The Holderness Family Gets Real About Perimenopause

She presents these pillars as her core clinical philosophy. They are not a quick fix but a comprehensive realignment of daily habits to support the body through estrogen loss. The emphasis on strength training counters the common but ineffective advice to 'eat less, move more.' The inclusion of community reflects the isolation women feel and the power of shared experience, which the Holdernesses model through their content.

Mary Claire points out that during the menopause transition, the proportion of women needing an SSRI doubles. Historically, clinicians over-prescribed antidepressants without addressing the underlying hormonal chaos. She now advocates a reversed order: stabilize with hormones first, then layer with psychiatric medication if still needed. This is a major shift from the 'suffer through it' or 'it's just aging' narrative. She ties this to the alarming suicide rate.

Mary Claire likens it to 'pinning the tail on a moving donkey.' She contrasts the ease of treating postmenopausal women (once hormones flatline) with the chaotic perimenopausal phase. Her advice is to listen to the woman's top complaint — be it joint pain, bleeding, anxiety — and focus on that, accepting that the target will move. This philosophy emphasizes partnership and adaptability.

Mary Claire explains that the first harbingers of perimenopause are frequently neurological: anxiety, panic, decreased resilience, and a sense of 'going crazy.' She ties this to Kim's experience of feeling like she was being chased by a bear and having a panic attack over marinara sauce. She stresses that because estrogen, progesterone, and testosterone receptors exist throughout the brain, the hormonal fluctuations of this phase knock out emotional regulation long before any outward physical signs. This framing breaks the silence around early symptoms that women often dismiss as personal failure.

Mary Claire states that if a woman had postpartum depression or anxiety, she is a 'ringer' for having a rougher menopause. She recounts her own intrusive thoughts after childbirth — imagining her baby drowning — that were completely missed by the standard screening question 'Are you thinking about hurting your child?' The medical community’s failure to recognize non-psychotic distress in both periods has systemically undertreated women.

Mary Claire notes that research on ADHD in women lags because studies predominantly enrolled male participants. Duke University now has a women’s center for ADHD. She connects this to menopause: many women feel like they 'got ADHD' in perimenopause because the drop in estrogen frays the executive function that had been tenuously maintained. She and the Holdernesses discuss the relief of diagnosis and how understanding gives permission to build systems rather than blame oneself.

Mary Claire drops this fact in direct response to Kim's admission of wanting 'out' despite having the life of her dreams. She links the suicide peak directly to perimenopause, emphasizing that this is not random. This framing validates the urgency of hormone-based treatment and comprehensive mental health support, rather than leaving women to 'deal with it.' It also gives weight to her argument for early hormonal intervention.