Puberty and perimenopause, under one roof

What it's like when you and your kids are both going through big hormonal changes.

At a back-to-school pool party for my fifth grader in August, I nearly leaped across the patio to accost a group of moms talking.

“Perimenopause,” I heard. “Puberty,” I heard. “So much crying,” I heard.

I ran up to this group of women — some of whom I knew, some of whom I didn’t — and said, “Can you roll this whole tape back and start over? I need to hear it all.”

More and more moms joined this crowd whispering poolside to commiserate about how hard it is to parent a daughter going through puberty when you yourself are going through perimenopause.

When I asked readers of this newsletter about this experience, I heard from lots of you about how intense this time could be: Tears. Screaming. Existential moments of self-reflection.

Reader Martha, 50, told me about how much she and her daughters (ages 11 and 13) enjoyed watching “Are You There God? It’s Me, Margaret” together — and how it’s just one major source of shared joy (and understanding) she and her daughters have found.

They’ve also bonded over how reliant they are on their friends to navigate a period of big hormonal changes. Martha said she turns to her group chat for advice on every new symptom — something her daughters say mimics the way they talk to their friends about puberty. It’s nice to always have a focus group to text, “Oh my God, this completely bonkers thing is happening to my body — is it maybe happening to yours too?!”

Reader Janine is 44 now, but was 39 when she first started perimenopause while also parenting three tween girls. She worried she had an anger problem, some flaw in her personality. She didn’t understand then that what she was experiencing was a symptom of her hormones changing.

She’s on hormone therapy and anti-anxiety medication now, which she says has made a world of a difference. But she wishes she and her family were more prepared for the impact of perimenopause — and she wants her own daughters to feel better prepared to handle all of this one day.

“How sad that I was going through that time and I didn’t have any information on perimenopause. I didn’t know these were normal symptoms. No one told me, ‘No, you’re not crazy,’” she said.

Given that I have a middle school-aged daughter myself, I also was really thinking that what we need most — in addition to camaraderie — is some really good advice on exactly how best we can parent during this season.

Cue the expert

That’s why I called the person I often refer to among friends as “the only person I trust on the Internet,” Lisa Damour. She’s a clinical psychologist who specializes in adolescent girls, literally wrote the book on how to parent these kids, has a wonderful Instagram account and a podcast with lots of good advice.

Also, if you loved “Inside Out 2” as much as my family did, you have Damour to thank: She consulted on the film to make sure it accurately portrayed the emotional development of adolescent girls.

She actually just discussed this very topic on her podcast, Ask Lisa.

What Damour told me is that puberty and perimenopause are actually just really different experiences — and that it’s important to understand these differences so we can show up better for ourselves and our kids both during this time.

“It’s kind of hormones and it’s kind of not,” she said. “I think it’s probably smart to uncouple the kids’ hormonal experience from the parents’ and not talk about them all in the same breath.”

The ‘brain renovation project’

For kids, it’s not a surge of hormones that makes their mood go haywire, she said. Researchers have used spit tests to measure hormone levels in adolescent girls and compared them to their changing moods. “You actually don’t see a strong correlation between heightened emotionality and high levels of hormones at any given moment,” Damour said.

During puberty, she explained, the brain undergoes a massive surge in development as a result of this new rush of hormones (as we mentioned in our edition on ADHD!), physically changing from back to front. The back of the brain contains the emotion centers and the front is the perspective-maintaining systems.

Teens of all genders are so readily dysregulated not because of hormones levels at any given moment, she said, but because of this “broader brain renovation project that leaves them with a very gawky brain that can become very, very reactive — and it can be hard for them to maintain perspective when they’re upset.”

(In girls, this typically peaks around age 13; in boys, it’s usually around age 15.)

So while your kid might be moody around this age, it’s not just hormones. “One reason to think carefully about talking about hormones and kids is one, it’s a much more nonspecific phenomenon — it’s the brain changing because hormones are driving that,” she said. “And two, it really rubs teenage girls the wrong way when adults are like, ‘Oh you’re acting that way because you’re hormonal.’”

What can be helpful, though, is explaining these neurological developments. All these feelings they’re having are because their body is doing so much work to grow and change — and it won’t be forever. There’s nothing wrong with them; their brains are just going through the hard work of a total remodel. Knowing this can make them feel much less overwhelmed.

And as for what you’re feeling?

Damour reminds us that moods can always be thought of as symptoms, no different than a fever or a cough.

If during perimenopause you’re feeling very emotionally dysregulated or struggling with sleep, “you need to talk to your physician about what can be done,” she said. “There are some really great changes that can be made or interventions that can be utilized so you just don’t have to be in this terrible hormonal soup at home.”

But even then, what you’re experiencing is different from what your child is. Hot flashes may not be fun, but at least your entire body didn’t morph overnight.

“In puberty, they go into it at like 5 foot with no boobs and no period, and then two or three years later, the kid is 5’8” and looks like an adult woman,” Damour reminded. “That is a really, really dramatic transformation, especially in terms of how the world relates to you.”

The best gift you can give your kids

By addressing our own symptoms and taking care of ourselves, Damour said, we can teach our kids a very valuable lesson about healthy coping.

For example, Damour said, if you’re not sleeping well, you might want to:

• Evaluate your caffeine intake

• Talk to your doctor about vasomotor symptoms that are interrupting sleep

• Explore what other emotional factors might be keeping you up at night.

“Talking openly about smart and healthy and adaptive coping choices … is the best gift you could give your kid. The best gift is being pretty boring and managing your own emotions on your own time.”

And to do that well, you have to make sure that you are getting the care you need, too.

‘Change equals stress’

One thing that’s true for both kids going through puberty and their grown-ups going through perimenopause? “Development is inherently challenging,” Damour said. “Change equals stress.”

And this is hard on kids and parents alike.

“Kids do nothing but change and by its nature, having a kid and being a kid are both very, very stressful. I think we are all in a better position if we start with that understanding, as opposed to continuing to guess, ‘Huh why is this always so stressful?’ because then we get stressed about the fact that we are stressed,” Damour said.

She also added that this dynamic is further exacerbated by a parenting industry that insists that if only parents were “to do this right move on this right day, raising kids will be easy. But raising kids is a really challenging thing and that’s the nature of it.”

“The best gift we can give our kid is to be a steady presence at home and to do that, we’re going to have to take really good care of ourselves,” Damour said. “That taking care of ourselves is part of how we care for our families.”

(More!) news about estrogen

Hormone therapy to treat the symptoms of menopause and perimenopause will no longer carry the strongest safety warning, the head of the Food and Drug Administration (FDA) announced Monday. The black box warning will come off all menopause treatments containing estrogen — including pills, patches, spray and creams — where it has been since 2003. The medication will keep some warnings about risks, like all drugs do.

I called Dr. Sharon Malone, chief medical advisor at Alloy Health — a telehealth platform for perimenopause and menopause care — about the news. She said it was a “big day” for women’s health.

“This is something we have been fighting for for years,” she said. “I would dare say it is something that has been a concern since [the black box warning] was first put on in 2003. The reason why that’s important is because it has disadvantaged not only a generation of women, but it also disadvantaged a generation of doctors.”

Malone said she has seen first-hand how much the black box deterred women who were good candidates for these drugs from taking them — and how much the hormones can help many people during perimenopause and menopause.

She noted that she didn’t agree with Dr. Sarah Brenner, the principal deputy FDA commissioner, who thanked the “MAHA movement” for pushing for the change.

“It’s not a MAHA win. This is a win for the women and for the physicians who have been advocating for this for decades,” Malone said. “This is about the scientists, doctors and researchers who have been advocating long before they got here.”

What doctors have the chance to do now, she said, is look at that information about hormone therapy and feel empowered to prescribe it when appropriate.

“I will say what I have been saying for 23 years, which is for women who are symptomatic — and that’s 80 percent of women — there is nothing more effective for the treatment of menopausal symptoms than hormone therapy, period,” Malone said. “I don’t want fear to be the reason that women suffer.”

(Doctors’ level of caution about use of the hormone varies, and it can depend on the symptoms and the patient. I wrote more about the warning and the debate here.)

I almost forgot

Last week I was fortunate enough to attend an event in D.C. with a bunch of wonderful women who author newsletters and host podcasts — an amazing and inspiring bunch. One of the fantastic people I got to meet was Debra Whitman, chief public policy officer at AARP and the author of the book “The Second Fifty: Answers to the 7 Big Questions of Midlife and Beyond.”

Whitman, an economist by training, spoke to our group about her work and research — and shared a few things that really left me feeling very hopeful. While I know I’m often here in this newsletter telling you, “We don’t know much,” Whitman had some great evidence-based things to share that we do know right now that I wanted to pass on to you all.

First, the rate of dementia in women is on the decline. Exact details of why this is are still being investigated, but it is definitely true that women are suffering from dementia at lower rates than in the past.

Also, Whitman shared five (easy! free!) healthy habits we can all do to extend our life expectancy by another 14 years on average:

1. Exercising regularly

2. Eating a healthy diet

3. Maintaining a healthy weight

4. Abstaining from smoking

5. Consuming little to no alcohol.

(Any one of these habits done in isolation will increase your life expectancy by two years.)

I found this information to be really empowering — and exciting. I hope you do, too!