Just Not Feeling Like Myself

#notfeelinglikemyself #nflm

What the Heck is Going on with Me?

“Not feeling like myself” (NFLM) is a common description of perimenopausal women showing up at their doctor’s office. The physical symptoms are easy enough for us to describe, but are you wondering how to describe the other stuff – the stuff that’s changed that makes you, you? A recent Cambridge, Massachusetts (USA) study surveyed over 1,500 women to try to put this feeling into words. Their goal was to clarify this phrase; however, it also provides a structure for patients to understand and describe their experience.

The “Not Feeling Like Myself” Study

The study “’Not feeling like myself’ in perimenopause – what does it mean? Observations from the Women Living Better survey” was published in the journal Menopause this year¹. The study was conducted by the founder of Women Living Better, Nina Coslov, MBA with Marcia K. Richardson, MD; and Nancy Fugate Woods ,PhD, RN in cooperation with Atrius Health and Beth Israel Deaconess Medical Center both in Boston, Massachusetts, and the University of Washington in Seattle, Washington.

1,529 participants ages 35 to 55 responded to an online survey in 2020 that asked, among other things, how frequently they felt not like themselves. The average age was 47.3 years. The study reported that “63.3% of participants said that they have not felt like themselves half of the time or more over the past three months.” That's nearly 1,000 women who are feeling out of sorts and not their usual selves more than half the time, just like many of us.

What Exactly is Causing This Feeling?

Let’s look at what the study said were the nitty-gritty symptoms that cause this feeling.

Here we go! I feel like I’m announcing the Oscars. Drum roll, please….

… and the Oscar for wreaking the most havoc on a woman’s sense of self during perimenopause goes to these 4 symptoms:

1. Anxiety –
   My note about perimenopausal anxiety: As mentioned in the study, it appears that fluctuating estrogen/hormones create a unique type of anxiety that differs from the medical criteria for generalized anxiety disorders. Our anxiety is less about worry and more about our response to stress, both internal and external. The study described it as “insignificant things becoming major stressors” and “decreased tolerance for stress.”
   
   I know from personal experience that this type of anxiety is most likely nothing like you’ve ever felt before. It shows up more as a physical experience instead of a mental one. For example, you may look in the mirror and not physically recognize yourself or develop a tightening lump in your throat called a “globus sensation.” You may all of a sudden find yourself unable to use the computer because it overstimulates you or you start having panic attacks when having to drive on the highway. You may find that people trigger you towards anger more often, or you cry easily at silly things.
   
   These reactions are all biological stress responses and are how the body is programmed to respond in situations of high stress to keep you safe. I believe that the hormonal changes of perimenopause and the additional cortisol (stress hormone) that’s released during this time are interpreted by the brain as a threat and cause this overexaggerated anxiety response.²
   
   If you’re struggling with this, I understand. This symptom is happening more and more frequently, and I have theories as to why. Stay tuned to learn more and to learn coping mechanisms that can help. For now, just know that the first step is understanding this underlying situation. You’re not broken. I’ll be covering this topic frequently on this site.

2. Mood Changes

3. Brain Fog

4. Fatigue

I also believe that through this biological stress response I mentioned above, the top 4 symptoms are linked hand-in-hand together. What happens in the brain during perimenopause increases anxiety, affects our mood, slows our cognition-thinking skills, and reduces energy levels.

“These reactions are all biological stress responses and are how the body is programmed to respond in situations of high stress. I believe that the hormonal changes of perimenopause and the additional cortisol (stress hormone) that’s released during this time are interpreted by the brain as a threat and can cause this overexaggerated anxiety response.” - Shelby Tutty, MHA

Now, onto the Oscars for best-supporting symptoms in making us feel not like ourselves. The honor goes to sleep issues, vasomotor symptoms, headaches, sore breasts, skin issues, vaginal and urinary changes, digestive symptoms, pain, and sexual symptoms.

Furthermore, within the top 4 symptoms (anxiety, mood changes, brain fog, and fatigue), the “individual symptoms most highly correlated with NFLM were the following:

• Fatigue (Fatigue)

• Feeling overwhelmed/less able to cope (Mood Changes)

• Low feelings (Mood Changes)

• Anxiety/more nervousness (Anxiety)

• Irritability (Mood Changes)

• Difficulty concentrating (Brain Fog)

• Harder time making decisions (Brain Fog)

• Feeling like ‘I can’t calm down inside’ (Anxiety)

• Being more forgetful (Brain Fog)

• Tearfulness/crying (Mood Changes)

• Worrying more” (Anxiety)

There you go – the list of winners! I hope this has helped you better understand how you’ve been feeling if you've identify with this.

But How Do These Symptoms Affect Us in This Way?

There are several reasons why these symptoms impact us. First, a lot of women tell me that they were not expecting their menopause transition to be what it is. They were not expecting it timing-wise, did not anticipate the number or type of discomforts they would have, and did not expect them to come on so suddenly. Therefore, perimenopause comes as quite a shock. Anything that comes as a shock is unsettling.

Second, we begin to develop a sense of loss of control during this time. We lose control over our emotions and what our bodies want to do without our permission. As women, many of us need to feel in control, and this new experience of having no agency or control over what our bodies are doing is upsetting.

Third, as human beings, we tend to link our body's natural processes to our self-worth and self-esteem. It’s our biology, but we take it personally and build up all sorts of self-critical beliefs. For example, if I just can’t get out of bed, then I must be lazy. Your biology is no reason to hate on yourself. When our bodies "betray" us in social situations by having hot flashes or panic attacks, we tend to pull back socially, resulting in loneliness. Fear of rejection or ridicule will drive us further into isolation which is not good for our mental health.

This is my favorite line in the whole study:

“those who identify as independent and brave find new feelings of being less able to cope, being more tearful, and more anxious as particularly difficult. Whereas, for those who prioritize strength and fitness, new fatigue is problematic. For those that rely on their intellect, cognitive challenges are more worrisome. In addition, new emotional volatility, not seen culturally appropriate for women, can be most disconcerting.” (Page 397)

Our bodies work best when we have a predictable pattern of hormonal cycles. The constant and often hourly hormonal fluctuations during perimenopause affect our identity, making us not feel like ourselves, because it knocks us off-kilter from what we were once able to do easily. The pull between what we want to do and what we’re physically and emotionally able to do during this transition is real. We start thinking of ourselves differently and often not in the best light.

So, taking in all of these considerations, a woman can hopefully see why she doesn’t feel like herself. The word about this study is getting out into the public space, and if we can understand for ourselves what "not feeling like myself" truly means, we can be better advocates of our health and communicate to doctors how we are feeling in terms they will understand.

In the future, I’ll be writing about what we can do during our transition to help recover our sense of self and how the impact of perimenopause changes our brains in a way that also contributes to this feeling. Please consider subscribing to receive all of the latest articles!

PNG Image Credit 588ku

1. Source: Coslov N, Richardson MK, Woods NF. "Not feeling like myself" in perimenopause - what does it mean? Observations from the Women Living Better survey. Menopause. 2024 May 1;31(5):390-398. doi: 10.1097/GME.0000000000002339. Epub 2024 Mar 23. PMID: 38531011.

2. I formed this theory when learning about how our bodies react to stress and trauma. Then, I read Louann Brizendine, MD. The Upgrade. Harmony, 2022, which confirmed my suspicions.