About “The Fifth Decade”

This year approximately 60 million American women will be between the ages of thirty-nine and fifty-three. Most of these women will be perimenopausal. Forty-five percent of this group will be diagnosed with clinical depression, 35 percent for the first time. An even greater number will suffer with low-lying, subclinical depressive symptoms, including sadness, lack of energy and joy. Twice as many women as men suffer from anxiety disorders, and will cost the United States workplace over 31 billion dollars annually. The prevalence of anxiety disorders makes a sharp incline with the onset of perimenopause. Middle aged women are the group most likely to suffer from anxiety.  Depression and anxiety combined contribute to the astronomical number of women suffering emotionally at this time of life. Nearly all of us have someone in our lives who fits these criteria.

Drawing on three decades of experience as a licensed psychologist with an established and successful individual and family clinical practice in the New York metropolitan area, as well as a strong background in child and family research, I have drafted this book as a guide with which to navigate the complex and often overwhelming landscape of changing emotions that are associated with perimenopause. My goal is to help women and their families learn what to expect through each stage of perimenopause and to understand, in lay terms, not simply the range of physical changes that occur but rather how each manifests as a change in a woman’s emotional state, life outlook, daily functioning, and sense of well being.

My intent in writing this book is to provide a new and different perspective than that found in many published perimenopause books, which, having been written by medical doctors, are primarily physiologically based with only a short foray into the psychological. My perspective, as a psychologist, is on the emotional states of women in this period. In providing a comprehensive understanding of the emotional challenges of women in this stage of life, I aim to accomplish for the psychological domain of this subject matter what Dr. Christiane Northrup has done for the medical.

In this book I deliver a comprehensive account of the emotional travails of the forty to fifty plus year old woman. This book goes well beyond the typical ‘perimenopause’ book. I weave together the physiological changes associated with perimenopause and the common emotional stresses that a woman in this phase of life experiences. Now that we know that perimenopause is a ten or more year event in the decade before menopause, women need to gain a much greater understanding of the difficulties in their lives at this time. The forty to fifty year old woman faces the most turbulent hormonal changes since she experienced puberty. Such hormonal changes have an enormous impact, not only on her body and how it functions, but on her emotional state, as well. Simultaneously, she is coping with the loss of her fertility, changing sexuality, aging parents, the emptying of her nest and resulting significant changes in her perspective on herself, her spouse and her self-defined meaningfulness. She is vulnerable to suffering an identity crisis equivalent in magnitude to one experienced in the teenage years. In addition, she will likely have stressful and challenging financial struggles as she manages both college tuitions and preparation for retirement. She is in the process of developing an entire new self as she evolves and redefines herself both physiologically and psychologically.

Last week a forty-one year old woman came in to see me for an appointment. She was on the verge of tears, had not only lost her libido but total desire for intimacy with her husband. Lindsay was also unable to experience the tender feelings for her two teenage sons that had always defined her as a mother. Where their sorrows and accomplishments had always evoked emotion and sense of meaning, now they evoked a sense of being burdened and even apathy. Her tears finally spilled over as she told me how she no longer could find anything that will give her pleasure, including the things she used to love to do. She just did not know who she was anymore. She wanted to hop on a plane to nowhere, but even that seemed a fruitless destination. As I listened to her story spill out, I knew that this book would give Lindsay valuable insight. It is for all of the Lindsay’s that I am writing this book.

What this book offers that other popular books on perimenopause neglect, is the combination and interaction of the physiological, psychosocial and psychological with the emphasis on the psychology of the woman. I offer a basic understanding of the physiology of the hormonal changes in order for the reader to establish a basis for understanding the psychological and emotional changes of this period in a woman’s life.  Part I briefly initiates the reader into the interplay of the physiological and psychological.  Part II gives the reader a profound understanding of the psychological.

I have treated countless women, husbands, couples and teens with troubles caused by the overwhelming emotional challenges the women in their lives confront in this stage of life. The majority will have very limited understanding of the scope of the impact that hormonal and life changes make on women at this time. Many are familiar, in a vague

sense, of ‘perimenopause’, but few are truly knowledgeable. Far too many women think of events related to menopause as being a concern only for those in their late forties or early fifties. More enlightened women, who are familiar with ‘perimenopause’ too often think of it only in terms of hot flashes, night sweats, menstrual changes and some occasional mood swings. The majority of women, including those who are very well informed, are frequently shocked to learn how global the effect hormonal changes can have on depression, anxiety and overall life satisfaction. More importantly, few understand how the interactive effects of life challenges and hormonal events can combine to create additional misery, not just for women, themselves, but for their loved ones, as well.

There is a critical dearth of information in the literature available to both professionals and the public in this area. My aim is to disseminate this insight.  Specifically, women will be enlightened about the psychological impact of perimenopause and the concurrent challenges of the forties and fifties. They will learn how many physiological systems in the body interact with one another and how these affect emotional well-being. They will have the opportunity to understand how all of these changes permeate throughout their families. They will come to an understanding of why this happens and how to manage negative outcomes. The reader’s own experiences will come alive as she follows the case histories of many women and some men as they struggle through similar challenges. The knowledge and understanding of what is happening to women in this phase of life will go far towards enabling women and their families to understand and subsequently cope with these challenges.

A wonderful example of the frustrations that so many men experience is Frank, who was happily married for twenty-eight years to his forty-eight year-old wife. In the throes of hormonal and emotional changes, his wife was miserable and Frank was distraught. In a session with me, Frank, looking helpless, implored of me ‘help me to understand, Doc, I am just a laborer. I don’t know what’s happening to my wife’.  Because of the hardship imposed on the loved ones of the women making this transition, I have included in this book an entire section written for men. This section speaks to the men directly in terms of what they need to know about the difficulties the women in their lives are experiencing and how the men can manage the transition with them in a healthy manner. This important aspect of the overall health of the family, and hence the well being of the transitional women, is unique in my book. The understanding and support of the women’s mates is a necessary component in managing these years optimally.

My psychological training, experience and orientation give me the advantage of being able to integrate the numerous emotional demands that afflict these women during this very trying stage of life. I have chosen to write most of this book before submitting a proposal. This has given me the advantage of allowing the book to evolve as I accrued more knowledge and understanding of this very complex subject matter.  As of this time, I am comfortable that through the extensive medical and psychological research I have completed, coupled with my extensive clinical experience in treating these women and their families, I am sufficiently knowledgeable on this topic to speak to these women, guiding, informing and helping them to manage this very complex transition in their lives.