The letter

From C, 40-49.

I’m resonating with your explanation of perimenopause rage, anxiety, depression. I love my husband more than anything and he’s a very kind man who was my best friend. Neither of us had heard of perimenopause so didn’t know symptoms.

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I’ve blamed him for nothing, something, everything, yelled, shouted, screamed at him in general, at noise, had meltdowns over nothing, overreacted to such tiny minor things that I thought were important like crumbs on counter and split tea, him forgetting something or other trivial things I never got mad about prior or even noticed really. No one really explains what “rage” looks like. Is this “normal” or is he right and I’m a bully or abusive.

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I genuinely thought he was hating life with me, not being a team mate. I was so distorted, negative. I had terrible insomnia, misophonia, startle and fight reflex, agoraphobia. I’m shocked when I look back at how I really believed things that weren’t true. I don’t understand this. Is this normal peri stuff?

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Please explain why I took it out around him or at him and not others. Allostatic load, window of tolerance overloaded, but surely I’d have blown up at everyone. Why just him, he asked. I have no idea. Inside I was feeling and thinking all sorts about everything and everyone and took it out on him I guess.

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I was on sertraline which didn’t help one iota. I’ve always had a form of anxiety but never let it hold me back or distort my thoughts or behave like this. I can’t find an answer but your words are making me hopeful you actually understand all this and might provide some insight.

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We were inseparable, hung out so much enjoying each other’s company, so relaxed and in tune with one another. We’d discuss things and talk, not fall out with each other. I was truly unkind and said the most hurtful things if I felt let down or whatever I imagined had occurred. What was the matter with me.

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I’m on HRT now and I’m calm and awake and can see my behaviour from his viewpoint and I’m devastated as I was so sure he was causing me grief or not pulling his weight. I wrote a list and saw how much he was actually carrying.

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Am I crazy? I’m not borderline, bipolar, ADHD - I’ve had this ruled out. A nurse told me it’s perimenopause after many misdiagnoses. Please can you shed some light. What is normal rage. Why did I call him my enemy and change from seeing him as my sweetheart to that. It makes no sense.

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I’m accountable. I hurt him. I hurt us. He’s left. He’s needing answers as much as I am. He said I know right from wrong, I should’ve stopped being unkind. I should’ve done more.

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I’d been to doctors, explained heavy bleeds, sweats, anxiety, fear, lashing out. It was put down to SSRIs and just stress and anxiety and more meds given. I was exercising, eating well as ever. Again, didn’t know it was perimenopause. I had white noise apps, ear plugs, still couldn’t sleep and I roared. I scared him. I scared me.

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Thank you in advance.

My response

Dear C,

You are asking me if what you did was harmful. You know it was. And you are afraid it makes you a monster. It doesn’t. It makes you a woman who was drowning in a body no one told her had turned on her.

The person you describe screaming at your husband was not a monster, and she was not the “real you” wearing a bad mask. She was you inside a nervous system that had been slowly emptied of its regulation buffer over months and years, by a hormonal cascade nobody named, layered onto sleeplessness, the wrong medication, and a body scanning for threat. That person caused real harm. And she was also in a physiological state that would have unrooted almost any woman. Both are true. Neither cancels the other.

The question you keep circling, “am I crazy?” is not really a diagnostic question. It is an existential one. What you are actually asking is: am I still the woman I thought I was, or has something in me become the thing I most feared. That question has kept women in therapy rooms for a hundred years and it is bigger than perimenopause. The reason it arrives with such weight is that you had a period of your life when you could not recognise yourself. The gap between the woman who screamed and the woman writing this letter feels like proof of monstrousness. What that gap actually shows is what the mind does under acute physiological threat. It splits.

Melanie Klein described almost a century ago what happens when the psyche runs out of tolerance. The person in front of us collapses into either good or bad. Sweetheart becomes enemy in the same afternoon, not because they are truly one or the other, but because the mind under overload cannot hold both. HRT gave you back the biological ground on which the mature position rebuilds. Where he can be your beloved AND fallible. Where you can be a woman who caused harm AND love him. Your letter is evidence you are already there.

Why him and not everyone else. Because he was the only person your body trusted enough to fall apart in front of. Small children do not have meltdowns in front of strangers. They have meltdowns in front of the parent who picks them up from school, because the parent’s presence is what finally allows the held material to move. That mechanism does not stop when we grow up. And the specific cruelty of it is that the person who becomes the site of the storm looks, from inside the storm, like the cause. The mind cannot separate accidental witness from culprit while it is drowning.

Esther Perel writes that every long marriage contains a third. A job, an affair, an addiction, a ghost. In your marriage, the third was perimenopause itself. It entered uninvited, unnamed, and unseen, and both of you believed you were only two people in the room. Everything the third was doing got attributed to each other. That is why the story feels senseless. The actual antagonist was invisible to both of you for years.

He is asking why you did not stop. He is right to ask. He is also, in a way that is hard to explain to someone who has never watched their own reactivity fire before their thinking catches it, missing what was happening. Under full sympathetic activation the prefrontal cortex, the part of your brain that runs values and restraint, is not entirely online. Which is why women in perimenopause describe hearing themselves and being appalled a half-second later.

The thing he actually needs from you is the version of you who can look at what happened, name it accurately, take responsibility without minimising, and stay with him in the grief for however long that takes. Yalom wrote that the deepest repair in a relationship is not the removal of what happened. It is the honest, non-defended presence of the person who caused the harm, remaining available to the grief of the person who received it. That is what he is asking for, whether or not he can put it in those words. He is looking for the woman who is sitting there writing this letter to me now.

Some couples come through this. Some do not. Both outcomes carry grief. The version of you writing this letter is the version who can walk through either one with integrity.

With care, Alla

Dr Alla Demutska is a Clinical Psychologist with 15+ years of practice across Australia, Singapore, and now Bali. DPsych (Clinical), SPS Full Member, AHPRA registered and AHPRA Approved Supervisor.

Ask Dr Alla is a public advice column. It is not therapy, diagnosis, or medication advice. If any part of this piece resonates and you are struggling, please contact a therapist in your country, or a crisis line if you need one now.

Submit your question at drallademutska.com/ask-dr-alla.