I often have women clients who are going through the peri-menopause or who are post-menopause and I am curious about how I might better support them therapeutically. I want to share some thoughts from a recent talk by Joanna Groves where she invited us to think about the peri- and post-menopause in more practical and energetic terms. The menopause is defined by 12 months without menstruation; on average this happens at 51 years old. The peri-menopause, the period when the sex hormones are reducing, can start from the late thirties to mid-forties and the symptoms can last for 4 or more years after the menopause.
Groves asked us to pay attention to the pressure of trying to maintain ‘normal’ life during a time of physiological and psychological change and to take seriously the stress this places on women’s physical and mental health. She outlines the physiological and psychological changes that occur during the peri-and post-menopause. There are common physiological symptoms including heart palpitations, sweating, sleep problems and fatigue, these are often accompanied by other changes such as food intolerances and sensitivity to alcohol. Along with anxiety and depression there are other psychological symptoms such as memory and concentration problems, confusion and a loss of confidence and self-esteem. The pressure to maintain work, family responsibilities and a relationship and manage everyday crises can become overwhelming, like trying to stop a burst pipe with a teacup and one hand tied behind your back.
The ‘fight, flight or freeze’ response is caused by Cortisol, the stress hormone. Cortisol is produced and managed by the adrenal glands and is a survival response, an alarm reaction to threat or danger. In contemporary life we’re not at risk from predators but we need cortisol to help us deal with an emergency or carry on under pressure. Cortisol helps us keep going partly by repressing non-essential functions such as digestion and the immune and reproductive systems. When the crisis is over or the pressure reduces cortisol levels drop and the body returns to equilibrium. But what if the pressure is continuous and we are in constant crisis? Eventually the adrenals become exhausted and we become energetically depleted, this can result in anxiety, depression, headaches, difficulties sleeping, digestive problems and burn out.
If all that wasn’t enough to contend with. Groves suggests that during the peri-and post-menopause as our emotional resilience reduces; we no longer have the energy to keep difficult emotional experiences supressed. Buried feelings of grief, loss and shame can re-emerge and memories of trauma can resurface. Long established relationships are examined and sometimes break up. What felt safe and secure no longer feels so and this can feel like a kind of madness.
Groves’ advice is to acknowledge that this time is a process of transition that will eventually lead to a new stage of life, a kind of post-menopausal rebirth with renewed energy. She highlights ways to reduce stress and conserve resources during this transition.
One key message from Groves is that ‘energy follows attention’ i.e. what we focus on consumes or generates energy. She invites us to reflect on this through several different aspects:
- The importance of getting enough rest and sleep, this might mean delegating some responsibilities, reducing working hours and includes sensory rest such as time without a phone.
- The physical benefits of movement and keeping mobile through activities like walking, stretching, swimming and gardening; movement creates energy.
- Gut health and nutrition are two aspects that may need adapting, for example reducing the consumption of sugar and alcohol.
- Relationships and friendships, it helps to prioritise friendships that sustain and nourish and to limit those that are draining. Family and romantic relationships can come under scrutiny and may be revived or changed irrevocably.
- Finally Groves emphasises (self) compassion, this might include physical and/or holistic treatments, new creative experiences, practices such as meditation and psychotherapeutic support.
At the same time as outlining these practical approaches, Groves acknowledges that in a culture driven by productivity and achievement attempts to cut down responsibilities and become less productive may feel like ‘weakness’ or ‘failure’. Women in my practice have asked – if I can’t do what I used to do what am I good for – and said – I feel worthless like there is no place for me.
On a more positive note Groves identifies a paradigm shift around the menopause. It is not just women that go through this transition but those who accompany them, friends, colleagues, parents and especially partners and children. Hopefully by welcoming a wider range of experiences including accounts from transgender women we might develop ways to support and improve life transitions for us all. Meanwhile, as therapists we can offer a conversation to help understand and contextualise what is happening to those who find themselves at the centre of this particular life transition.
Further reading by Angela Rogers –