Mind the Body Podcast

The Changing Body - Perimenopause, Identity and What We're Really Carrying : Episode 12

• Yvette Vuaran • Season 1 • Episode 12

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🎧 Episode 12: The Changing Body - Perimenopause, Identity and What We're Really Carrying

Something is happening that remains largely unspoken, yet deeply felt.

In this episode of Mind The Body, I explore the psychological and relational experience of perimenopause - a biological transition that also reshapes identity, visibility, and self-perception. This conversation moves beyond symptoms to examine what it means to inhabit a changing body in a culture that equates a woman’s worth with youth.

Drawing on clinical experience, psychoanalytic thinking, and research on body image, I look at how this transition can surface long-held questions about worth, desirability, and belonging, and why, for some women, it can feel less like a passage and more like a quiet unravelling.

We also explore the emotional context behind the rising use of GLP-1 medications in midlife women, asking what might sit beneath the desire to change the body at this particular moment in time.

In This Episode:

  • How perimenopause reshapes a woman’s relationship to her body and sense of self
  • Why this transition can activate deeper questions of worth, identity, and attachment
  • The difference between true acceptance and a quiet withdrawal from the body
  • What may sit beneath the urge to “fix” the body, and why it often isn’t about the body at all
  • The emotional and cultural context behind increasing GLP-1 use in midlife

A Question to Sit With:

What is this moment in your body bringing up for you?

References:

Szymona-Pałkowska, K., Adamczuk, J., Sapalska, M., Gorbaniuk, O., Robak, J. M., & Kraczkowski, J. J. (2019). Body image in perimenopausal women. Menopause Review, 18(4), 210–216.

Murphy, M. B., Lane, A., Cuskelly, G., & Heavey, P. M. (2025). Experiences of weight and body shape changes during perimenopause. Women & Health, 65(10), 861–870.

Kolod, S. (2022). I’m not myself today: Dialogues with Philip Bromberg. Contemporary Psychoanalysis, 58(2–3), 321–334.

eMarketer (2025). Twice as many US consumers now using GLP-1s. Retrieved from https://www.emarketer.com/content/twice-many-us-consumers-now-using-glp-1s

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Hello and welcome back to Mind The Body. Something is happening that nobody is really talking about. Women in perimenopause are navigating, disrupted, sleep, hormonal shifts, a body that feels different in ways it never did before. And beneath all of that, something else is present, something that seems harder to name a feeling of becoming less visible at the exact moment. They are becoming more themselves of knowing who they are, perhaps for the first time clearly, and discovering that the culture around them has already started to look away. That tension is what today's episode is about. I wanna explore three things. First, what perimenopause actually does to a woman's sense of herself. Second, why for some women this transition lands not as a natural passage, but as a crisis of identity And what attachment history has to do with that. And third, the particular pain of arriving at midlife, wanting connection, at a time where she's starting to feel invisible. And what that tells us about the rise in GLP one, prescriptions in women of this age. So let's begin. Let's start with what this transition actually feels like from the inside. We live in a culture that glorifies youth, that equates a woman's visibility with her youth and perimenopause arrives biologically and inevitably into that context. The word perimenopause itself carries weights. For many women, it happens gradually. It's in the accumulation of things that feel slightly off sleep, that doesn't restore a body that responds differently to food, to exercise, to stress moods that arrive without obvious cause and leave just as mysteriously. And underneath all of it, a shift in the felt sense of self that is very difficult to articulate. What I find in my work is that the transition during perimenopause doesn't just change a woman's body. It changes her relationship to her body. And for women whose sense of self has always been held, even partly in how their body looks and how it is perceived, that shift can feel profound in the ways that have nothing to do with hot flashes or hormonal tests. The research on body image across the menopausal transition offers us something interesting here. Studies show that postmenopausal women tend to reduce the importance they attach to how their bodies look, particularly to the parts most culturally coated as feminine and sexually visible. And the dominant reading of that finding is positive. Liberation freedom. From the male gaze, a woman, finally released from the tyranny of appearance. But here is what the same data also shows satisfaction with the body. Doesn't improve. Women care less about how their bodies look, but they don't feel better about them. And I wanna sit with that for a moment because I think the gap is telling us something important. There is a profound difference between a woman who has genuinely made peace with her changing body, and one who has withdrawn from it. Body neutrality. The idea of the body simply existing without constant evaluation is a more honest framework than the relentless positivity we have been sold. But even body neutrality doesn't fully account for what's happening here. Because withdrawal and acceptance can look identical from the outside. But is it liberation or can it from the inside feel like something closer to disappearance? Knowing yourself more clearly than ever. Having perhaps for the first time, a real and settled sense of your own values, your own mind, your own desires, and feeling at the same time that the world has started to look through you. That is the contradiction at the heart of perimenopause. The experience of the aging woman can be one of becoming a stranger to herself, not because she has changed internally, but because the reflection, the cultural mirror holds up to her, no longer matches the self. She knows from the inside. What perimenopause asks of a woman, culturally and psychologically is important. It asks her to remain herself to embody her presence, own her authority, her desire in a context that is actively withdrawing the recognition that has for most of her life, been part of how she understood herself to exist in the world. And so for the second point, For some women perimenopause passes as exactly what it is a biological transition. Significant, but. Something to be moved through rather than something that redefines them. But for others, it is experienced quite differently with a weight that feels disproportionate to what is actually happening physically. A distress that is hard to explain, but can't just be reduced to hormones and symptoms. And when that is the case, in my clinical experience, it is almost never really about the body. What perimenopause has a way of doing is surfacing what has already been there. The stories a woman has been carrying about her worth, about what her body has always meant in relation to other people, about whether she feels fundamentally enough. These things have often been present for decades. Perhaps they've been managed and contained, organized around the demands of life that kept them at bay, and then something shifts. Her body changes. And what felt settled no longer is I find the psychoanalytic literature helpful here. The idea that an experience doesn't have to be felt as painful at the time in order to carry pain, that dissociated material. The things we have not been able to process, the relational wounds, we have not been able to fully metabolize has a way of finding its moment. And perimenopause with everything it stirs physically and culturally can be exactly that moment. Susan Colludes paper in contemporary psychoanalysis describes what she calls the hormonal body, the way in which hormonal transitions can lift a veil, can make accessible material that has been kept at a distance. The clinical observation maps onto something broader. The body in transition becomes a site of emergence. What was held below the surface begins to rise. I think of the women I work with who describe perimenopause as a kind of unraveling, uh, loosening of the structures that have kept certain questions at bay. Who am I outside of how I look? What do I want now that wanting itself feels different? What have I been carrying in my body that I have never quite been able to put into words? A woman who grew up learning that her value was contingent on how she looked, how she performed, what she achieved, how she was received by others, carries that learning in her body long after she has intellectually moved past it. It lives in the way she monitors herself in a room in the particular quality of anxiety she feels when she gains weight in the effort, often invisible even to herself. That goes into looking, put together what the body begins to change on its own timeline. Outside her management, what gets activated is not simply discomfort with aging. It is something far older, a relational anxiety that the body has been holding for decades. a question she may not even know she's asking a question, will I ever be enough? And the unfortunate reality is that this question frequently remains completely unasked because the culture hands her a different question. Instead, how do I fix this? What can I do about the weight? Which medication, which treatment, which intervention will return her body to something she can recognize? The fixing becomes a way of not having to feel the thing underneath the fixing. And this is where, as a clinician, I wanna slow down because the impulse to fix is completely understandable. It is a response to distress. But if the distress is not actually about the body, if the body is the site where something much older is being held, then fixing the body will not reach it. It will at best provide temporary relief, and at worst, it will deepen the conviction that the body is the problem, that if she can just get the body looking better, everything else will follow, but it won't because the body was never the problem. Which brings me to the third point. Recent statistics show that women are significantly more likely to be taking GLP one medications than men and the use of these medications peak in midlife, precisely the window in which perimenopause arrives. There is a particular kind of woman, one I see in many forms in my consulting room in her mid to late forties. She has built a career. She's proud of a life that is genuinely hers. Friendships, autonomy, financial stability. And somewhere along the way, her love life got deferred. There would be time. There was always going to be time, and she believed that because she had to, because the alternative, sitting with the grief of what was being postponed was not something she could afford to do while she was building everything else. And now she's here wanting, perhaps for the first time to share her life with someone ready. In a way she perhaps wasn't before clearer about what she wants, what she will not settle for, what genuine intimacy might actually feel like. And her body is changing at exactly this moment, this from the outside may look like anxiety about aging. A preoccupation with weight and appearance. That seems disproportionate for a woman who has in every other area of her life such clarity and groundedness. But when you sit with it in the room, what you find underneath is something far more tender, a fear, often unspoken, and sometimes not even fully conscious. That she has left it too late, that the body she's in now is something less worthy of being wanted, that desire, hers and desire directed towards her belongs to a version of herself. She can no longer quite locate. And so the body becomes the focus, the weight gain that comes with perimenopause, biologically inevitable. The body doing exactly what it is designed to do at this stage of life becomes something she cannot leave alone, a problem to be solved before she can begin, before she can put herself out into the world the way she wants to. And increasingly what I am seeing is women reaching for GLP one medications in this specific context, not for metabolic health reasons, not on medical advice, for weight related conditions, but because the perimenopausal body feels to them like an obstacle to love, and changing the body feels like the only thing they can do. The one place they have a say on a situation that otherwise feels entirely outside their control, I wanna be clear that I am not making a judgment about GLP one medications. We explored that in the last episode, what I am doing is asking a different question when a woman in perimenopause reaches for a medication to counteract. The natural weight changes of this transition specifically because she wants to be more desirable, more visible, more worthy of being chosen. What is she really trying to address? Because it's not the weight, what is being managed or rather. What is being medicated rather than metabolized is a kind of grief. A grief. For the years, the love life was deferred for the version of herself she imagined she would be waiting on the other side of all that work for the time. She now fears she no longer has and a fear rarely spoken aloud that the culture she lives in, a culture that glorifies youth, that equates desirability with a particular kind of body that makes women over 40 feel they are competing on terms that were never designed to include them, has already decided she has missed her moment. That fear is not irrational because the cultural messages are loud and clear. The experience of becoming less visible as we age is real. But the body is not the obstacle. It never was. The obstacle is the story, the narrative that worth is contingent. That desirability has an expiry date that she needs to fix something before she's ready to be loved. That story has roots that go back much further than perimenopause. It was there long before the weight gain, long before the hormonal shift, long before the mirror started showing her something she didn't quite recognize, and this is what therapy is for, to help her trace the story back to where it began to explore whether there is a relational wound underneath the body, preoccupation to ask with real curiosity and without judgment what her body has been carrying on her behalf, and whether it is time to put some of that down. So to bring it all together, we started with the contradiction at the heart of perimenopause. A woman becoming more herself clearer, more grounded, more real in a culture that equates visibility with youth and has already begun to look away. The research tells us women in this transition care less about their bodies. It doesn't tell us that they feel better. And that gap between caring less and truly making peace with the body is where so much of the real distress lives. And then the question underneath all of. Will I ever be enough for women whose sense of self has been organized consciously or not around how the body looks and what that makes possible relationally. The changing body doesn't just feel physical. It feels like a renegotiation of the self. And we ended with a specific kind of woman, one I see in many forms in my consulting room who has arrived at midlife, wanting love, wanting connection, wanting to be chosen, And who is reaching for a medication to make her body feel more acceptable before she is ready to begin? out of a fear that the culture has confirmed often enough to feel like a fact that her moment has passed, that she has left it too late. What I wanna leave you with is this, perimenopause is a threshold, Thresholds ask something of us. They ask us to look at what we are carrying to ask whether the story we have been living about worth, about the body, about what we need to be before we are enough is actually true, or whether it is old, whether it belongs to us, or whether it was handed to us so early and so consistently that we simply never thought to question it. That questioning is available. It is the most important work a woman can do, and it does not require a different body. It requires a different conversation. We as women, can lead with compassion, can lead with kindness. My newsletter goes deeper into many of the themes we explore here, and I'll put the link in the show notes. Until next time, stay curious. I.