E121: The Spiritual Domain of Perimenopause

Kirtly: Can a hot flush be a spiritual experience? If you call it a hot flash instead of a flush, does it make it feel more spiritual? And what do you do when you can't find a word? When your brain, that was your best friend, doesn't work the same? Is it telling you to slow down?

I'm Dr. Kirtly Jones from Obstetrics and Gynecology at the University of Utah, and we have been working through the 7 Domains of Perimenopause. And in this session, we're going to think about the spiritual domain.

With me is my co-host, Katie Ward. Katie is a professor in the School of Nursing, has a practice in midlife women's health, and has a PhD in anthropology.

I'm a reproductive endocrinologist. We both have spent our careers thinking about women's hormones, how to start them, how to stop them, how they grow the body and wire the brain, and we're always trying to bring the science to our "7 Domains of Women's Health."

Today, we'll be talking about how brain wiring changes through four important developmental steps in women's lives. And of course, some of these steps happen to men, but in the spiritual domain, we'll have to drift away from what we think we've learned through the scientific method and lean in a little to what we've experienced and what our patients have taught us.

So if you've been listening over the past years to the "7 Domains" topics Katie and I have done together, you'll know that Katie is often conflicted . . . and that's my word, not hers. I'm not sure what the word is. Uncomfortable or different for me . . . with the spiritual domains topics. And me, I am all in.

So, Katie, what word would you use? Tell me about it.

Katie: Well, I think my hot take, in a nutshell . . . And if you want a longer version, you can go back and listen to our Spiritual Domain of Risk episode because I think I talked about it a lot there. Maybe it's the anthropologist in me, but I'm fascinated that, as a species, we've been using symbolism for tens of thousands, maybe hundreds of thousands of years. You can see it going back to the Neanderthals even, and other kinds of humans that were just a little different from us, Homo sapiens.

And so this goes way back, that we had symbolism, and with symbolism came storytelling and meaning-making. I mean, I really do think that we are a meaning-making species, and it's one of the oldest things that we do. I'm fascinated by that and curious about all of it. I think where I might be conflicted is being able to believe in any one of them.

Kirtly: Right.

Katie: So I'm a skeptic about everything, but the through line is that I'm fascinated by the fact that, as a species, we all do it.

Kirtly: We do. And thinking again a little about the power of stories in neurodevelopmental genesis, and I'll talk more about this later, is that the stories that we hear over and over, from the time we're littles, to adolescents, to pregnant women, they wire our brain for the way we perceive what we're going through, whether it's got a religious or spiritual bent or a cultural bent.

And I think that's okay because it's the way we are wired. When our brains are rewiring, we are open to ideas. And if the ideas or stories are cultural, then that's who we are.

But the current cultural spiritual framework that I'm hearing at least, maybe it's my newsfeed or "The New York Times," which is all over it, about perimenopause, it's pretty negative. And except for tigers and lions being dangerous, I don't like dangerous stories because they rewire my brain.

So let's talk a little bit about the developmental stages that wire up the brain and rewire the brain, and opportunities to grow in our inner life.

In childhood, toddlerdom, the brain grows very quickly, 0 to 3, in the first couple years of life, and then begins, at 3 or 4, pruning back pathways that aren't used. So it made lots of neurons and lots of pathways, and then it can't use everything. It was preparing for every possible possibility that there could be.

But then these transformative types are molded by the environment, and it's a critical time for the development of language, empathy, self-confidence. Children with supportive parents of all kinds, in supportive environments, have a brain that will work for them as they grow and function as little humans with emotional intelligence. And kids who have traumatic experiences in those first three years wire their brains a little differently.

And there's some data that people who had more adverse childhood experiences, and we've talked about that, ACEs, have a much more difficult menopausal experience.

Wiring your brain for trauma when you're young rewires your brain to make it more reactive to trauma later. So how we respond to a situation that we're in when we're rewiring our brain is important.

Now, in adolescence, we're rewired for sex and attachment and powerful emotions, and the brain undergoes remodeling again. We lose some areas, and we build up some others, the loss of gray matter in some areas, with subsequent growth in others.

And the spiritual domain consequence of this attachment can be a strong spiritual attachment or a change in spiritual foundation. So you see young people who might be at a spiritual revival who are almost ecstatic in their sense of connection with their God or worship. It's part of their adolescent brain to be so connected.

Katie: Or rave.

Kirtly: Or go to a rave. It's the way the adolescent brain works, and with the brain rewiring comes the resulting formation of identity. So the stories you're being told as adolescents help wire your brain.

I think stories or cultural experiences which improve your sense of feeling of community and helping others as adolescents help you maybe do that later.

And in pregnancy, rewiring for attachment and social bonding happens again. So there's some loss of neurons in some areas, and afterwards there's build-up in others. So there's making room for social bonding and for attachment to your baby.

Some small amounts of the brain are pruned back with new growth in areas that provide opportunity for identity, like parenting, motherhood, and feelings that you're a part of something profound and bigger than you.

And there's some new data. I just saw this on national TV, so I haven't read the stuff myself, but the woman that was being interviewed, I've read her stuff. I've read her research. The data that men who are closely involved in caring for children have a shift in their brain structure for parenting and attachment, as well as a change in their hormones to look a little bit more like women.

So this business that in important times of our lives, our brains remodel, and it's good for us, but the stories we're told at the time from the environment in which we find ourselves kind of predict the modeling that we're going to be experiencing.

Katie:Right.

Kirtly:So at perimenopause, some rewiring . . . And this is new. There's some rewiring with brain changes. Not in all women. Again, this is new research, and knowing who experiences this. Is it more women with hot flushes who experience this? Do people who are on hormones during this transition experience it? So when faced with these changes in your brain, how do you respond?

Katie: I mean, I think there are changes. And we've talked about this, I think, probably a long time ago when we were talking about menopause, but in the perimenopause . . . And again, I think it's good to look back at those other times of change because we do see that there are windows of vulnerability for reacting to change, whether that's a positive experience or a negative experience. It's a little bit shaped by what's happened to you in the past.

Kirtly:Yes.

Katie:And so I think we see more prediction based on if women have had a lot of issues with PMS or PMDD or postpartum depression. Those shifts in hormones, in that time when the brain is changing, then perimenopause is also a really challenging experience.

There are some ways to predict maybe who might have a more challenging experience than another, but then it also is happening in this sort of soup of social media and contemporary voices in the moment. But I think there are many ways to adapt to these changes.

There are women . . . I see people that are really struggling and suffering, and people who are not. You mentioned slowing down, and I sped up about as fast as I could possibly speed up in my perimenopause.

Kirtly: I don't mean slow down in life, but slow down for that minute. Slow down for a minute, and say, "What's happening? How am I going to choose to respond to this right now? What am I doing with this information?" And maybe it'll mean that this is an important part of my life, and I'm going to jazz it all up again, but at that minute when you're feeling different . . .

Katie: Well, it was a slow-down minute. I would spend a lot of time jogging and thinking to myself, "What am I going to do next?" And so I think that's where I said sped up, is when I started thinking, "Well, what am I going to do next? I am going to go back to school and take on some big responsibilities at work, and big physical challenges, and get in the best shape of my life, and run marathons."

I was right at that stage, and I had just gotten divorced, which may or may not have been part of the perimenopause, but I started just taking things on in a big way, and I'm still doing that.

Kirtly: Right. Well, I want to talk about transformative neurogenesis. And when I thought of this while I was working on this podcast, I thought I had invented this phrase for this podcast. I was patting myself on the back. I thought, "Oh, Kirtly, you are so great with words, and this is a perfect idea, transformative neurogenesis." And then I plugged it into my Google search, and it popped up as someone else. So I didn't invent it. I just thought I did. And that's the problem with memory.

So it's what happens when there is an event that changes the brain and provides for growth in new areas.

The research about the changing brain in perimenopause is new, and it doesn't happen to everyone. I actually wonder about my own brain, which was exposed to low-dose birth control pills throughout my entire perimenopausal period until I stopped in my mid-50s, and my menopause happened at that time.

I concurrently had a serious acute medical event, and I was surrounded by care from my medical and professional community. I felt so loved as I was in the hospital. I felt like I was a queen bee, surrounded by everybody taking care of me, and the love of my family. I felt fortunate and blessed.

I spent some emotional and cognitive time thinking about what things I wanted to do in the next 10 years, who I wanted to become. And I would have, should have, thought about becoming in the best shape of my life, Katie, but I didn't. I thought about ruling my academic world.

But it was an event that happened at the time that my hormones were changing, and maybe it would have happened anyway. I'm a glass-half-full kind of person, if you haven't figured that out.

I thought this was a fantastic opportunity for me to become the next stage in my life. And that means I didn't want to look . . . well, I never really wanted to look like someone that men would look at. That was never something I aspired to. But I just thought, "I'm going to get status here. I'm going to be a woman of a certain age."

So thinking about the opportunity for transformative neurogenesis, what do you bathe your mind in during this time for potential rewiring? Is your brain bathed in anger or disappointment or irritability? And maybe that's not your fault because you're surrounded by people, elders, and adolescents who are doing their own rocking and rolling.

Is it being rewired for disappointment? And I'd say in social media and even op-ed pieces in "The New York Times" say how badly women are treated, and then you start feeling badly. And I get that. I have concerns about how social media and the press have framed this time so negatively. A process that almost every woman that ever was went through, mostly quietly, has now become a thing, a moment for careful cultural inspection, and not, I think, in a good way.

A phrase attributed to the psychiatrist Viktor Frankl, but may not have been him, comes to mind when I think about the events of perimenopause and hot flushes. "Between the stimulus and the response, there is a space. And in that space is our power to choose our response. And in our response is our growth and our freedom."

So from the minute of the hot flush, the recognition of the hot flush, and you're taking off a couple layers of clothing, you can either get totally ticked off, which I would, I guess, you can get angry, you can be frustrated, or you can say, "Well, this is interesting."

How might we achieve the opportunity to slow down as an opportunity for personal and spiritual growth? I don't mean slowing down your life, but for a minute or two or something, when this happens every day, how do you in your workplace or your family . . .

I might say, "Can you give me a moment to collect my thoughts?" How do you collect your thoughts and frame what you're going to do about it? How are you feeling right now? Where do you want to be?

So tell me if I'm crazy, Katie, but that was the way that I tried to frame it as I got old enough to be responsible for my behavior, which people say that's maturation, being responsible for my behavior. I would try to take that little time and frame how I was going to respond.

Katie: Yeah. When I just was thinking, for me, it was an exercise meditation, right? So I was in that stage. Like you, I was not having hot flashes because I'd sort of planned my perimenopause. Long before I was perimenopausal, I had decided that I was going to get through this period of time by being on birth control pills and just ignore it. So I wasn't suffering terribly from hot flashes.

But I was still perimenopausal with a lot of the things that are going on, as far as I still had some other physical symptoms. I mentioned that I've had palpitations, but I was also in that space where I knew.

And I think that that's the thing about the perimenopause, is you're on the cusp of some change and you can kind of see it coming. You know that your reproductive years are ending, and you're going to be in this new state of menopause. And you're vulnerable to all the things anybody wants to sell you to try and slow it down.

But that was my reaction to it. As I was running, it was to just ponder. It's like, "Okay, I have one big change left in me, and if I could be anything I wanted to be, if I could have been anything I wanted to be, what would I have done?" And I landed on anthropology and went back to school at age 50, right at my menopause.

Kirtly: All the years I knew you, between . . . not quite 17, but between 17 and 50, you were raising children and rapidly expanding your credentials and your personal credentials. So you were full-on. Not currently what you are now, you're doing even better, but I don't know how you would have had a moment to do that before you turned 50.

Katie: It's true. And it coincided with my daughter going to college and all of the things about being in that time of life that made me say, "Well, now what am I going to do with this?"

As we were getting ready for this episode, I was thinking about Erikson's stages of change, which is another developmental psychology kind of approach. Not so much spiritual, but I'm going to bring it into spiritual in just a second.

And I won't go through all of them because we're talking about perimenopause, but the stage of change around perimenopause was this idea of generativity versus stagnation, or sometimes called self-absorption.

So that was sort of his framework for this kind of task that one needs to resolve around this time of life. And the idea was one side of this was a little bit more healthy way to resolve this, and that was to become generative.

I know that that sort of implies that you're giving and giving and giving, and maybe that is what people start doing at this point, is you're constantly giving. Part of that has to do with having grandchildren, and it's hard to avoid if you're a grandparent.

But I think the converse of that, the other side of that task of stagnation or self-absorption, was actually Erikson . . . one of his words about it really fits with what I'm seeing happen that you just mentioned around social media and marketing, is people are becoming really self-absorbed.

And this perimenopause moment that we're experiencing, asking us to not just treat our symptoms, but optimize ourselves, and measure and monitor and adjust and work at it, count our steps, count our macros, optimize our sleep, and worry about our hormone levels, I think it almost forces people into a kind of self-absorption that becomes stagnation.

Kirtly: Oh, I completely agree.

Katie: The main task of this stage of life is getting co-opted by people trying to make money off of our anxiety there.

So how does this fit with spirituality? Well, back to my little spirituality, or spirituality in any form, that is a way to orient yourself outward, to orient yourself on something beyond yourself. And I think that that's really the way to get to the generativity resolution of this phase of life, is to not be so oriented on optimizing self, but a little bit more oriented on something greater than yourself, whether that's spiritual, family, work, beauty, poetry, or any sort of anything that's connecting you to something bigger than just your own symptoms.

That's one of my concerns in this moment, is people are just so busy optimizing that they're missing the bigger picture.

Kirtly: Well, I don't want to take away at all from how distressing perimenopausal symptoms can be, because there can be unpredictable bleeding that can really ruin your dress and your life in the middle of what you're trying to get done, or unpredictable hot flushes, which keep you from sleeping. There are some very good treatments for that of different kinds, and not all hormones.

I think, Katie, in my experience in caring for women through this time and thinking and researching . . . I did my whole fellowship on new drugs for hot flushes, so researching the events and treatments that have shaped how we think about it. And we've learned from our patients.

Each woman will experience this normal biological phenomenon called perimenopause a little differently. And their biological and physical makeup and social makeup will partly frame their response, but it isn't the only way to frame the response. We can do so much to help women with some of the difficult physical events of this necessary transition, but it's time for each of us to find ourselves in a new way.

So we've been thinking about this as person-to-person, Katie and me, and about carers for women and carers from my family, and now my nieces, and the people I know who are making this transition with either more or less acceptance and grace. But we've been working through the 7 Domains of Perimenopause, and if this is your first episode, you may want to see our other domains in this important time of women's lives.

You can get our other podcasts in the "7 Domains of Women's Health" series wherever you get your podcasts, or at womens7.com.

Thanks for listening, and take a little moment and see who you want to become.

We will finish out this 7 Domains of the Perimenopause with a little haiku.

You have a new brain.
Not sure if you really like it?
You will bloom anew.