Not My Mother’s Menopause- Chapter Five

Chapter 5

My Asylum

“What’s wrong with me?” I ask quietly in the middle of the night. He doesn’t say anything in response. When I check the clock, the digital display shows that it’s 3:05 a.m.

My heart is racing as I look at the free blood pressure app I downloaded on my phone a few days before. Everything appears to be normal; however, the app was free. 

All of these thoughts race through my mind, causing me to become even more anxious: Should I pay for the upgrade? Is it not functioning properly? Maybe if I pay for the upgrade, I’ll get a better version, which will reveal the truth. I’m going to die right here on this couch in my family room, four hours before I have to wake my youngest daughter for school. 

“I don’t know who I am anymore,” I confess quietly to him. 

“You’re still you. You’re going through a really difficult time,” he says half-heartedly. 

He rubs my back because he knows I’m onto him.  

I take another look at the clock. It says 3:10. 

“Would you hold my hand and lie with me?” I ask.

“Of course.” 


In February of 2020, my friend Kristen shared with me a piece titled “Pause” written by Mary Ruefle on her perimenopause experience. As I read this essay, I was taken aback. Another female was telling a story about her symptoms, which were almost identical to mine: days spent crying, thoughts of walking myself into the sharp end of a butcher knife, and feeling like a shadow of the person I used to be. I was overwhelmed with shame because I assumed what I was going through was unique to me.

Then, I read this in Mary’s piece: 

“If you take the time to peruse the annals of any nineteenth-century asylum, as I have, you discover that the “cause of admittance” for all women over forty is listed as “change of life.” 

For the uninitiated, an asylum was a facility for people suffering from mental illness. 

When society failed to recognize how to support these women’s mental health needs during perimenopause, they were institutionalized-admitted to mental health hospitals. Were their bodies experiencing the same things that my body was going through? Depression? Anxiety? Rage? Hopelessness? 

After reading Mary’s story, I couldn’t stop thinking about the women who were committed to the asylums. I imagine they were horrified at the prospect of being separated from their loved ones. They must have felt abandoned at a moment when they were at their most vulnerable. Was there ever a time when they were reunited with their families? What kind of care did they get while they were in the asylums? How many of us may have female ancestors who were institutionalized because they were going through perimenopause and we are completely unaware of it? 

There was this pressure placed on women to be perfect, even as their bodies gradually betrayed them. While this treachery was taking place, no one could help them, not their spouses, not even other females, since they, too, were worried about when it would happen to them. According to Elisabet Rakel Siguroardottir’s article Women and Madness in the 19th Century, “as is common with oppression, the oppressed took active part in enforcing the rules on their own kind and, with only a few exceptions, women lacked the solidarity to stand up for themselves and each other.” 

In the late 1600s, women who were going through perimenopause were suspected of being witches. Females who did not have functional ovaries were considered insane during the Victorian era. Women who were going through this stage of their life were described using words like “hysteria.” For centuries, females have been misunderstood going through this stage of their lives.


Two years into perimenopause, I began experiencing heart palpitations. At first, it was just on rare occasions, but it wasn’t until they began waking me up in the middle of the night that I got sufficiently terrified. I eventually went to the ER one evening because I thought I was having a heart attack. The doctor at the hospital informed me that everything looked to be okay and that I appeared to be suffering a panic attack. He handed me a list of therapists affiliated with their hospital and then sent me on my way. 

I’d been dealing with anxiety issues for much of my life, but they were manageable. It was at the perimenopausal stage when my anxiety became overwhelming. My thoughts had a way of eating me whole, making me feel as if I was struggling to take a breath, drowning in my anxious thoughts and terrifying conclusions.

Ego-YOUR LEG HAS BEEN SORE. DO WE THINK IT’S A BLOOD CLOT? 

Breathe, Kari. You’re just fine. 

Ego-ARE YOU SURE YOU’RE GOOD? I THINK YOU’RE DYING A SLOW DEATH. 

Kari, don’t listen. 

Ego-YOU’RE RIGHT. IT’S NOT A BLOOD CLOT AFTER ALL. 

See? All good. 

Ego-I THINK IT’S A HEART ATTACK INSTEAD.

The fuck… 

Ego– I AM YOUR VOICE OF REASON. I AM YOUR BEST FRIEND. REMEMBER THOSE PALPITATIONS? I GAVE YOU THOSE! YOUR IDIOT BRAIN DOESN’T WORK HALF AS HARD AS I DO. I LOOK OUT FOR YOU CONSTANTLY. 

That’s true. You do look out for me…

Ego-ARE YOU SURE THAT DOCTOR DIDN’T MISS A SYMPTOM? THEY ARE KNOWN TO DO THAT FROM TIME TO TIME. 

Maybe you’re right.

Ego-DO YOU FEEL THAT? THAT PAIN IN YOUR LEG? 

I do feel that!

Ego- THAT’S WHAT I THOUGHT. 

In addition to my typical anxiousness, my diminishing estrogen was causing even more worrisome physical manifestations within my body. Prior to perimenopause, my anxiety was characterized by limiting thoughts and compulsive behavior, but as perimenopause progressed, I began to encounter anxious feelings that I had never experienced before. On a daily basis, I had palpitations, a sinking feeling in my stomach, sweaty palms, and vertigo. This was how I felt for nearly three years.

My fight or flight reflex seemed to be triggered at all hours of the day. When I disclosed these symptoms to my general practitioner at routine exams, I was received with either skepticism or concern. Nobody could figure out what the hell was wrong with me. As a result, I stopped informing others. I began to shut down and retreated inside of myself.

There was never any conversation regarding my mental health with my gynecologist when I was in perimenopause. I was never asked how I was feeling in terms of my moods or emotions; I was never asked if I was depressed or sad, anxious or upset. When I was pregnant with both of my daughters, there were excellent discussions about postpartum depression, but there didn’t appear to be any information about perimenopausal depression and anxiety; it felt like a huge disconnect.

My gynecologist’s office provides services to make women more attractive, such as Botox injections to restore my brow to its youthful appearance. They offer cellulite removal treatments for my legs and buttocks. They can even permanently remove the hair on my upper lip. I wasn’t interested in Botox. I didn’t require hair removal. I couldn’t afford cellulite removal. 

But what I desperately needed was treatment for the depression I was experiencing. What I needed was help coping with the anxiety that was interfering with my ability to function on a daily basis. Where could I find the necessary procedures? I didn’t need to smooth the lines on the outsides of my body, I needed to smooth the lines on the insides. I wasn’t broken, and I didn’t need to be institutionalized. I simply needed to be supported and encouraged. 

The asylums, witch hunts, and “hysteria” all make sense. I wasn’t at all alone. I was in glorious, historical company with women who had also felt alone, misunderstood, and disregarded for years before me. The difference was that I wasn’t imprisoned in a cell, hung and buried in a shallow grave, or stashed away in a rat-infested dungeon until they figured out what to do with me. I may have struggled with mental health problems throughout perimenopause, but I did not have to suffer alone in a jail as a result of them.

My asylum was the loneliness I felt throughout perimenopause. What will that look like to others in 100 years? What will my great granddaughters think of this book when they read it? Why wasn’t there more help available for my grandmother? Why didn’t she have more support? We’ve come a long way since then, but there is still much more work to be done. 

I will not keep silent about the injustices of perimenopause or menopause. I’ll never forget the women who ended up in asylums because they were going through menopause. I shall remember the females who were hunted down and slain because of the symptoms I experienced. I will forever think of the women who were abandoned and rejected when they needed someone to understand them in their darkest hours.

I hope you will forever think of them too. 

If you are depressed and experiencing suicidal thoughts, please get professional help. If you don’t have someone in your life whom you can trust with this information, you can call the suicide prevention hotline at 1-800-662-4357. It is anonymous, and they will get you the help you need.