Actress Sharon Stone said, “It’s not like 50 is the new 30. It’s like 50 is the new chapter.”