Deborah R. Wagner - The Fifth Decade: Is It Just My Life or Is It Perimenopause? Sorting Through the Emotional Upheaval of Women in Their Forties and Fifties

Jerilynn C. Prior BA, MD, FRCPC,
Professor of Endocrinology, Director of the Centre
for Menstrual Cycle and Ovulation Research
University of British Columbia and
Vancouver Coastal Health Research Institute

O ut of the blue, Deborah Wagner, a psychologist from New Jersey, emailed asking to use a table I created about the Phases of Perimenopause Higher estrogen (and lower progesterone) levels are unique, and experience changes are newthus even with bang-on regular periods, a new name is needed: perimenopause.

I was gratified that my integration of perimenopausal hormonal swings with the physical and emotional changes of midlife caught Dr. Wagner's eye. Of course she could reprint this table! But please use a more recent, refined version.

I soon learned that Dr. Wagner is as committed as I am to making accurate perimenopause information available to the many perplexed and frustrated midlife women. On that basis I agreed to read her book and write this Foreword. I admit that I was initially apprehensive that she, as others have, would take the equally wrong approaches of blaming women's midlife madness on estrogen deficiency or attributing it solely to distress over aging as people who rely on sexual allure for our value in the social hierarchy. Instead, Dr. Wagner has done an excellent job of balancing individual personality traits, past and present life experiences, lack of cogent, helpful midlife transition information and the hormonal chaos of perimenopause, all of which contribute to perimenopausal Turbulence.

Having read it, I believe that The Fifth Decade will be a life-saver for the many young-looking women in their late thirties and forties who, besides being on an emotional and physiological rollercoaster, are wrongly told that dropping estrogen levels are responsible for their misery. What helps most of all, is to know, that they, in Dr. Wagner's terms, will move from Turbulence to eventual Quietude as they survive perimenopause and thrive in a calmer, gentler menopause.

I recall so well those days in my late 40s when, though my periods were regular, I was totally miserable. I cried during my three kilometer walk up hill through parks and by single family homes to the Osteoporosis Clinic of which I was then director. Although a hormone expert, I didn't know why I was falling apart. It was worse because, whatever was making me miserable, I had to hide it from my patients and colleagues. At the clinic I found an isolated washroom in which to blow my nose and wash my faceif asked, I bravely grinned and blamed my swollen eyes on bad allergies.

The good news is that The Fifth Decade amazingly integrates midlife mind and body and much, much more. Many social scientists past and present seem allergic to anything of the body However, making a connection, as this book does, between the truly higher and swinging levels of estrogens of perimenopause and women's midlife emotions, is a major advance for women.

I am also astonished and gratified that Dr. Wagner considers progesterone to be the feel good hormone. Even I, who believe strongly in the power of progesterone, would not be so baldly positive. I had come to believe, however, in progesterone's important role in women's health after 30 years of research on its functions within regular cycles, in perimenopause and in menopause.

For example, Centre for Menstrual Cycle and Ovulation Research (

While you read, The Fifth Decade be prepared to giggle or laugh out loud as Wagner recounts women finding lost keys snuggled with the milk in the fridge, waking with pjs inside out or discovering they have poured orange juice rather than cream into their coffee! Stories pepper this book. Stories that feel authentic, of women's lives, social situations and emotional distresses. Most thoughtful and important of all, Wagner describes four perimenopausal emotional phases with the last one being Quietude. This is much like I envision estrogen's storm seasonof perimenopause eventually becoming the safe and quiet harbor of menopause.