The pause that does not refresh

The pause that does not refresh

Dr. Deborah Wagner Grundleger to talk about perimenopause at the JCC of Paramus

“This year nearly 30 million women between 39 and 53 will experience clinical depression and anxiety disorders associated with the onset of perimenopause,” Dr. Deborah Wagner writes.

The chances are that you know one of these women – or even that you are one of them yourself.

Deborah Wagner Grundleger

Wagner, 54, lives in Paramus (where she often is known by her married name, Deborah Grundleger) and is a member of the JCC of Paramus. She counsels many women in that age range, along with their families, and she has just published a book on perimenopause, “The Fifth Decade: Is It Just My Life or Is It Perimenopause?”

In “The Fifth Decade,” Wagner writes about her Ridgewood practice as a developmental psychologist, where she treats people “from age 2 to 80, men, women, couples, and families.” She notes that “one group has stood out as having unique needs that were barely understood: perimenopausal women.”

Perimenopause is defined as the 5- to 10-year period preceding menopause, when minor hormonal changes are followed by more dramatic changes. “Before people thought only of menopause when you have night sweats and hot flashes, but 5 to 10 years before, a woman can be moody, feel out of sorts, and have trouble sleeping,” Wagner said. Such symptoms are related to hormonal changes that lead up to menopause itself, which is characterized by the cessation of ovulation and the monthly cycle.

In the first few years of perimenopause the changes are very subtle. “A woman may be more short-tempered, her PMS may be a little worse,” Wagner said. “Then it ramps up, and once it’s on the radar they realize what they had been going through.”

Women first have to understand the hormonal changes that happen to them in their forties and fifties, Wagner said. “Most women don’t understand the scope of the hormonal changes.”

“I really want to get the word out,” she said. “When I did a couple of radio shows in the Midwest, people didn’t know what perimenopause was.

“When changes in mood and behavior occur, women sometimes self-diagnose, thinking they have ADD or a nervous breakdown. If a woman understands, it helps them relax and know what they are dealing with.”

Spouses, partners, and children can be affected when a woman suffers perimenopausal symptoms. “Part of my approach is to get men involved in understanding and supporting women during this transition,” Wagner said. “I’ve had a lot of men who have wives in that age range come in for therapy, or couples therapy. I’ve heard men say ‘what is going on with my wife?’ It’s not just a woman’s issue.”

A whole section of “The Fifth Decade” is addressed to men, with chapters called “Who are you and what have you done with my wife?” “I’ll take directions, just tell me what to do,” and “Who is going to take care of me?”

“One of the most important things for men to know is that women can’t help what they are going through, and that the women don’t like it either,” Wagner said. “They really need a lot of support. So the man can step up and take some of the pressure off the woman – it could mean bringing home a pizza for dinner occasionally so she doesn’t have to make dinner, or taking care of the kids.”

Insomnia, fatigue, irritability, and decreased libido are a few of the more difficult psychological symptoms. “The women’s libidos come down significantly and men are saying, ‘why don’t you want me?'” Wagner said. “It isn’t that women don’t want sex. They want comfort in other ways. Cuddling and holding may open up the sex drive a little bit.”

In the chapter called “Finding a Way Out,” Wagner explains some treatment options. Hormone replacement therapy (HRT) had been prescribed routinely to help women transition through perimenopause and menopause. However, she reports, “HRT is frowned upon now because the Women’s Health Initiative showed that there are many adverse effects of HRT. So, HRT is the last resort for women who are suffering [serious symptoms].” In 2002 the Women’s Health Initiative, which studied tens of thousands of women, found that HRT was associated with increased risk of heart attack, stroke, and breast cancer. “Since that time, doctors are reluctant to prescribe this type of treatment and wisely, women are very frightened to take it, leaving women to find alternate ways to ameliorate unpleasant premenopausal symptoms,” Wagner writes.

Wagner said that bioidentical hormones, which are phytoestrogens derived from yams and soy products, can provide some relief. The chemicals are less potent than HRT, but “they alleviate some of the symptoms. You can get them nonprescription, at low doses, or higher doses prescribed by a doctor.”

Wagner said that she spent four to five years doing the research and writing the book, which is her first.

“It’s important to start bringing it out and talking about it and sharing with each other,” she said. Women who experience perimenopause have the “highest risk for onset of depression in their lifetimes. They don’t have to suffer alone. There’s a lot that can be done to help them.”

It’s important to talk to the men as well as the children in their lives about it, so they can be more understanding.

“It makes me so happy every time I hear it helped someone understand,” Wagner concluded. “It’s a very tough transition.”

Who: Dr. Deborah Wagner Grundleger

What: A talk about her new book, “The Fifth Decade: Is It Just My Life or Is It Perimenopause?”

Where: The JCC of Paramus, E. 304 Midland Ave.; sponsored by the JCCP’s sisterhood

When: Sunday, Nov. 15, 11 a.m.

Information: (201) 262-7691,, or

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