The Perimenopause Transition and Mental Health

Lately I have been reflecting on how little information I knew as a new therapist about the perimenopause transition. I think about the women I sat across from that were in their 40s and up, and how I assumed, without any viable information about the topic, that women simply experienced more anxiety and depression in midlife. To say I am now humbled by what I did not know then is an understatement.

This information was not readily discussed either in my own graduate school experience, or when I later became a counseling professor.  I am someone who not only taught therapists about human development in graduate school, but I also developed online curriculums for this topic. The articles or books that I came across often described midlife as a crisis, or a second adolescence. Rarely did they specifically address perimenopause or menopause as part of mental health treatment. If it was mentioned at all in a textbook the topic was minimized. For example, a theorist from the late 90’s described menopause as something that was not “universally distressing.” Another described that only 10% of women have anything beyond mild concerns. From my own lived experience, as well as women that have shared theirs with me, this seems wildly dismissive. While research on menopause and perimenopause is still sparse in comparison to other hormonal times of life, thankfully in 2022 the research and up to date practices for hormone therapy shifted considerably.

Since women spend forty percent of their lives post menopause, I believe that therapists must strive to be up to date on research and practices to better serve this population. The best description I have found for perimenopause is that this is a vulnerable window of time when people assigned female at birth experience symptoms that become inconsistent with the typical monthly cycle that they have experienced since puberty. Along with that comes both physical and mental symptoms. For some folks, this is mild but for many present with new or exacerbated symptoms. This includes cognitive functions, anxiety, depression, sleep problems, and libido problems. A new mental health diagnosis may present itself that may have been present but problematic. Many women I have worked with describe this as an unmasking of symptoms where they previously had strategies and coping skills to manage symptoms. And now the previous strategies have stopped working.

Here are some guidelines I recommend for women when seeking mental health treatment during or after perimenopause.

1.      Know that you are not alone, and while it can feel chaotic, you are not going crazy.

2.      When seeking therapy, ask what the therapist knows about perimenopause and menopause. In the absence of knowing, willingness to learn can be critical for support.

3.      Remember that comparison is the thief of joy- here is no one size fits all solution. Some women experience brain changes for the first time, such as brain fog. While others might have past symptoms come up. You can work with your therapist to determine what can be helped in a therapeutic setting.

4.      How you navigate your symptoms is your choice- while the research noted above is sound, many women find the idea of hormone therapy unsettling. Your therapist should help you navigate this while emphasizing your values, intuition, and overall choice.

5.      Useful methods that therapy can provide include Cognitive Behavioral Therapy, Dialectical Behavior Therapy, and Mindfulness practices, as well as psychoeducation on physical and sexual changes. Therapists that use these approaches along with a trauma informed lens can be helpful in supporting your symptoms.

On average, 3 in 10 people seeking medical treatment for perimenopause do not get the support they need. I have found that The Menopause Society is a useful website for finding providers. In addition to therapy, finding social supports is invaluable.

If you are in Washington state and you are looking for a therapist that is informed about perimenopause, menopause and mental health please reach out to me. I am also interested in building my network with other therapists, dieticians, and primary care providers who either specialize in this or want to know more to better understand their patients. I am available by email at janysmurphyrising@gmail.com

Sources

https://menopause.org/

https://wholehealthnaturopathy.com/hormone-therapy-for-peri-menopause/

The Menopause Brain by Lisa Mosconi