9 Lives | Chapter 5 | Intro: Perimenopause and the Emotional Body

Perimenopause, the transitional phase before menopause, begins when the body starts to run out of eggs, and hormone production begins to sputter as it adjusts to the new reality. As the egg supply dwindles, the need for reproductive hormones decreases, leading to unpredictable fluctuations in levels of estrogen and progesterone and testosterone. Symptoms like irregular periods and mood swings and dozens of other manifestations might occur as the body transitions toward menopause. It’s natural, even if it feels a bit chaotic.

It typically starts in a woman's 40s, though it can begin as early as the mid-30s or as late as the early 50s. It’s not always obvious at first and can easily be confused with stress, as early symptoms like difficulty sleeping or weight changes are often attributed to life's pressures. 

As women approach perimenopause, the realization that their ability to conceive naturally is diminishing brings a wide range of emotions, from relief to anxiety and grief. Research on how women in the West feel about this stage of life reveals a complex mix of feelings as they face the reality of their reproductive window closing. For some women, perimenopause marks a time of relief, especially if they’ve come to terms with their family planning decisions or feel ready to transition into a new phase of life. With the pressure to bear children easing, many women experience a sense of freedom and closure.

However, for others, this transition brings anxiety and sadness. Even if they weren’t actively planning to have more children, the finality of losing the ability to conceive can trigger feelings of loss or regret. Studies show that women who delay childbirth for career or personal reasons often feel a sense of pressure as perimenopause approaches, grappling with what might have been or feeling like they’ve missed opportunities. The uncertainty and urgency of this time can weigh heavily on women, especially when social expectations around motherhood persist.

Western society places a strong emphasis on personal choice, yet the underlying belief that motherhood is a central life goal can add complexity to how women feel during perimenopause. Research indicates that women in their late 30s and early 40s are particularly susceptible to these pressures, as they feel the ticking clock of fertility more acutely. The societal narrative around having children can intensify feelings of regret or inadequacy for women who haven’t had children or who wish they had more. This pressure is often heightened during medical appointments or in social conversations about fertility, which can create a sense of stress as women navigate this stage.

For many, the closing of the reproductive window during perimenopause also brings a profound sense of grief. Women may not only mourn the loss of potential children but also the end of a significant chapter in their lives—the transition from being able to conceive to no longer having that biological capacity. This grief is particularly pronounced for women who have faced fertility struggles, miscarriages, or who had planned to have children but are now confronted with the biological realities of aging. It can be a time of deep reflection on personal choices and circumstances, as women process this pivotal life change.

At the same time, assisted reproductive technology (ART) has provided hope for some women in perimenopause. With the increasing use of ART, such as in vitro fertilization (IVF) or egg freezing, many women see these options as a way to extend their reproductive window. While these technologies offer possibilities, they also come with emotional, financial, and physical demands, and the success rates of fertility treatments for older women remain lower. Women often find themselves weighing the hopeful prospects of ART against the natural aging process, creating a complex decision-making landscape.

Despite these emotional challenges, research also points to a growing sense of empowerment for many women navigating perimenopause in the West. With greater awareness around fertility, reproductive health, and aging, many women are consciously making decisions that align with their personal goals and values. This can lead to a sense of acceptance and relief, especially when women feel supported and informed about their reproductive health. Some women see this stage of life as an opportunity to focus on other aspects of their identity, such as career, personal growth, or relationships. For those who have made peace with their family planning choices, perimenopause can signal a time of freedom, where life becomes less defined by the biological drive to have children.

The experience of perimenopause and the closing of the reproductive window is deeply personal, shaped by cultural expectations, personal circumstances, and individual feelings about motherhood. In the West, women often face a mix of emotions as they navigate this life stage—balancing relief, anxiety, grief, and empowerment. Whether they embrace this transition as a time for renewal or struggle with the finality of fertility loss, it is a moment of profound reflection and transformation.