Symptom checking had once helped me stay well. But perimenopause challenged everything I thought I knew about managing my body.
I went to my shower and sat on the floor, letting the warm water run over my body. In the past, when mixed bipolar episodes made my skin crawl with agitation, a shower or bath offered safety, as if the sensation of water on my skin grounded me. Like many people with bipolar disorder learn to do, I did a quick inventory of my symptoms.
Skin crawling? Yes. Agitated? Yes. Can’t sleep? Yes.
But something felt different. My mind felt fully present — not like when I experienced mixed episodes and felt strangely disconnected. During those cycles, the collision of mania and depression made my thoughts frenetic and full of rage. I did not feel angry, just confused by a body that didn’t feel right.
As water ran down my shoulders, I wondered if I was having a panic attack. Because I also have generalized anxiety disorder, I ran through those symptoms, too. I was definitely having anxiety, but there was no sense of impending doom. Instead, I was just frustrated by a body that felt hijacked.
Over the past year, I had experienced this feeling occasionally, usually in the week before my period. I had been diagnosed years earlier with premenstrual dysphoric disorder, but it had gotten worse. A few months before, I had asked my general physician about whether my various pains and increased anxiety might be related to perimenopause.
“It could be,” he had said, and then laughed. “Call me if it gets unbearable … or if you feel like killing your husband.”
I laughed too — the polite reflex — but the joke landed wrong. I was bringing him a body I couldn’t recognize, and he’d handed me back a punch line.
As I sat on the shower floor, I longed to be that woman, the one my general physician and I assumed would be the creature of perimenopause: someone angry, having hot flashes, perhaps even wanting to throw things. But instead, I felt frail, scared, and confused.
Recognizing Perimenopause Symptoms
A few days after I sat in the shower, I had a meeting with my psychiatrist. I told her about the strange sensations, the heightened anxiety, lowered pain tolerance, muscle knotting, and a body that felt like it had rebelled against me.
Her eyes warmed with recognition, and she gave a gentle smile.
“My dear, that sounds like perimenopause,” she said. “I’ve never had anxiety, but over the past couple of years, I suddenly developed it.”
Unlike my physician, who had laughed, she listened. In that moment, I understood the difference between being dismissed and being seen.
As the months passed, my perimenopause symptoms seemed to turn me increasingly inward. My skin thinned and grew sensitive; I wept easily. I had been reading my body like a lab report, and the habit that once kept me stable now made me suspicious of every sensation.
One morning I stared at my face in the mirror. I was 48, and there were wrinkles across my forehead and near my eyes. But those did not really bother me — to me, they were a sign that I had laughed, cried, and survived nearly three decades with bipolar 1. Instead, my body no longer felt like a friend.
I no longer felt like I could trust my body, one that had once propelled me up cliffs as a rock climber and set athletic records in track and field. I thought longingly about who I used to be — a woman who had agency over her body.
While I had gained bipolar stability over the past decade due to my careful monitoring of physical and mental symptoms, my tendency to investigate and quantify now seemed to be backfiring.
Every Woman’s Perimenopause Is Different
That afternoon, I called my sister. She is a year older and a psychiatric nurse practitioner. Her symptoms seemed to fit my textbook understanding of perimenopause. She was struggling with weight gain, anger, mood swings, and hot flashes.
“Wanna trade?” I asked.
“Sure,” she said. “I want to be nicer. My husband would definitely like that better!”
I laughed. “I don’t think you want my version. I feel like a giant baby!” I said.
Frustrated and wondering why it seemed like I always had a different version of human experiences, I went for a walk in the woods. I felt the muscles in my calves and thighs supporting me, and the strength in my arms as I swung them. As I walked, I identified trees and checked the plant species in the shrubs. The next day I walked again.
Managing Perimenopause Anxiety Through Movement
I began taking short hikes nearly every day. The more I moved my body, the less I felt trapped in a cycle of monitoring it. When I felt a strange sensation in the house, instead of scanning, I would do 10 squats. On the days when I could not go for a walk, the anxiety returned, so I made daily movement a scheduled priority. Over the next few months, I began to engage with my body in a new way.
My body and I have an evolving relationship. While the symptoms continue, I’ve learned to enjoy the body that carries me through the landscape instead of constantly examining what might be wrong with my version of a woman’s life. On my walks I notice the way my boots grip the trail, the swing of my arms keeping rhythm with my breath, and I let that be enough.