How to stay sane during perimenopause

40+ mental health with insights from Dr. Jen Gunter and more • Sunscreens that don't cause cancer

Can some sunscreens cause cancer?

Uh, I feel like I've been reading conflicting messages about the good and bad of sunscreens for at least a decade now. On the one hand, sunscreen is a must for skin cancer prevention; on the other, certain chemicals in some products could also cause cancer.

Here’s what this Fortune story reports in a nutshell:

• Some of the active ingredients in sunscreens are linked to skin allergies and immunotoxicity and some are linked to hormone disruption and endocrine disruption.

• Two ingredients in particular — octinoxate and oxybenzone — have been linked to disruption of the endocrine system, which creates and releases hormones for myriad bodily functions, says a safety scientist with the nonprofit Environmental Working Group.

• TLDR:

  • You should still wear a “safe” sunscreen. The scientific consensus is that the benefits of using sunscreen to prevent skin cancer far outweigh the potential risks associated with some sunscreen ingredients.

    • Use broad spectrum mineral-based sunscreen. You’ll know it’s mineral sunscreen if the only two active ingredients are zinc oxide and titanium dioxide.

    • Use a stick mineral or cream-based sunscreen because aerosol (spray) sunscreens can pose yet another health threat if inhaled.

    • Avoid sunscreens that include “fragrances” on their inactive ingredients label because they often include phthalates, which are also endocrine-disrupting chemicals.

Shop safe sunscreens on The Midst Amazon Storefront. Some are up to 37% off for Prime Day.

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Midlife, estrogen, and mental health

How-to prioritize your sanity during perimenopause

By Amy Horton

Some days I feel like I’ve unwittingly gotten on a roller coaster ride and can’t get off. Even the smallest things seem to stress me out and I go from crying to laughing to panicking in the amount of time it takes me to walk from my car to the front door.

I hate to use the c-word, but I really do wonder on those emotional, whirlwind days, “Am I CRAZY?! Have I actually gone completely mad?”

Turns out, I can blame it all on being a 43-year-old perimenopausal woman (yay me!).

What in the world is happening to me?

During perimenopause, our estrogen levels fluctuate, causing common symptoms like hot flashes and irregular menstrual cycles. Perimenopause can also affect mood and mental health. Estrogen is responsible for a great deal more than simply controlling our menstrual cycles.

Studies show that there is an increased risk of developing mood disorders and depression associated with fluctuating estrogen levels that occur during the menopausal transition. Studies have also shown that there is an increased risk of major depressive disorder (MDD) in perimenopause and that estrogen fluctuations affect stress response, cognition, and emotional regulation.

If estrogen is responsible for that much of our mental health, and perimenopause turns estrogen into a yo-yo toy, how are we supposed to stay sane during this phase of life?

I turned to Dr. Thara Vayali, ND, Chief Medical Officer of hey freya co., to find out exactly how estrogen affects our emotional regulation and what we can do to feel a bit more in control on the rollercoaster ride of perimenopause.

Why do I feel emotionally all over the place during perimenopause?

Dr. Vayali explained the importance of estrogen in modulating neurotransmitters, like serotonin and dopamine. Those interactions can have profound impacts on emotions, influencing our mood, calmness, and a sense of connection with others, she says. “Generally, estrogen helps to maintain someone’s levels of serotonin and fluctuations in estrogen can result in mood instability.”

Estrogen increases dopamine release and interacts with dopamine receptors influencing feelings of motivation, reward, and attention, explains Dr. Vayali. “When estrogen levels drop or rise quickly, the relative change in dopamine receptors and dopamine release can leave people feeling an inability to feel pleasure and fatigue or feeling anxious, irritable and easily distracted, respectively,” she notes.

Getting at the root cause of dysregulation — is it really estrogen?

While it’s incredibly common for estrogen fluctuations to be at the center of all the symptoms causing us to feel dysregulated, Dr. Vayali cautions against blindly addressing estrogen without considering anything else going on in your body, mind, or life — and take some time to get to the root cause. “I tend to ask a few layers deeper. Is it really the estrogen causing this change? And if so, what is causing the estrogen to fluctuate beyond that person’s baseline?”

“What we all need is for the solution to suit our current situation,” she explains, “We can only get to that answer by asking ourselves: What am I feeling and why do I think it is not OK to feel this way? Then keep digging. That first question that will lead you to your solution.”

All of the hormonal changes in perimenopause can be incredibly anxiety-inducing. "Anxiety is one of the first and often missed signs of perimenopause,” says Kate Higgins, LCSW–turned-coach-for-women-in-midlife and founder of Your Magical Midlife. “When estrogen drops, anxiety spikes.” But we are not helpless or hopeless during this transitional phase of life.

Perimenopause and pre-existing mental health conditions

For women with pre-existing mental health conditions like Major Depressive Disorder (MDD) or Generalized Anxiety Disorder (GAD), perimenopause can worsen baseline symptoms or trigger relapse, says Vayali. “This happens because estrogen changes affect brain regions responsible for executive function, decision-making, and threat vigilance.”

If you have a pre-existing mental health issue and are going through perimenopause, Vayali says a practical tool is to track your cycle and symptoms — “It is the map.” It’s also important to seek guidance from your mental health professional.

On a more philosophical level, she shares this heartfelt advice:

“Know yourself as a transformative being. You’ve done this before — when your first period came, if you’ve ever been pregnant, if you’ve given birth.

And now, when peri/menopause arrives, you are entering yet another stage of transition — your body, hormones, and life will look different going forward.

This is the window of time to reassess everything from labs, life choices, medications, and mental health. What is actually working? What needs fine-tuning? What changes do I need to make?”

7 ways to support your mental health during perimenopause

1. Pay attention to your nervous system

Hormone regulation can be addressed through cortisol management, botanical remedies, and therapies that regulate the nervous system, suggests Dr. Vayali. Likewise, Dr. Mary Claire Haver, MD says she prioritizes daily habits that calm her nervous system, like deep breathing, mindfulness, and even short walks outdoors.