“Behold, I am doing a new thing; now it springs forth, do you not perceive it?” (Isaiah 43:19)

I’ve been a Natural Family Planning (NFP) instructor for over a decade, working with women and couples through many different stages of reproductive life. By far the most complicated and varied experiences I have seen with my clients are the years of perimenopause.

The one thing they all have in common is the great desire to know that we are not alone in this experience– to have someone (even an NFP instructor who has not yet gone through menopause!) tell them: “You are not crazy. These symptoms are real.” 

You can understand where they may feel alone or crazy. Fewer than ⅓ of OB/GYNs in the United States had a formal menopause curriculum as part of their residency training.

So, here I sit, as an NFP instructor, trying to help my client make sense of her charts, when all the doctor can think to offer is a hysterectomy or birth control. And that’s just the tip of the iceberg!

Women undergoing the menopausal transition are caught up in a busy time of life: kids, careers, aging parents, tending to our own health … it’s a lot!

What I’d like to offer here is a quick overview of perimenopause, common symptoms and changes, and how we might navigate perimenopause more positively in both our work and our spiritual life.

What Is Perimenopause?

The term “perimenopause” describes the transitional phase surrounding menopause. Technically, menopause is the end of a woman’s cycling years, determined by the absence of vaginal bleeding or spotting for one year.

But much like the tumultuous years of puberty, menopause is not simply a single event. It is a years-long process that involves the gradual breakdown of communication between the ovaries and the brain (the HPO axis) that previously regulated a woman’s menstrual cycles.

The term “perimenopause,” therefore, captures not just the time of menopause itself but also the many stages of transition that occur prior to and even following a woman’s final menstrual period. The prefix “peri” means “around” and allows us to speak meaningfully about this entire period in a woman’s life.

Many doctors will still use terms like “menopause,” “pre-menopause,” or “the menopause transition” to refer to this time, and in popular parlance, we most often hear of someone “going through menopause.” The terms are not important in and of themselves as long as women (and men!) understand that we are referring to an extended period of time, often spanning as long as eight to 10 years, during which women’s bodies undergo many different stages of transition.

Common Symptoms

So, what can we expect during this prolonged transition? In general, we experience symptoms related to two primary shifts in estrogen and progesterone. Estrogen is the dominant hormone prior to ovulation, and progesterone is the dominant ovarian hormone after ovulation.

The first perimenopause change is an overall decrease in both estrogen and progesterone, which can lead to hot flashes, vaginal dryness, insomnia, and more. 

The second change is in the ratio of estrogen to progesterone, which significantly increases in perimenopause. Individual levels vary a lot, but in regular cycling situations, women generally make about 100 times more progesterone (about 20 nanograms/mL) than estrogen (about 200 picograms/mL).

In perimenopause, though, estrogen can sometimes have dramatic surges that tip those numbers higher, while progesterone remains low. In some ways, this change actually mirrors the process of puberty, when girls typically have higher estrogen-to-progesterone ratios as well. This means perimenopause can cause the resurgence of similar symptoms, including heavier bleeding, more painful cramps, PMS, and hormone-related headaches.

Other common symptoms associated with these changes are irregular cycles, brain fog, irritability, weight gain (especially around the midsection), decreased libido, and even heart palpitations. Of course, women should be careful not to automatically assume that all changes are directly related to perimenopause, since a lot of other health issues can pop up during this time; make sure that you mention all of your symptoms with your health care provider.

Additionally, remember that “common” is not the same as normal! Cycle variability and discomfort around these shifts can be perfectly normal, but anything that interferes with your ability to function deserves attention—and Catholic women are permitted to use hormone replacement therapy for medical reasons! There are many options for treatments and supplementation, some of which can be applied in a cooperative way with your menstrual cycle rather than overriding it. So, be sure you are honest with your doctor about your concerns and know that if you ever feel that those concerns are not heard or respected, you have the right to switch providers!

If you’re not sure where to start with finding a new doctor, you may want to consider: 

• Finding a telehealth Catholic physician through MyCatholicDoctor.

• Looking for a NAMS (North American Menopause Society)-certified practitioner.

• Seeking a physician who takes a restorative reproductive medical approach.

• Finding a NaProTECHNOLOGY provider.

Navigating Perimenopause While Working

So, how do we navigate these changes, which effectively add up to going through puberty all over again?

With cycle irregularities and heavier bleeds, I highly recommend that women entering perimenopause get more intentional about packing “period kids” again! It’s something I teach families to do as preparation for a girl’s first period, but it’s often a habit we fall out of when we become more familiar with our cycles.

Take this as your invitation to buy a cute little pouch (now that you probably can afford more than a little pencil case!), and stash it with all the supplies you’d want to have handy:

• An extra pair of underwear.

• Your choice of menstrual products.

• Wet wipes.

• Stain remover pens.

• Medications.

• Heat pads (or a TENS unit for stubborn cramps!).

• Herbal tea packets.

• And, of course, as much dark chocolate as you want!

Other quick tips for navigating common perimenopause symptoms include:

• Dress in layers, with a nice sleeveless (or flutter sleeve) blouse as your base. If a hot flash hits, you’ll be able to remove layers temporarily and can always put them back on once the moment has passed.

• Be creative with memory aids, for whenever brain fog leaves you befuddled. Prior to an important meeting, have a nice notebook prepped with a list of keywords that you absolutely cannot blank on during your presentation. Consider keeping physical calendars or task lists, since the act of writing something down is better for memory than typing.

• After you have eaten, use your lunch break for walking/exercise and other calming activities like deep breathing, prayer, or journaling. These simple additions can help decrease anxiety, lower cortisol levels, and improve mood.

Embrace the Transition

When I survey women prior to my perimenopause presentations, about 60% of them say that they have a mix of positive and negative emotions when they think about menopause. Even though many of them are somewhat eager for their cycles to stop, there is also a sense of worry about what that transition may mean.

Women worry about suffering through all of the symptoms of perimenopause, but they also worry that going through menopause marks a time when women are no longer considered “productive” in society—that, somehow, the end of our reproductive years will also bring a demise to our career, a demotion in the eyes of our peers, or even the loss of our own sense of self-worth as we come to terms with this next phase of life in our female body.

This is an area where I think our Catholic faith can be particularly helpful, because it is a place where we are always asked to encounter transition as a threshold of hope: an invitation from God to pass from one phase to the next. Even in this sentence, you can hear familiar elements of salvation history, like the Angel of Death passing over the Israelites in Egypt (Exodus 12:13).

Christ passed from life into death and death back into life—a parallel that was solidified in the early Church through Christ’s identity as our Passover lamb. In Baptism, we undergo this same crossing over from death into life.

In short, transitions can always be a place of deep encounter with God. 

So, I encourage women (and couples!) to mourn the passing of one stage into the next—but to always remember that God has designed every aspect of life to be good and to lead us to holiness.

Many women discover that menopause is actually a time of deep renewal in their life, and they find energy, excitement, and creativity in new hobbies. In some ways, entering this time “beyond cycles” is a hearkening back to our childhood days, before cycles began. With that transition comes an opportunity to think again about being childlike in the presence of God (Matthew 19:14), adding a new layer to our understanding of God’s image springing forth in us.

Christina Valenzuela is the owner and creative director of Pearl & Thistle, LLC, where she offers a unique blend of theology and science to bring better body literacy to Catholics. She has been a certified instructor in the Boston Cross Check™ method of Natural Family Planning since 2013 and offers cycle education from puberty through menopause. She holds an undergraduate degree in Philosophy and Theology from the University of Notre Dame as well as a Master’s in Theological Studies from Harvard Divinity School. Christina is a life-professed member of the Lay Fraternities of St. Dominic and resides with her husband and four children outside of Boston. Her latest book is titled The Language of Your Body: Embracing God's Design for Your Cycle (OSV, 2024).