Navigating the Midlife Maze

By: Joan Starker, M.S.W., Ph.D.

Hot flashes? Mood swings getting you down? Confused about hormone replacement therapy?

You're not alone.

A Natural Transition

Midlife is a natural transition but the changes it brings are rarely neat and tidy. Women feel overwhelmed as they struggle to navigate dramatic changes in almost all areas of their lives. There are no maps to chart the journey. They find themselves asking the same questions they asked as adolescents: Who Am I? What do I want? Where am I going? What is happening to my body? But now they face their own mortality. They know that time is running out.

Losses and Longings

Midlife women may also grieve for a series of painful losses: the death of parents, the end of a long-term relationship, the empty nest, and the loss of youth. This stage of life becomes a time of introspection, soul-searching, and evaluation, with a focus on inner longings, often buried for years. While this is often a difficult stage of life, it can also be viewed as a gift, allowing women to stop and assess their own goals and desires, to resurrect passions and talents long ignored. Women in their 40's and 50's today often have been outer-directed, focusing on the needs of others. Now, perhaps for the first time, they can begin to sort out what they want for themselves.

The Tyranny of Hormones

Even as midlife women cope with profound psychological changes, they are also approaching menopause. The time of intense hormonal upheaval before a woman=s last period is called perimenopause and it may last for years. Often women find that they are strangers in their own bodies, which shift overnight from Apear@ to Aapple-shaped.@ They used to count on their periods like clockwork but suddenly they are unpredictable. Sometimes they are close together, or months can go by without menstrual bleeding. Their periods may be lighter or heavier than ever before. Whereas some women sail through menopause, others experience insomnia, hot flashes, or numerous other symptoms such as bloatedness, hair loss, heart palpitations, short term memory loss, and loss of libido. But often the most troubling issues are the emotional symptoms of depression, anxiety and irritability. Women may wonder if they are clinically depressed and need anti-depressants. Or they may think that the mood swings are caused solely by life stresses and may not link the fluctuations with hormones. They may struggle with the complex, difficult decision as to whether to take hormone replacement therapy, and may feel overwhelmed by the numerous hormonal and non-hormonal options, and costs and benefits of different approaches.

Reaching Out

Women who feel isolated with their midlife concerns may need a safe place to sort out the complex decisions and emotional issues. Counseling and education can help them to understand the enormous physical and psychological changes underway. As they let go of their familiar selves, and find new ways of coping, midlife women can reclaim their lives.

In her private practice, Dr. Joan Starker specializes in midlife and menopause. She is also the Ahealth expert@ for WebMD, answering questions online about menopause. She can be contacted by e-mail at: or at 503-246-7332.