What is menopause?

A psychologist’s evidence-based holistic view on managing menopause symptoms and the menopause transition.

What is menopause? So menopause is a thing that happens to all women—but women experience menopause differently. I wanted to write this post to chat about the history of menopause, menopause symptoms and treatments, and how to best deal with it all. Let’s dive in! I hope you feel more informed and less alone by this article’s end.

The Biology of Menopause

“Menopause” refers to the final or last menstrual cycle in a woman’s life. Menopause is the end of a woman’s reproductive years. This is when she stops ovulating and producing cyclical estrogen and progesterone. A woman who has gone 12 months without having her period is said to be “postmenopausal.” The average age of menopause is typically between 45 and 55, with a typical onset at 51 years. Menopause is defined as “early menopause” when it occurs between 40 and 45 years old.

Premature menopause

Natural menopause occurs when ovarian function declines and ceases due to the natural ageing process at or around the average age. However, the natural ovarian function may stop prematurely, called premature menopause, before age 40. Premature menopause can occur due to surgery to remove the ovaries (surgical menopause) or cancer treatments.

What is perimenopause (the menopausal transition)?

Perimenopause is the time right before menopause when most women start to experience irregular periods. They might become unstable, or the amount of menstrual bleeding might change. Also begin to have menopause symptoms: such as hot flushes (hot flashes) and night sweats, as well as pain or aches, feeling tired or irritated, and feeling worse before her period. Natural menopause occurs due to changes in female hormone production, particularly estrogen and progesterone, from her ovaries.

How long is this transition?

Some women may experience menopause symptoms for up to ten years before their final menstrual period. It is impossible to predict when a woman’s menopause symptoms will start or how long they will last.

Physical menopause symptoms

The most commonly reported physical symptoms of menopause by perimenopausal and postmenopausal women are:

• hot flushes, also known as hot flashes
• night sweats
• joint and muscle aches
• dry skin
• vaginal dryness
• loss of libido
• urinary symptoms such as increased urinary frequency or urinary tract infections
• weight gain
• and sleeping difficulties

However, it is important to note that not every woman experiences severe symptoms. In fact, about 60% of women will only experience mild symptoms for around 4-8 years. Additionally, 20% of women will have no symptoms at all. In comparison, another 20% might experience severe menopausal symptoms, with symptoms potentially continuing into their 60s or later.

How is menopause diagnosed?

It isn’t necessary to have hormonal testing to “prove” that a woman is menopausal. Menopause is diagnosed based on a woman’s symptoms and changes in her menstrual cycle. It is a precise diagnosis when a woman has had surgery to remove her ovaries.

The Social Aspects of Menopause

Menopausal women feel like they are turning a new page in their lives. However, this change can mean different things for different women, depending on where they are in their current stage in life, their culture and where they live. It can be a time when social stigma’s are placed on women both consciously and subconsciously. 

The views in this section of the article do not reflect my personal views. They are ideas from media, research, religion, cultures and societies. The point of talking about them is to raise awareness that menopause carries stigma and mistruths that can have an impact on how a woman approaches this time of her life.

Here are some interesting historical and cultural opinions that show how the view of menopause could influence how a woman felt about herself and her place in society:

Historical opinions of natural menopause:

• Sigmund Freud described menopause as an “anxiety neurosis” and a physical illness. Another psychologist, Helen Deutsch, likened menopause to puberty, describing it as a “woman’s last traumatic experience as a sexual being”.
• Until the twentieth century, menopause was seen as a condition that caused women to become deficient and lose their womanhood. According to Colombat de L’Isere, in menopause, “women now cease to exist for the species, and henceforward live only for themselves.”
• In the 1960s, Robert A. Wilson, a gynecologist, claimed menopause to be a threat to the feminine essence. Author David Reuben said that when estrogen is turned off, women become like men; they are no longer useful as human beings.
• In the 1970s, Therese Benedek talked about how cultural expectations of women play into their views of menopause. She said many women fear the change and feel like losing something. However, she believed that the decline in hormones and sexualisation can be positive because it allows women to explore a new way of living in their middle age.

Cultural views on menopausal and postmenopausal women:

• In the Arab world, the word for “menopause” and “midlife” is roughly translated as “the desperate age”, reflecting a negative cultural perception of menopause.
• In certain parts of Latin America, some elderly women are abandoned by their spouses and children or are expected to care for their grandchildren.
• On the flip side, the working women of a rural Indian village felt unburdened by menstruation and free to work on their business postmenopause.
• After menopause, many urban Korean women felt liberated from the oppression they had previously experienced. They went from being wives and mothers to transformed women.

Early menopause

Suppose menopause onset was unexpectedly due to natural or surgical causes. In that case, this might disrupt a woman’s reproductive plans and suddenly bring upon the premature transition into menopause. It might mean those otherwise healthy women who may have wanted to become pregnant no longer have that option. This can also lead to vaginal dryness and problems having sexual intercourse. The sudden feeling of loss of her role as a woman might change how she relates in her marriage and how she is viewed by her family and within her culture.

The meaning of menstrual periods

The menopausal transition can be a confusing and emotional time for some women. On the one hand, women might feel relieved that they no longer have to deal with menstruation. On the other hand, she might feel like this transition signifies getting old, the sudden loss of femininity, and her role in producing life. In many societies, a women’s first menstrual period signals the beginning of womanhood.

The experience menopausal symptoms have on other important roles

The typical timing of menopause is in middle age. It may coincide with motherhood, career changes, grandparenthood, caring for an elderly parent or other roles.

Common symptoms such as severe hot flushes (hot flashes), night sweats, mood swings, urinary incontinence and mild depression can impact the ability to maintain essential roles.

Empowering women

While a menopausal woman cannot control societal expectations or her family’s reactions, she has some individual agency to make decisions.

Overall, it’s vital to remember that this does not have to be a negative stage in life. Menopause can be a time for reflection – a natural process or life transition. A time where women no longer have to deal with periods, premenstrual problems or fear of pregnancy. A stage of relief and refocus rather than a sense of loss. Ending reproductive capacity can mean the birth of a new role amongst other women within your family and community.

Many women are inspired at this time to explore and review their lives and establish new objectives. Personally, I take inspiration from ancient traditional cultures that see aging women as elders, naturally beautiful, wise, respected and valuable members of their society.

The Psychology of Menopause

Several psychological concerns arise for women during menopause.

The notion of the “superwoman” has been cultivated over numerous generations. Women have felt a duty to help others above themselves while striving to maintain a good “do it all” appearance.

Many women are bogged down by a sense of guilt that they’re not doing enough, which prevents them from taking care of themselves. They feel chained to their commitments and unable to find time for anything else. This can lead to an overwhelming feeling of being time-poor and stressed out.

Many women feel unprepared and stressed when they have to deal with the additional challenges of this stage of life.

This is a subject I will be expanding on in future blog posts. In this article, I want to present a brief outline of some of the research on how menopause can impact mental health:

• Low levels of oestrogen are associated with lower levels of serotonin, a chemical that regulates mood, emotions and sleep.
• Hormonal changes and sleep deprivation can contribute to mood changes. These can include anxiety, irritability, forgetfulness, trouble concentrating or making decisions.
• A past history of depression, particularly post-natal depression, and stress during perimenopause may make a woman more likely to succumb to mood problems.
• Previous studies have demonstrated that women may be at an increased risk of depression and anxiety during perimenopause and the menopausal transition. Also, that depressive symptoms experienced in perimenopause are of higher severity than pre-menopause and post-menopause. In addition, they often do not respond well to standard antidepressant therapy.
• Anxiety related to menopause can trigger past experiences of complex trauma and the resurgence of traumatic memories and symptoms.

Treatment of Menopausal Symptoms

In future blog posts, I will expand on the treatment for specific symptoms of menopause. In this article, I want to present a brief outline of evidence-based effective treatments for menopausal symptoms:

First, being informed about what may happen during menopause is an excellent starting point.

In the late 1970s, a group of feminists decided to take on menopause and fight against the negative stigmas and societal expectations that came with it.

They raised important questions about women’s health and menopausal hormone therapy. This led to a better understanding and awareness of menopause and the establishment of organisations dedicated to researching and improving treatments for menopause.

Major menopause organisations

The International Menopause Society (IMS) and the North American Menopause Society (NAMS) were formed to create the best clinical and research standards for menopause.

The Australasian Menopause Society (AMS) is another significant menopause organisation based in Australia and New Zealand. Members of the AMS are doctors and other health care professionals interested in women’s health in midlife and menopause and the promotion of healthy ageing.

Evidence-based treatments

Based on the information presented by the AMS, below are the treatments that have good evidence of being effective for most women in treating menopausal symptoms:

Hormonal therapy (Hormone therapy)

Menopause hormone replacement therapy (MHT), also known as hormone therapy, as patches or tablets, has been demonstrated scientifically to reduce menopausal symptoms. However, for each woman, the benefits of hormone therapy must be weighed against the increased risk of side effects. Talk to your GP about hormone therapy or go to The Australasian Menopause Society at www.menopause.org.au and use their search to find an AMS doctor near you that specialises in Menopausal treatments.

Cognitive behaviour therapy

Evidence shows that cognitive behavioural therapy (CBT) and mindfulness-based stress reduction improve wellbeing and decreases the impact of symptoms of menopause.

Cognitive behavioural therapy (CBT) is a talk therapy (Psychotherapy) that helps you become aware of your inaccurate or negative thinking to view challenging situations more clearly and respond to them more effectively. CBT can help treat mental health disorders, such as depression and anxiety, but it can also be helpful for anyone who wants to learn how to manage stressful life situations better.

Group and individual cognitive behaviour therapy are both effective at reducing the impact of menopausal symptoms (sleep/hot flushes (hot flashes)/mood changes). This approach could be used in conjunction with other therapies for a holistic approach.

“Every woman experiences menopause differently, and managing it effectively requires a holistic approach that considers the biological, social, and psychological aspects of her experience.

Treatments with varying evidence

Based on the information presented by the AMS, below are some treatments with varying evidence. This means that the some research indicates it works, and some research suggests it does not work or has not had an impact.

• Lifestyle changes: include quitting smoking, having a healthy diet, getting exercise regularly, and using some stress-relieving techniques. Carrying a fan, dressing in layers, and always having a cold drink and facial water spray can be beneficial self-management strategies. Avoiding spicy meals, caffeine, and alcohol will also help you feel refreshed.
• Hypnotherapy
• Medications (SNRI / SSRIs, Gabapentin or Clonidine) and
• Other Complementary and Integrative Health Therapies

Summary:

The biology of menopause

Approximately 60% of women will experience mild menopausal symptoms, and 20% will experience severe symptoms. These can include hot flushes (hot flashes), night sweats, muscle and joint aches, urinary issues, sleep issues, loss of libido and weight gain. 

It is important to note that biological changes can also be linked to the social and psychological aspects of menopause. Physical symptoms can impact a woman’s ability to balance her many roles in day-to-day life. In addition, it can lead to overwhelming emotions and trigger mental health issues. On the flip side, mental and social issues can have a negative impact on physical health.

The social aspects of menopause

There is still a lot of work to be done in terms of the social aspects of menopause. Women are still expected to conform to unrealistic standards of beauty and youthfulness, and there is a lack of understanding and empathy for what women go through during this time. However, there are signs that society is slowly changing and becoming more accepting of the natural aging process. Menopause can be seen as a new beginning: it’s an excellent time to assess lifestyle and health and to make a commitment to strive for continuing ‘wellness’ in the mature years. 

Keep in mind that social issues are not independent of the biological and psychological factors of menopause. Physical and psychological symptoms can impact on social relationships and the ability to manage social expectations. Issues such as sexual dysfunction, irritability, mood swings and sleep deprivation all can contribute. In reverse, social problems can lead to poorer psychological and physical symptoms. 

The psychology of menopause

Several psychological concerns arise for women during menopause, including feelings of overwhelm, stress, depression, anxiety, irritability, forgetfulness, and trouble concentrating or making decisions. Anxiety related to menopause can trigger past experiences of complex trauma and the resurgence of traumatic memories and symptoms. Many women feel overwhelmed in their lives, and the impact of menopausal symptoms is the tipping scale that sends them into a downward spiral. 

 In addition, the physical symptoms and social issues surrounding menopause can negatively impact mental health. Conversely, poor mental health can worsen physical symptoms and effects essential relationships and social roles.  

Available treatments

Several effective treatments are available for those who experience difficulties. Menopausal hormone therapy, cognitive behavioural therapy and mindfulness-based practices are a few proven therapies to help manage menopause symptoms. However, seeking medical advice is crucial if you consider starting menopausal hormone therapy.

The patient-centered holistic approach, every woman is unique

Every woman experiences menopause differently, and managing it effectively requires a holistic approach that considers the biological, social, and psychological aspects of her experience. This has been termed the Biopsychosocial approach. Seek out someone who you feel comfortable talking to and who will understand your unique needs. If you are experiencing any difficulties, many professionals can help.

Menopause is natural, and you’re not alone

The most important thing to remember is that menopause is a natural process all women go through. It is not something to be ashamed of or embarrassed about. If you’re going through menopause, remember that you’re not alone. Talk to your friends and family about your experiences, and don’t be afraid to seek out medical help if you’re struggling. There are many resources available to help you through this tough time.

Feedback is welcome

Thanks so much for reading my blog post on menopause. What did you think of this post? Was it helpful? Do you have anything to add? I’d love to hear from you in the comments below! Until next time, be well.

This blog post was brought to you by Kimberly Vucurovic, The Menopause Psychologist.

Kimberly is an Australian psychologist who helps guide women back to themselves during their Menopause transition. Her goal is to help women learn about their health and how to control it- physically, mentally, emotionally, and spiritually. By exploring different ways of living and learning about their mental fitness. Kimberly hopes to help women find peace, purpose, and wisdom during this time in their lives. She is a strong advocate for women’s health.

Sources:

Col, N. F., Guthrie, J. R., Politi, M., & Dennerstein, L. (2009). Duration of vasomotor symptoms in middle-aged women: a longitudinal study. Menopause, 16(3), 453-457.

Gordon, J. L., Nowakowski, S., & Gurvich, C. (2022). The Psychology of Menopause. Frontiers in Global Women’s Health, 2, 828676.

McKinlay, S. M., Brambilla, D. J., & Posner, J. G. (1992). The normal menopause transition. Maturitas, 14(2), 103-115.

The Australasian Menopause Society. Retrieved from https://www.menopause.org.au/ in August 2022.

Yisma, E., & Ly, S. (2018). Menopause: A Contextualised Experience Across Social Structures. In Global Perspectives on Women’s Sexual and Reproductive Health Across the Lifecourse (pp. 391-409). Springer, Cham.

Note: 

Medical and scientific information or advice provided and endorsed by Kimberly Vucurovic, The Menopause Psychologist, might not be relevant to a particular person’s circumstances and should always be discussed with that person’s healthcare provider. This article is for information purposes and is not a replacement for proper medical and psychological assessment or intervention. 

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