Raising Awareness of the Menopause Transition
by

Theorists like Sigmund Freud, Jean Piaget and Erik Erickson formalized concepts related to developmental theory. Their contributions, along with that of many others, gave us a blueprint for understanding and treating psychological challenges and disorders for clients at different stages of life. But their contributions were inadequate in regards to the specific needs for women experiencing the menopause transition and menopause.

Misinformation and inadequate research prior to the 1970’s fueled the stigma attached to what had been referred to as “hysteria” or “deficiency disease.” The disease models were not effective in the treatment, care and support of women experiencing the spectrum of difficulties and victories of menopause. Many women suffered in isolation from crippling conditions, symptoms and impairments related to menopause. And many women were not aware of their right to acknowledge and celebrate the victories.

The Menopause Transition: Today menopausal women are more empowered to ask questions, practice self-love and find appropriate treatment and care. Some of us are celebrating and ritualizing this great rite of passage. Women and some men are forming alliances to support our sisters to and through the process. We have also gained access to resources that ease suffering, especially during the menopause transition, also called perimenopause. Perimenopause is often considered the most difficult phase of menopause. It is the period when most symptoms are acute.

Perimenopause is defined by The North American Menopause Society (NAMS) as “a span of time typically lasting 6 years or more that begins with the onset of menstrual cycle changes and other menopause-related symptoms and extends through menopause (the last menstrual period) to 1 year after menopause.” Since 1989, NAMS has been “dedicated to promoting the health and quality of life of all women during midlife and beyond through an understanding of menopause and healthy aging.” They put a much needed spotlight on the importance of treatment, care and support of women experiencing the menopausal transition and beyond.

Awareness: If a woman is not aware that she has been thrust into perimenopause, she may suffer from symptoms that could easily be misdiagnosed, and subsequently mistreated. Too many women are still left to cope with the complexities, symptoms and impairments in isolation. Loved ones and care providers aren’t equipped to recognize the signs that the “change” is occurring.

So how can mental health care providers become more sensitized to the menopause transition and provide better care for women in midlife? Awareness of some basic facts could help care providers be more effective in the treatment and care of menopausal women. Be aware that the onset of the transition could begin for some women in their 30’s and others in their 50’s. Consider her family and medical history, physical condition and stressors. Be aware of the special needs that may be out of the mental health provider’s scope of practice. If appropriate, encourage collaboration with health and well-being professionals like nutritionists, physicians, spiritual advisors and others who can provide services, treatment and care. Be aware of and please consider possibilities beyond what is found in the Diagnostic and Statistical Manual of Mental Disorders (DSM).

I was not aware of the significance of this midlife change during my marriage and family therapist traineeship, or the early years of my internship. The subject of menopause never entered my mind as a possible reason for some of the symptoms presented by women I served. In retrospect, I wonder how many of my client’s issues, concerns, problems and behaviors could have been more easily addressed and resolved had I considered the effects of menopause.

I had to forgive myself for not providing more comprehensive treatment and care for some of my women clients who were experiencing severe midlife challenges. I know that my diagnoses were correct based on the criteria of the DSM. I also know that my approach to their treatment and care would have been different had I known to consider menopause as an underlying factor for some of their issues, concerns, problems and behaviors.

Presenting in the Therapy Room: Sitting in wisdom circles with mature women expanded my treatment and care toolkit for women in midlife. And asking women clients certain questions during initial client interviews/assessments, and hearing their answers revealed a list of considerations and revelations. The revelations awakened me to my own list of issues related to the menopause transition, and the importance of further investigation into what I could offer the women I served.

Below is a list of some complexities, symptoms and impairments that menopausal women may report or present in the therapy room.

A woman reporting and presenting in therapy with some of the symptoms listed above could be diagnosed with depression, anxiety, sexual dysfunction or disorder and any number of somatic, nonmedical or medical conditions and disorders. Even though medical intervention may be appropriate, recognizing the symptoms as menopause related could influence treatment and care strategies. If you are the first well-being professional that she engages, perhaps you can “pause,” normalize the symptoms and empower your client with the freedom to make more informed choices about her treatment and care. 

Unfortunately, too many women have limited or no access to well-informed health and wellness practitioners who recognize the link between menopause and what is reported and presented in the therapy room. In addition, there often is a significant absence of a “safety nest” for these women. This safety nest is a space where a woman can “lean into” and depend on people who help her gather and translate relevant information. This nest can also include places to go for respite and objects that remind her to stay connected to her “self” in the midst of “its” that happen.

Resources and Advocates: Fortunately, many women will not suffer in isolation or be crippled by menopause because of organizations like NAMS. Prominent voices like Lonnie Barbach, Ph.D who authored “The Pause” and Christiane Northrup, M.D., author of “The Wisdom of Menopause” have added their voices to a list of influential people speaking with women and advocating on behalf of women. These advocates have created forums for dialogue and platforms for a more wholistic approach to services. But the most important voices are the millions of women who are experiencing menopause and insisting on best practices in their health and well-being treatment and care.

There are a number of local and national resources available to women experiencing the trials, triumphs, symptoms, impairments, conquests, gifts, energy surges and victories of menopause. As mental health care providers, it behooves us to look into resources and raise our awareness of how we can be of service in a way that is consistent with our ethical, moral and legal obligations. If it is our intention to provide appropriate care for menopausal women, perhaps some of the resources listed below can help you increase access to additional treatment and care for the clients you serve. I welcome any feedback regarding what I have shared here, and thank you for your continued commitment to our diverse community. Be well!

Sacramento:
Women’s Health Specialists

Dr. Priscilla Monroe, RN, ND
http://www.drpriscillamonroe.com

StepINtuit Healing Arts Oasis

National:
The North American Menopause Society

Office of Women’s Health

Mayo Clinic: Menopause
http://www.mayoclinic.org

Third Age
http://www.thirdage.com

The views expressed in the Special Feature Articles do not necessarily reflect the Sacramento Valley Chapter of CAMFT or CAMFT. They should be understood as the personal opinions of the author. No information in this articles will be understood as official.  Other views and commentary are welcome and will be published as long as they are respectful and stick to the topic.

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