Glossary
The medical words that come up around perimenopause and the nervous system, explained the way a friend would explain them.
Each word has a plain-language explanation. If you need the clinical version (to take to a doctor or to google further), it's underneath.
The flatness around pleasure. The food is the right food and it doesn't taste like anything. The bath is the right temperature and you're just sitting in water. It's a state, not a personality. It can lift.
Reduced ability to experience pleasure. A core symptom of major depressive disorder, but also occurs as a stand-alone state in chronic stress and perimenopause.
Related: dopamine, interoception
also: ANS
The part of your nervous system that runs without you thinking about it. It has two settings: revved up (fight or flight) and settled down (rest and recover). Most women in midlife are stuck in revved up.
The branch of the peripheral nervous system regulating involuntary functions, with sympathetic and parasympathetic divisions in dynamic balance.
Related: vagus nerve
The stress hormone. Useful in short bursts, exhausting in long ones. Years of running hot leave it dysregulated, which shows up as 4am wake-ups, flat afternoons, anxiety with no clear cause.
Glucocorticoid produced by the adrenal cortex. Follows a diurnal rhythm; chronic stress flattens or inverts it.
Related: autonomic nervous system
The feeling of watching yourself from a distance, or of the world feeling unreal. In mild forms, it's the zoning out that happens on autopilot. Clinical dissociation usually traces to trauma, has specific features like lost time, and warrants professional support.
A disruption in the normal integration of consciousness, memory, or sense of identity. Dissociative experiences exist on a spectrum. Clinically significant dissociation is usually trauma-related.
Related: perimenopause
Not the pleasure chemical, despite what you've read. It's the wanting chemical. The reaching toward. When dopamine signalling thins out (chronic stress, perimenopause), you can still know what you used to want, but the reaching-toward feels effortful.
Catecholamine neurotransmitter. Modulates reward prediction, motivation, and motor control. Estrogen modulates striatal dopamine.
The main female hormone. It does a lot more than reproduction: it shapes mood, sleep, skin, joints, brain chemistry, sex drive, the works. In perimenopause it doesn't just go down; it swings around erratically before it goes down.
Steroid hormone, primarily 17β-estradiol in reproductive years. Modulates serotonin, norepinephrine, and dopamine signalling.
Related: perimenopause, progesterone, hormone therapy
A brain chemical that quiets things down. When GABA is doing its job, your nervous system can settle. Progesterone helps your brain make use of GABA, which is one reason that, as progesterone drops in perimenopause, things start to feel less settled.
Gamma-aminobutyric acid, the primary inhibitory neurotransmitter in the central nervous system. Allopregnanolone, a metabolite of progesterone, is a positive allosteric modulator of GABA-A receptors.
Related: progesterone, autonomic nervous system
also: HRT, MHT
Replacing some of the estrogen and progesterone that perimenopause has taken away. Modern hormone therapy is well-tolerated for most women, and the framing that it's only for hot flushes is out of date. It's a clinical conversation, not a lifestyle choice.
Menopausal hormone therapy (MHT), formerly hormone replacement therapy (HRT). Modern protocols typically use transdermal estradiol plus oral micronised progesterone. Risks and benefits are individualised.
Related: estrogen, progesterone
Having your own interior life, separate from the people around you. In long relationships, the woman who has spent years anticipating and accommodating others can lose this. Desire and closeness both need it back.
Used by Esther Perel and others to describe the maintenance of a distinct sense of self within a relationship. Erosion of individuation is associated with loss of desire and emotional disconnection.
Related: interoception
Your body's sensing of itself from the inside. Knowing you're hungry, tired, cold, anxious, calm. When this gets quiet, you stop being able to feel pleasure or read your own warning signs. It can be retrained.
The neural process by which the brain represents internal bodily states. Largely mediated by the insular cortex.
Related: vagus nerve, anhedonia
The point twelve months after your last period. Before that point you're in perimenopause. After that point you're post-menopausal. The age varies; the average is around 51.
Defined retrospectively as 12 consecutive months of amenorrhea in the absence of other causes.
Related: perimenopause
The years before periods stop, when hormones swing around. Most women hit it sometime in their 40s. Cycles get strange, sleep gets bad, mood shifts. It can last anywhere from two to ten years before it ends in menopause.
The transition phase before menopause, marked by fluctuating estrogen and progesterone. Diagnosed clinically by symptom pattern; bloodwork is rarely conclusive because levels swing day to day.
Related: menopause, estrogen, progesterone
The other main female hormone. It calms, helps sleep, balances out estrogen. It tends to drop earlier in perimenopause than estrogen does, which is why sleep often goes first.
Steroid hormone produced primarily by the corpus luteum and adrenals. Has GABAergic metabolites (notably allopregnanolone) that influence anxiety and sleep.
Related: estrogen, perimenopause, hormone therapy
Wanting sex after the warming-up has started, not before. You don't feel like it. You start, and then somewhere a few minutes in, the wanting shows up. Most women in long relationships work this way. It's normal, not broken.
A model of sexual desire described by Rosemary Basson and others, in which desire follows arousal rather than preceding it. Distinct from spontaneous desire.
Related: spontaneous desire
Wanting sex out of nowhere, before anything has started. Common in early relationships and in younger bodies. Less common in long partnerships and in midlife. Not the only valid kind of desire, despite what films and porn imply.
Related: responsive desire
The longest nerve in the body, running from the brain down to the gut. It's the main wire that brings the body out of fight-or-flight and into rest. Slow breathing, especially long exhales, is the simplest way to tone it.
The tenth cranial nerve. Mediates parasympathetic input to the heart, lungs, and digestive tract. Vagal tone correlates with heart rate variability.
Related: autonomic nervous system
The medical word for hot flushes and night sweats. The blood vessels open suddenly, you feel hot, you might sweat or flush. They can be wildly disruptive in perimenopause and respond well to hormone therapy.
Episodes of perceived heat, flushing, and sweating triggered by central thermoregulatory dysfunction during the menopausal transition.
Related: perimenopause, hormone therapy
The range of activation your body can hold without tipping into panic or shutdown. Inside the window you can think and choose. Outside it you react. Sleep, hormones, and stress all change how wide the window is. Perimenopause shrinks it.
A concept introduced by Dan Siegel describing the optimal arousal zone for emotional regulation. Below the window: hypoarousal/freeze. Above: hyperarousal/fight-or-flight. Trauma and chronic stress narrow the window over time.
Related: autonomic nervous system, vagus nerve, cortisol
The blog uses plain language by default. When a clinical word does come up, it links here.