She looked sad, distant, unwilling to say a word. I was unsure how to break the silence. Usually, when a session begins like this, I turn toward the mundane—just to ground the twirl of feelings, the abstract but powerful vortex of emotion, in the concreteness of ordinary life. But this time it was she who broke the silence.

"This weekend it was sunny." A short pause. "So my family and I decided to go to the lake."

I welcomed the story with a warm smile, relieved, inside, that the sadness had only been an impression of mine.

"I put on a bathing suit for the first time this year. You know, it has been so cold here." I nodded, still smiling. "Before leaving the changing room, I couldn't help catching a glimpse of myself in the mirror. And I went so far down. I don't know how to come back."

More silence. I gave her space, but nothing came.

So I asked, "What brought you down?"

"I didn't recognize myself in that mirror. Swollen. Tired. I used to be good-looking." A pause, to collect her thoughts. "The idea that I will never be loved again—that's what brought me down. With my femininity goes almost my right to be loved, desired, wanted. I'm fading. My husband doesn't want me. When we were younger, he only mildly wanted me—mostly when other men did. Now I don't stand a chance."

I asked her what was, for me, the real question. "What is love, for you? And is it the same as desire? Do you love him? Do you desire him?"

"That's the point," she said. "Perimenopause is changing me. Maybe it's me I should learn to love. I'm becoming someone new. I don't desire much, and I don't feel worthy of desire either. My energy is often very low. I do love—that part is real—but in a way I can't yet understand. Being low-energy makes me feel unworthy of affection. Sometimes I even feel reluctant to receive it—as if........

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