​If there were ever anything to keep a woman on her toes, it will be perimenopause.

One thing is for sure when it comes to perimenopause and figuring out what works for you – the formula may periodically change, though the goal post never moves.

The goal post, or the “True North,” for most perimenopausal women, is to restore and sustain as high a quality of life as possible through this transition. A transition that lasts, on average, for 4 to 12 years. For most of us, that means remaining as functional as possible and with a sense of well-being that hearkens back to a feeling of normalcy, even as we navigate our “new normal.”

What we attempt and try during these oft-tumultuous years of symptoms is as varied as the millions of women gradually transitioning toward menopause themselves. As reported in Glamour magazine, 1.3 Million Women Enter Menopause Each Year, and at least 27 million women between the ages of 45-64 officially hit menopause annually. Plus, now Millennials – the generation that has gotten so much attention and analysis regarding youth trends – are no longer young whippersnappers, nor are younger members of the Generation X cohort (that’s me!). Many Millennial women are now in their mid-30s+, and are already in or about to hit their perimenopausal stride.

Each of these women has her own equation of what works for her symptoms. Yes, that means there could be millions of different approaches, methods and components involved in addressing those pesky perimenopausal symptoms.

I went through a lot to figure out what works for me. Once I finally landed on what seemed to be a magic formula, I felt golden. The sun was shining, the clouds had moved away, and I had a song in my heart! I felt like I had conducted a clinically proven process of self-discovery. My formula was repeatable; I’d tried it over the course of weeks and then months. And it worked well each and every time . . . for about eight months straight.

Until it didn’t.

The first alarm happened a couple of months ago when my breasts got so sore, they felt so sensitive, swollen and painful, it reminded me of post-partum engorgement. My boobs were so sore that it was difficult to get comfortable in bed or wear a bra, and even moving the wrong way disrupted me. I also found myself more alert than usual, making it harder to fall asleep.

I sought help from communities of strangers – strangers who in our times of perimenopausal challenge become more like confidants and trusted advisors, as so many of us lack real people in our real lives who are really equipped to empathize with us or offer reasonable guidance. On an HRT forum, I was met with multiple responses by women and clinicians who suggested that my estrogen was probably running high (“having a spike”), and that I needed to counteract it with a higher dose of progesterone. So that’s what I did. For about a week, I increased my progesterone by an additional 100mg nightly, and the problem soon subsided, and I was back to my trusted formula of what had been working for me for the previous eight consecutive months.

“Whew, dodged that bullet,” I thought.

Then, just recently, I hit another unforeseen hurdle.

I found myself awake at 4 a.m., feeling like I had slept all night. I tried to go back to sleep, but it proved to be an exercise in futility. I soon found myself thinking about all manner of things, especially my daughters and the random concerns I have about them. I am the mother of a high school senior who will soon be starting college and a high school freshman who, though nowhere near leaving the roost, still gives us enough parental angst to keep us on our toes. In the wee hours of the morning, the bed was no longer a sanctuary. So I arose, made some coffee, watched the news for half an hour, and then changed into my workout gear to get my morning exercise routine underway – much earlier than usual.

And so the day went.

That night, I found myself unable to switch off as I typically can. I found myself lying in bed awake, not thinking about anything in particular, not feeling concerned or on edge about anything at all. Just awake. I did not fall asleep until after 2 a.m., and I woke up by 7 a.m. Yes, I was kind of tired, but I got on with my day as usual – no harm, no foul.

The next night played out in much the same way – awake into the wee hours for no discernable reason at all, not worried or concerned about anything, not irritable or agitated either. Just up, wishing I were asleep instead, but comfortably lying in the darkness and silence.

But I knew this could be the beginning of a decline, a return to the old ways that landed me into the medical spiral that initiated me awareness of perimenopause itself. And I knew I had to take action. So, as I did before when my breasts got extremely sore, I decided to distance myself from my symptoms and my problem as much as possible, and to try to look at this objectively.

Here's what I knew: Nothing I was doing had changed. I was still on my combo of HRT and an ultra low maintenance dose of an antidepressant that had been prescribed off-label for sleep, mainly. My activities and lifestyle behaviors were the same – I wake up, make coffee, exercise for about an hour, work for a few hours, take an afternoon walk, work a bit more, then start planning dinner, cook and prepare for the evening. I may read, work on my blog or other interests, talk to some friends or family members, watch TV, read some more, take a shower and then go to bed.

Rinse. Repeat. This is the cadence of an average week day.

Nothing outside of myself had changed fundamentally either. There was no reason for me to feel more stressed, pressured or uptight about anything. By all indications, our lives are good.

But I knew something must be off, and whatever it was needed to be addressed, even if it wasn’t my “fault” and was totally out of my control.
So the next night, I brought out the bigger guns. I went up on my antidepressant dose, and even added a small dose of a prescription antihistamine to boot. I decided not to take any melatonin or magnesium (which I had been doing for months) because I wasn’t even sure those were helping me anyway. And guess what?

I slept fine and felt great in the morning.

However, I noticed I woke up in a wet nightshirt. So I had experienced a night sweat but slept through it. This was a signal to me that indicated a couple of things: 1) Just as I had experienced a hormonal switch-a-roo two months prior with the sore breasts, I was going through another one again, based on the night sweating; 2) Maybe my hormonal silliness is causing some funny business with my cortisol and serotonin levels, which antidepressants help to control and contain.

So here I am again, almost a year on HRT and about eight months into a formula that had worked beautifully until now.

I am not one to sit by passively and let a situation degrade or go off the rails without taking action. So I have scheduled an appointment with one member of my healthcare team to discuss options for now and the plan going forward. I also reached out to another member of my medical squad to report the issue and ask for input.

In my daily work, I help people with their careers. Doing so involves so much more than what is close at hand, like their resume, cover letters and LinkedIn profiles; it involves some make-it-plain conversations about concepts like getting comfortable with vulnerability and developing agility and adaptability. I give great guidance and advice that, honestly, has changed thousands of lives.

I now realize it’s time to apply the sample principles to myself.

In fact, perimenopause asks this of all of us. As our hormones shift, fluctuate and roller-coast, so will whatever works for us in dealing with the hot flashes, night sweats, migraine headaches, hormonal acne, body aches, sleep problems, sub-clinical depression and low-level anxiety (the most commonly reported symptoms among women).

I realized that I need to get more comfortable with the ambiguity and, frankly, the powerlessness I have in this situation. I know I am doing everything I can for the sake of my immediate and long-term health. I also know that I have researched extensively about perimenopause, medications, treatments and more, and I now possess a high degree of clinical knowledge.  

But there was something within myself that felt I had reached my personal Eureka, that I had found the panacea that would be my ally at least until the age of 50, over the next six years or so, until I am projected to reach official menopause. And knowing that I haven’t – that the goal posts have moved yet again – makes me kind of sad.

So as I mourn the loss of the assurance I thought I had, I am also working to embrace possibility. And finding solace and hope in the panoply of options available today for women like me.
​
Perimenopause is the ultimate exercise in adaptation. No corporate master class on agility comes close. What helps us today may change every six months or every ear, but what will best serve us ultimately is a mindset that is fixed on nothing in particular, aside from the knowledge that, “This too shall pass,” and “God is in control.”

By Khaya Ronkainen

I am a plump child afflicted with a skin disease, which doctors cannot diagnose. Only their repetitive advice, “Stay out of the sun!” brings me temporary relief. Regardless, I am beautiful. But I don’t hear much about my beauty from my parents, instead from relatives and strangers. In fact, my beauty often compels strangers to plant kisses on my cheeks without my parents’ permission. As young as I am, I can see a twinkle of pride in my father’s eyes and a hidden smile dancing on my mother’s lips.
 
As a teenager I add to my plumpness, eyeglasses and bookworm tendencies. Because I have no interest in sports, my body size makes me look older than I am. In addition to residual dark marks and scarring on my legs and arms from the skin disease, I start battling severe bouts of acne. In spite of everything, my beauty status doesn’t change. At boarding school, boys my age compete for my attention. At home, my mother starts to fend marriage proposals from villagers, who want me as their daughter-in-law. I’m only thirteen years old.
 
This attention starts to get me confused about what beauty really means. Because I certainly don’t feel beautiful. Yet I can’t dismiss compliments from people who see me as such. I don’t bother to ask others what exactly makes me beautiful because comments about my beauty are varied. But I begin to imagine it might have to do with my soft eyes, which allow me to hold things at the center of my gaze while I remain aware of everything that goes on around me. Perhaps, it’s my affiliative smile from which people expect to see dimples. But I don’t dimple.
 
In late adolescence, I learn my body loves to move. This is a coincidental discovery as I take up tennis only to imitate my older sister, who is a professional player. While I find slight enjoyment in being confused for her in tennis circles, even though we don’t resemble each other that much, I branch out to find my own identity. And it’s at the university great hall, in my sophomore year, I first become aware of the power rested on my hips as I learn to cha-cha dance.
 
While I’ve completely shed my baby fat, my pear-shaped body struggles to find a good fit with clothes. I take to making my own or buying clothing to refashion it in order to feel comfortable in it. Wearing skirts and dresses doesn’t make me cool among my peers, who have discovered the appeal of sexy jeans. I don’t despair much because I find my memorably beautiful and unique friends. 
 
As a young woman, I learn to walk on stilettos. But I’m hopeless as I teeter on uneven pavements in a big city with blisters on my feet. Hence, when I land my first job, I add a gym contract to my monthly expenses to strengthen my muscles. My determination pays off. I measure this by a turn of heads each time I approach. Unfortunately, disdainful catcalling from men who have hopes to own my body also ensues.
 
I’m told about the power of women appreciating one another but in the same sentence, I hear about women who envy appearance. That’s why sometimes I can’t distinguish between appreciation and envy. So, I learn to tread with caution as I navigate mixed looks I get from other women. Sometimes these looks are decidedly lustful across the board, something that makes me feel awkward and leads to avoiding social gatherings. Regardless, I am a success as I sashay my heavy thighs and curvy hips around town.
 
Suddenly I’m a plus-size, my shopping experience in ages. Who designs these customized size charts, anyway? As a grown woman, I wish I could say I don’t really care. But the industry seems intent on making us hate our bodies. Nonetheless, the fact that I am beautiful holds true now as I mature to myself with heavier arms, disappearing waist and a derriere that needs firmer support. Because when you’ve been told all your life that you are beautiful, it’s really difficult to see yourself otherwise.
 
My beauty was never perfect. Along the way, I learned my beauty has little to do with my physical appearance or age but a sense of self that was instilled in me from a very young age. In a society hell-bent on qualifying and quantifying beauty as it offers an array of invasive and expensive promises for youthful beauty, I simply smile. Because my middle life crisis is strapped on my hiking boots. This too is a journey of constant self-affirmation.

Khaya Ronkainen is a South African-Finnish writer of poetry and prose. Her work is largely inspired by nature, often examines duality of an immigrant life and also explores themes on ageing. To learn more, visit her site at https://www.khayaronkainen.fi

Instagram: @Khaya Ronkainen 

 
 
 

​By V.J. Knutson

​Avoiding mirrors is my superpower. I learned it growing up in a house full of women. While sixteen-year-old Jo-Jo would stand in front of the large mirror above the living room fireplace, backcombing her hair, twelve-year-old June was posing in front of the full length, and I would be ducking out the backdoor avoiding mother’s scrutiny. At five, I already knew that when it came to beauty, I didn’t stand a chance.
 
Dubbed “Moose” by my siblings, I was broad-shouldered, thick waisted, and could throw a punch as well as any boy. My mother, not in the habit of using nicknames, just shook her head and mumbled, “No one will ever love you.”  I didn’t need a mirror to tell me I was ugly; I had family.
 
Mother’s criteria for a successful woman: 1) complete the eleventh grade; 2) work as a secretary; 3) attract a husband; 4) marry and have babies. Jo-Jo rebelled, got pregnant at nineteen, and was whisked away into marriage, leaving June to fulfill the expectations. She was submitted to etiquette classes and later registered with a modelling agency. I’d sneak into her bedroom and glance through her notes, hoping to gain insight into to how to become more feminine, but I couldn’t walk with a book on my head, or sit with the elegance required. June had the figure of Twiggy and the looks of Mary Quant. I was still “Moose.”
 
I gave up hope of ever having an acceptable physique and focused on academics and athletics. I excelled at the first and was mediocre at the latter.  My body was just too awkward. 


“Stretch” and “Tree” were added to my list of monikers, and one male classmate drew a portrait of me that depicted big breasts on a pair of ridiculously long legs, which translated to “no hips” or “no ass.”  
 
While June was receiving marriage proposals, I was being hit on by the fathers of the kids I babysat, or later, work supervisors.  Confused, I sought guidance from my mother, who advised that some men will do “it” with anything that stands still, and I needed to not provoke attention.  When I accepted a ride home from a friend of a friend that ended up in sexual assault, I learned firsthand that what my mother said was true: the police confirmed that my tight jeans and halter top were enticement for predators. I learned to loathe my body more.
 
I married the first boy who was willing to date me without making his erect penis my responsibility. We were both nineteen, and when after three weeks of marriage we had not consummated the marriage, he admitted that he just didn’t find me sexy. I was willing to bear that burden: I knew it to be true.
 
Separated at twenty-one, I threw myself into work and fitness. I worked out twice a day, put in lots of overtime, and chose rum and sodas as my meal of choice. Drunk, I was much more desirable, or so it seemed. Men from my past came knocking on my door, but I pushed them away. I couldn’t bear for them to see the ugliness underneath. When one of June’s suitors asked me out, I thought this must be love: surely anyone who would want me over her was willing to accept all of me. 
 
I would marry this man and have his children just like Mother wanted. I would endure seventeen years of “if you loved me more” and criticisms that wore me down. My breasts were too large, my waist too thick, my legs too skinny—never enough. He played to all my insecurities, and I just kept trying harder, because I believed him.  The day he told me he didn’t love me anymore, and in fact, had never loved me, I heard the echo of my mother’s words, No one will ever love you, and something inside me snapped.
 
I was forty years old, had just lost one-hundred-and-eighty pounds of no-good husband, and I was enough! If I didn’t love myself, I realized, no one else ever would.  I had work to do.
 
First, I took a photo of myself in a swimsuit and posted it on the fridge door. Till I could look at that image and not cringe, I promised to dig deeper.
 
I set boundaries for myself, and goals that represented self-respect. I would no longer be a babysitter, mother, therapist, or punching bag for some man’s shortcomings. I wanted to be desirable and cherished, so I needed to know how that would feel. I stopped dating and started courting myself. When I was down, I bought myself flowers. I dined alone, trying out different restaurants until I learned what I liked. I took myself to the movies and discovered that I preferred a night in with a good book. I signed up for dance classes and auditioned for an improv company. I started a social club for dating misfits like myself—first rule of participation that members be friends only. 
 
As time passed, that woman on the fridge didn’t look so bad. She encouraged me to go back through my life and look at old photos of myself. I was surprised to find an attractive young woman, who bore no resemblance to the me I had experienced. 
 
The improv company—a murder-mystery troupe—hired me, and the first role I was assigned was a nudist named Ivana BeBuff.  My costume was a form fitting, low cut, sequined gown, slit at the sides to accentuate my long legs.
 
“Just strut your stuff,” the director coached.  “Exude your sexiest self.”
He had no idea the mountain he was asking me to climb, and I wasn’t about to tell him. Leaving self-loathing in the dressing room, I made my entrance as Ivana—a bombshell looking for a rich investor. The experience was life-altering.  
 
After Ivana, came a line of female characters who inadvertently helped me learn that to be comfortable in my own skin, I just needed to exude confidence. 
 
No one called me Moose anymore, or any other body shaming name, but I needed to confront my mother about her put downs.
 
“You weren’t like your sisters,” she said.  “You were so smart, and such a tomboy, I honestly didn’t know how anyone would want to marry you. I thought I was preparing you to be independent.”
In a convoluted way, I get it.  She didn’t know any different. 
 
I gave up declaring myself as enough and decided that “I am” sums it up best. I spend my time now completing the sentence with nouns:
 
I am Grandmother, writer, teacher, artist. I am friend, lover, sister, seeker.
 
Funny how once I stopped worrying about my physical image, I started living my best life. I went back to school and completed a post-graduate degree, finally fulfilling a childhood dream.  
 
My body, I now appreciate, is a sacred vessel: as unique and perfect as the spirit it carries.   


VJ Knutson, BA (French), B Ed, writes to make sense of life. Her poetry and short stories have been published in numerous anthologies. A memoir and book of poetry are in the works. Visit VJ at vjknutson.org or onewomansquest.org.   Twitter @Vjknutson and Instagram @1womansquest.