The following article was written by Palmeira Practice counsellor Bella Cranmore.

It is estimated that approximately 13 million people in the UK are experiencing perimenopausal or menopausal symptoms, accounting for approximately one-third of the whole female population. And yet, until more recently it has not been openly discussed and spoken about.

This article explores what menopause is, the potential symptoms that can arise, and ideas for navigating this transition, including the potential role and benefits of therapy. Menopause can be seen as a time of loss and change, but there are also those who advocate that the menopause journey also holds opportunity for new and positive growth and change, including greater wisdom, authenticity and integrity. This reframe is also explored.

Lessening Menopause Taboo

Fortunately in recent years, the conversation around menopause (and perimenopause) has been opening up, with many celebrities and high profile women becoming more vocal about their experiences. Women such as Davina McCall and Gabby Logan are speaking openly about the challenges they have faced in their own lives and are helping to lessen the taboo about this natural change and transition.

Each person will have their own individual journey and experiences. Some may breeze through this time with no issues, while others may experience strong and challenging symptoms. For these women, developing awareness, acceptance and taking action to put the right support into place can be extremely helpful.

What Exactly is Menopause?

Menopause is the end of a woman's reproductive years and occurs when her menstrual cycle stops, and she can no longer conceive. To be diagnosed as being in menopause, a woman will have gone 12 consecutive months without menstruating. Technically this single day marks the transition into post-menopause, with the proceeding time being described as perimenopause when a woman's body begins to produce less oestrogen.

In the UK the average age for menopause is 51, with many experiencing symptoms of perimenopause from the age of 45 (although many may experience symptoms from their late 30s). The perimenopause stage can typically be anything from 4 years to 10 years.

Some people may also experience a forced menopause as a result of medication or medical treatments such as chemotherapy or transitioning. Early menopause is typically seen to be a menopause before mid 40s. In this case, instead of being a gradual process, menopause can become an instant event, which can be extremely disorientating. In these cases, therapy can be an important part of acknowledging and integrating this experience.

Potential Symptoms of the Menopause

Many of the symptoms that are experienced, are due to big fluctuations in hormones, changes which can be experienced yearly, weekly, daily and even hourly. This is followed by a longer-term decrease in hormone production by the ovaries including oestrogen and progesterone. The reduction and big swings of these hormones (as well as testosterone and cortisol) can result in a wide variety of physical and emotional symptoms and experiences, including mood swings, hot flushes, and dryness.

The exact symptoms experienced vary from person to person, and may start to appear over time, or all at once in the case of a forced menopause. Due to our fast-paced lifestyles these symptoms are often ignored and pushed through (we have things to do after all!), which can ultimately lead to burnout and need for help. The number, type and severity of symptoms will vary greatly, and if you are concerned it is worth talking to your GP or healthcare provider. A talking therapy can also be a useful way to help you explore and understand what is going on emotionally and physically.

Turbulent Emotions - Emotional and Psychological Symptoms of Menopause 

Along with the physical symptoms there are several emotional and psychological symptoms that have been associated with menopause, making this a potentially turbulent time emotionally. Challenges might include mood swings, anxiety, depression, irritability, insomnia, extreme fatigue, greater sensitivity, reduced resilience, suicide ideation, and feelings of being out of control. Some women also experience strong feelings of ‘having HAD ENOUGH’, relationship power struggles, newfound desires to end relationships or make major life changes, grief and loss for their youth, fears of aging and dying, and resurfacing of earlier trauma.

If any of these symptoms relate to you, know that you are not alone. And there is help in lots of different forms, which can be supported through talking therapy.

HRT & MHT – Hormone Treatment

Whether to take Hormone Replacement Therapy (HRT), also known as Menopausal Hormone Treatment (MHT), is a very personal decision and one to be made in conjunction with a medical doctor. For some it can be very useful for dealing with symptoms, and it can also be worth doing your own research to come to a decision that you feel personally comfortable with.

Whatever your decision, most experts recommend making diet and lifestyle changes either as a first point of call and/or alongside any treatment. These include addressing stress, wider lifestyle circumstances and pressures, and prioritising self-care.

Stress and cortisol

During the menopause transition, our adrenal system may be on higher alert with an increased sensitivity to stress. So many experts recommend taking steps to reduce stress in our lives. While reducing stress is not easy, it is still vitally important. 

An age of challenge

Many women in their late 30s, 40s and 50s, are extremely busy and may have many other things going on, resulting in them feeling overwhelmed, overcommitted and over worked. This might include workplace pressures, burnout, relationship difficulties, sexual disharmony, feelings of isolation and difficulties getting medical support. Many may also have parenting challenges, clashes with teenagers in the household, or a void from the empty nest. There may also be caring responsibilities for parents, grandparents and partners. 

Talking therapy can be a useful way to explore the complexity of what is going on, while also acknowledging that menopause is likely to be only one component of a much larger picture. This might result in a decision to make potentially difficult lifestyle changes, from greater delegation and outsourcing, through to letting go of relationships and situations that no longer support you.  

Whatever is going on, it is likely that greater self-care may be beneficial. 

Keeping Self-Care at the Forefront

While there is much disagreement between experts about the menopause, one of the common areas agreed on, is the benefit of greater self-care. 

The exact approach will depend on your specific circumstances and preferences, and may include a focus on healthy nutrition, gut health, movement and physical activity, quality rest, stress management, putting sufficient support in place (whether that is friends and family who ‘get it’, a therapist or support group), and developing self-compassion. Learning about menopause through watching documentaries, reading or going to a menopause café or support group can also be helpful to resource yourself. 

How to do this? For many self-care can be seen as selfish, self-indulgent or as low on their priority list. The problem is that if we don’t attend to self-care, we can burnout and hit a brick wall, which means we don’t have the resources to help those who might depend on us. Having the support of a professional therapist to help resource yourself, reduce stress and develop a personalised approach can be enormously helpful, so that you can still be there for others. This might also include working with your window of tolerance and developing nervous system awareness to help you manage your energy. 

What if Menopause isn’t a medical condition to be treated or cured?

There are those such as Alexandra Pope and The Red School, and Kate Codrington who hold strong that menopause is not a medical condition to be ‘treated or cured’ but a time rich in potential for transformation and greater self-awareness.

Alexandra Pope and The Red School

Alexandra Pope and The Red School, advocate that menopause is a natural and transformative stage in a woman's life. They promote the idea that menopause is not a medical condition that needs to be treated or cured but rather a natural process that should be honoured and celebrated, leading to the potential for greater self-awareness and fulfilment, increased creative and greater intuition. 

Kate Codrington and Second Spring 

In her 2022 book, Second Spring: The self-care guide to menopause, Kate Codrington describes menopause as a second spring, rooted in the idea of seasonal cycles and life cycles. 

As with the annual seasons, our lives also follow a cyclical rhythm of expansion and withdrawal. She advocates that Menopause, particularly the perimenopausal stage, marks a transition into the autumnal season of our lives. It is a time of introspection, letting go of what no longer serves us, and preparing for the winter of menopause where we can focus on healing and repair. She acknowledges that this inward focus can be challenging for those of us who have been trained to prioritise productivity, outward focus and constant doing and achieving. But like the season of winter, there can be rich rewards in this time of wintering, including the underground preparation for the upcoming Springtime. 

Embracing the concept of second spring invites us to view the menopause journey as a time of liberation, growth, and renewal. We can emerge from the quiet of winter with renewed energy and explore new ways of being without the constraints of societal conventions. 

Whatever your view, help during this time can be extremely supportive. 

Why Counselling and Therapy Helps During Menopause

In conclusion, counselling and therapy can be very helpful for women on their menopause journey. Benefits can include:

1. Emotional support: Therapy can provide a safe and supportive space to express and process the complex emotions that can arise.

2. Coping skills: A therapist can help you develop coping strategies to deal with symptoms such as anxiety, depression, and mood swings.

3. Relationship support: Menopause can sometimes put a strain on relationships. Therapy can offer tools for improving communication and fostering stronger connections with loved ones.

4. Self-care: Women going through menopause may need to prioritise self-care to manage their symptoms. A therapist can help you develop a self-care routine that works for you, and help you resource yourself and build resilience. 

5. Understanding and validation: a therapist who is knowledgeable about menopause can provide education and validation about the physical and emotional changes that you are experiencing. This can help you feel less alone and more empowered to manage your symptoms.

6. Exploring what is means to be aging: in a society that worships youth and has largely forgotten the contribution that elders have to make, it can be useful to explore fears and challenges that might arise as part of the aging process.

Whatever your journey, know that there is a lot of help out there, whether you choose to see a therapist or counsellor or draw on the growing number of books, resources and support networks that are becoming increasingly available. 

For support around issues relating to menopause and perimenopause, book an introductory appointment with Bella Cranmore.