Meet the Cast of Perimenopause

One of the strangest parts of perimenopause aren't the symptoms themselves, it's how quickly you can start to feel like you are them, so you start to question "What is wrong with me?", and it is exhausting.

Its like you are anxiety, you are exhaustion and forgetfulness, you no longer just have them as a symptom

And that's where things get a bit murky, because the more tightly you identify with what's happening in your body, the harder it is to get any distance from it.

But what if that isn't true?. What if there is a way to gently help your experience so you stop identifying as the symptom itself.

So here's a reframe which sounds a bit daft but genuinely works.

Give your symptoms names.

Not clinical names, actual real people names. Preferably ones that belong to someone's slightly difficult uncle or a woman from your mum's old book club. It's like the menopause version of the film "Inside Out" (awesome film, definitely watch it).

The psychology behind this is something therapists call externalisation, a technique rooted in narrative therapy that helps you separate your sense of self from the experience you're having. It is used in Mindfulness and ACT therapy, but this is just that, explained without the clinical language.

When a symptom becomes a character rather than a state of being, you move from "I am this" to "this is visiting me." This is not diminishing your experience of the symptom, but it allows you to keep separate from it.

So, allow me to introduce my cast of characters.

🔥 Barbara. The Hot Flush

Barbara has no concept of timing or occasion. She does not care what you are doing. She arrives in the middle of meetings, during school pick-up, and inexplicably just as you've put on a nice jumper.

Hot flushes happen because falling oestrogen confuses the hypothalamus, the part of your brain that regulates temperature, into thinking you're overheating when you're not. It then fires off the sweating response to cool you down. Very helpful previously, but completely over the top in perimenopause.

So instead of thinking that you can't cope with this hot flush, feeling embarrassed or self conscious, just quickly identify it in your mind.

"Barbara's here again. Don't panic, she'll be gone in a minute." .

This prevents you attaching too much emotion and meaning to the experience, and you can try one or more of these quick practices to help cool you down.

Cooling your wrists or the back of your neck is faster than splashing your face.

Layering clothing is your best friend. You need to be able to strip immediately and as easily as possible.

And if Barbara's showing up more than seven times a day, that's worth mentioning to your GP.

🧠 Derek. The Brain Fog

Derek wanders in and quietly removes whatever you were about to say. He subtly but relentlessly walks off with your thought mid-sentence.

This one surprises people the most, because nobody really talks about cognitive symptoms in the same breath as hot flushes. But oestrogen plays a significant role in supporting memory, focus, and verbal recall. So as levels fluctuate, you get Derek. Standing in doorways, and making you forget the word for fridge.

Again, just identify that Derek has appeared for a minute and say something to yourself like

"Derek's taken that thought. No problem, deep breath and I'll grab it another way." or

"Get lost Derek, you can have that thought but there's an even better one on its way"

It's temporary, it's hormonal, and it is not early dementia (a fear a lot of women have ). Other things to help. Externalise your thinking as much as possible.

Say things out loud to anchor the thought. Write things down immediately if you can, use a sticky note, the notes app on your phone or any random piece of paper.

Just take a deep breath and slow down a little. Stop trying to hold multiple threads at once, one tab open at a time and Derek will get lost and go for a wander elsewhere, not in your mind.

😡 Linda. The Rage Wave

Linda doesn't do mild irritation. She could be triggered by a noise, a comment, a drawer that won't close properly, Linda always turns it into an event. And afterwards you are left feeling "Why did I react like that?".

The important context here is that this isn't you becoming a difficult person. Oestrogen has a calming effect on the amygdala, the part of your brain that processes emotional threat. Less oestrogen, more reactive amygdala, more Linda. It's physiological, not a permanent personality flaw.

So what you can do instead, if you feel a rage? You could say to yourself something like,

"Linda's loud today. I'll give it a minute. I don't need to act on everything she says"

This again separates you from the emotion you are feeling, and gives you a second to change how you are going to react.

What can also help in the moment is firstly, movement. Once you have identified Linda might be on her way, or is already there, movement is genuinely the fastest reset, even a two-minute walk outside.

Also, reducing background noise and overstimulation helps Linda stay quieter overall. If you can catch her at the pause, before you even respond, and tell her to back off, then you are on to a winner.

🌙 Colin. The 3am Wake-Up

Colin works nights. He shows up at 3am with a rotating selection of old memories, imaginary arguments, and a to-do list for things that can absolutely wait until morning.

Sleep disruption is one of the most common and most underreported symptoms of perimenopause. It's partly down to night sweats (Barbara in nocturnal mode) and partly because oestrogen and progesterone both have roles in supporting deep, restorative sleep. When they drop, Colin moves in.

What you can say if you find yourself waking in the early hours.

 "Colin's here. This is just a night wake-up, not a crisis"

I'm sure if you are a night waker, you have heard all the remedies, and feel like you have tried everything. A couple of things I genuinely find help every time are, once you have identified Colin, just imagine him walking away, and going off to his own bed and going to sleep. This helps your thoughts from spiralling and separates you from the insomnia. If you keep your room cool, and light exposure minimal that also really helps. Do not check your phone, not even for the time. Colin thrives on stimulation so don't engage with him. Insomnia can be a huge problem, but try not to make it part of your personality. Don't identify with it and hopefully this will minimise its effects.

😭 Susan. The Emotional Overflow

Susan brings tears, and not always for a reason. Sometimes during an advert, sometimes during nothing at all. She will form a lump in your throat for no clear cause and makes you feel emotionally full up.

This isn't weakness or instability. Oestrogen has a relationship with serotonin, one of your key mood-regulating neurotransmitters. So when oestrogen drops, emotional processing becomes more of an effort and things sit closer to the surface. Susan is essentially your nervous system recalibrating. When you feel like Susan is around, you can say to yourself

"Susan's visiting, I can just let it flow, I don't need to apologise or analyse it"

You need to remember that you are not going to be in that emotional state forever, and it will pass. What can also help is that you let it move through you, rather than trying to clamp it down. Create a bit of environmental calm with less noise or outside stimulation. If you need a cup of tea and a blanket for a while, then get one and allow yourself a bit of time and grace. Sometimes when Susan arrives, your friends and family will worry and try to help. They sometimes can, but if you let them know its just Susan, and she will be gone soon, then it helps them understand too.

Just a quick note though. If Susan is visiting constantly and affecting your day-to-day functioning, that's a conversation worth having with your doctor, not just something to manage alone.

⚡ Nigel. The Anxiety Surge

Nigel scans everything predicts problems that don't exist yet and makes them feel real. He runs worst-case scenarios with impressive efficiency, checks everything twice, and keeps the whole system on low-level alert.

Anxiety as a menopause symptom affects a huge number of women. Many women arrive at their GP with what looks like a new anxiety disorder, when what's actually happening is hormonal. GABA, a neurotransmitter that creates calm, is partly regulated by progesterone. As progesterone falls, so does that background sense of ease.

What you can say to yourself if Nigel starts to take over the show.

"Nigel's talking. I don't have to listen or believe everything he says"

Other things that can help, once you have identified Nigel in the room. Grounding. You may have your own ritual for this, or you could try, notice five things you can see, four you can touch, etc. This interrupts Nigel mid-spiral more effectively than trying to reason with him.

Slow breathing activates the parasympathetic nervous system and tells the body the threat scan can stop. So make sure you take a deep breath in, hold it for a few seconds and ensure your out breath is longer.

Again, if Nigel is showing up multiple times a day and you are unable to regulate him then please talk to your medical professional.

💤 Margaret. The Exhaustion

Margaret lowers the volume on everything, she's heavy. Not tired-tired, really bone-level, why-am-I-doing-this, everything-feels-very-far-away tired.

Hormonal fatigue is different from ordinary tiredness because it doesn't necessarily respond to sleep. It's systemic. Your body is doing a significant amount of background work during this transition, and Margaret is the result. Add disrupted nights, emotional processing, and temperature dysregulation and you have a body that is working very hard while appearing to do nothing.

When you identify that Margaret may be around and taking over just allow yourself the thought something like,

"Margaret is here. Today might need to be a little slower"

You can lower the bar for the day, and reduce the expectations on yourself.

Make sure you eat regularly (blood sugar crashes amplify Margaret considerably), and stay hydrated. We menopausal women need to make sure we are drinking plenty and take short rest breaks rather than pushing through to a collapse. A rest doesn't have to be a full on lie down in bed sleep, just micro moments in the day to shut off your body and brain. ( If you are looking for ideas have a look at my e book " Return to calm").

Remember that rest is not a failure, it is essential.

🌪️ Kevin. The Mood Swings

Kevin is unpredictable. Calm, then not calm, then calm again, sometimes within the same hour.

The key thing about Kevin is not attaching to whichever mood is currently present. The mood is not information about reality. It's a hormonal weather system passing through. This is genuinely useful to remember when you find yourself in a low that feels permanent, because Kevin's whole thing is that it isn't, but it can feel destabilising.

When you feel like Kevin is around during the day, you can say this to yourself,

"Kevin's passing through. I'll ride it out."

Small, steady routines act as anchors and can keep your mood steady when you feel like Kevin is taking over. You don't need to stick to rigid timetables, just a few consistent things each day that Kevin can't disrupt.

For example, your morning tea ritual, a short walk, something you make with your hands. Just don't over identify with Kevin. Notice any patterns or cycles where he might turn up more, and merely identifying this can help shift him.

🌿 Janet .The Forgetfulness

Janet removes details, quietly. Names go first, then tasks, then the reason you walked into a room. She's quieter than Derek but more persistent.

Janet and Derek often work together, which is delightful. The distinction is roughly. Derek takes your active, working memory mid-task, while Janet tends to thin out longer-term recall and retrieval. Both are oestrogen-related. Both are usually temporary, or at least significantly manageable.

If you feel like your are forgetting things you can give yourself a moment and say,

"Janet's just nipped off with that. It will come back once I'm a bit more relaxed."

Remember you haven't lost yourself, its just a moment in time.

Try to keep things visible rather than relying on memory. Lists, labels, routines that mean the same thing happens in the same place. Reduce decision fatigue so your cognitive load isn't carrying more than it needs to, and try just doing one task at a time.

🔥 Frank. The Joint Aches

Frank provides commentary on movement. Stiffness in the morning, aches that weren't there before, and a general announcement every time you stand up from the sofa.

Oestrogen has an anti-inflammatory effect in the body, which means as it drops, joints and connective tissue lose some of that protection. Frank is particularly common in the hands, knees, and hips. He's also the one that gets dismissed most often because it doesn't "sound like" a menopause symptom, but it absolutely is, and one that I know very well.

When Frank is around, you generally know about it. You could say,

"Frank is complaining again, I will just take it easy today."

This may seem counterintuitive but it does actually help, and that's gentle movement over rest. Movement keeps joints lubricated. Warmth, whether that's baths, heat pads, or just not sitting in a draught for long periods of time. I use a collagen supplement which helps a lot with my joint pain, but if Frank is severe and prolonged, it's worth flagging to your GP, because inflammatory joint conditions can also emerge at this stage of life.

🧩 Patricia. The Overthinking

Patricia runs continuous analysis. Every conversation gets reviewed and every text message gets interpreted seventeen ways. She doesn't clock off.

Patricia and Nigel are cousins. Nigel is reactive, he responds to immediate triggers. Patricia is more chronic, she reviews everything that has already happened and everything that might. The result is a mental background noise that is relentless and exhausting. When you identify Patricia running her programmes you could say something like,

"Patricia's looping again, I don't need to attend every one of her meetings. I will just step out for a while"

This separates you from your overthinking and allows a bit of space

There is a CBT technique called scheduled worry time, where you give Patricia a specific 10 - 15 minute time slot and redirect her there if she shows up outside of it. This can sometimes work in the moment, and allows you to focus on other things.

Writing thoughts down is also very effective because it convinces your brain the thought has been processed, which quiets the loop somewhat. For this reason I am a huge advocate for journalling, for many things, but in this instance if you get the thought out of your head and on to paper, it really calms your system.

The actual point of all this.

None of these characters live here permanently.

They visit, they make themselves comfortable for a bit, and they leave, sometimes mid-sentence. Your midlife body is going through a genuine transition, and these symptoms are evidence of that, not evidence that something is permanently wrong with you. Sometimes granted, you will need to look in more depth at a particular symptom so you can get some extra help, but naming them really helps to create distance. Distance creates a bit of calm so you don't become a walking talking menopause symptom. It also helps to find the humour, and humour makes the whole thing slightly more survivable.

So the next time Barbara shows up at an inopportune moment, or Colin decides 3am is the ideal time for reflection, you know their names now. You can see them coming.

🖤 Black Cat Wellbeing