Maybe it’s more than hormones?
For decades, research on any type of women’s health problems was limited to pregnancy and childbirth. To put it into context, women were not even required to be included in medical research in the United States until the 1990’s. That’s horrific. There is no question that the growing awareness of menopause and perimenopause has been a positive development. For too long, women's health concerns were dismissed, minimised, or ignored altogether. Many women spent years struggling with symptoms that affected their sleep, mood, relationships and quality of life without being offered appropriate support or treatment.
The renewed focus on hormone replacement therapy (HRT) and menopausal health is long overdue. For some women, it has been transformative.
But somewhere along the way, a new problem has emerged.
Increasingly, it seems that every challenge faced by a middle-aged woman is being viewed through a hormonal lens. Tired? Perimenopause. Irritable? Perimenopause. Unhappy in your relationship? Perimenopause. Questioning your career? Perimenopause. Struggling with the pressures of modern life? Perimenopause.
The explanation is attractive because it is simple. Human beings like simple explanations. They provide certainty and a clear path to action. But this is simple reductionism, because life is rarely that straightforward. In my work as a licenced therapist, I have the extraordinary privilege of listening to dozens of people of all ages—many are women in the perimenopausal age—but there are certain commonalities across the board, regardless of age, gender, or any other defining factor. We all carry a load of some kind, as this is the experience of being human. But it is only middle-aged women that seem to be told by the people around them, that their problems are in fact, biological.
Many women in their forties and fifties are carrying extraordinary loads. We are managing careers, supporting children, caring for ageing parents, navigating financial pressures, maintaining households and trying to preserve (or find for the first time) some semblance of our own identity in the process. We may be facing divorce, loneliness, grief, burnout or the cumulative impact of years of putting other people's needs ahead of their own. Children may be now independent, or almost there, so we have time to sit back and assess: are we heading where we really want to go? What is the health of our personal relationships really like? Against that backdrop, is it really surprising that some women feel exhausted, overwhelmed or dissatisfied?
The danger is that by attributing every struggle to hormones, we risk overlooking the broader context of women's lives. We risk treating a perfectly understandable response to difficult circumstances as if it were primarily a biological problem requiring a biological solution.
We also risk repeating a pattern that has followed women throughout history.
For generations, women's emotional responses were explained away through our reproductive biology. We had "hysteria", "female troubles" and countless variations of the idea that women were somehow governed by their hormones in ways that made their experiences less rational or less credible. Terrible things happened to women that would now be unthinkable.
The language has changed, but the instinct remains remarkably familiar.
Today, a woman expressing frustration with an unequal relationship may be told she is experiencing perimenopause. A woman questioning the fairness of expectations placed upon her may be told to have her hormones checked. A woman who has finally reached a point where she is unwilling to tolerate poor behaviour from others may find her perfectly reasonable boundaries reframed as hormonal irritability.
Sometimes I wonder how differently we would interpret the exact same symptoms if they occurred in males. If a 50-year-old man became increasingly dissatisfied with his job, would we assume it was a hormone problem? If he became less willing to tolerate being taken advantage of, would we describe him as biologically reactive? If he felt exhausted after years of work, family responsibilities and financial pressure, would our first thought be that his body was malfunctioning? Or would we look at his circumstances and conclude that perhaps his life had become difficult?
The answer reveals something important about the way we continue to understand women's experiences. None of this is an argument against HRT. Nor is it a suggestion that perimenopause is insignificant. For many women, hormonal changes are real, substantial and distressing. Hot flushes, sleep disturbance, night sweats and cognitive changes can have a profound impact on daily life. Women experiencing these symptoms deserve access to evidence-based care and informed medical support.
The problem arises when we allow one explanation to crowd out all others. When a woman is struggling, the most helpful question is not always, "Could this be hormones?" but rather, "What is happening in her life?" Sometimes the answer will be hormones, and sometimes it will be a difficult marriage, workplace stress, loneliness, caregiving responsibilities, grief, financial hardship or simple exhaustion. And sometimes it will be all of those things at once.
The challenge is resisting the temptation to reduce complexity to a single cause. Everybody deserves to have their lives viewed in full context. Not every emotion, symptom, frustration or dissatisfaction is because of changing hormones. Sometimes she is struggling because life is hard.
Recognising that possibility does not diminish the importance of perimenopause. If anything, it honours women by acknowledging what we have always known: that our experiences are shaped not only by our biology, but by the realities of the lives we are living.
Kathryn Wright
Rural Mental Health Clinician/Educator
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