This year, World Menopause Day is the 18th October. The aim of the day is to provide support to women who are going through menopause and to raise awareness of the menopause and the support options available.
My experience of the (peri)menopause thus far is that it’s an exhausting, lonely, scary and overwhelming place to be. The menopause and perimenopause remain one of those subjects around which there is a conspiracy of silence – cloaked in a blanket of shame and embarrassment and often discussed in private using hushed voices. Mental health problems are a natural part of life, like having a cold, we should be able to talk about it.
So, let’s talk about the menopause … firstly, what is it? Well, it’s is a point in time 12 months after a woman’s last period – when the ovaries stop producing a hormone called oestrogen and no longer release eggs. The years leading up this point, when a woman’s periods may become less regular as oestrogen levels fall is known as the ‘perimenopause’. Perimenopause often begins between ages 45 and 55 and lasts, on average, about 7 years.
Menopause affects every woman differently. Some women may have no symptoms at all, or they might be brief and short lived. For other women the symptoms are severe and distressing. The hard truth about being menopausal is that it can make everyday life a challenge and not only affects a woman’s life but also impacts the lives of her family and work colleagues as well.
Unfortunately for those women who do experience symptoms, it can be a very difficult and frightening time to navigate through. Often menopausal symptoms can, incorrectly, be (and often are) explained away by many other ‘medical diagnoses’.
What are some of the most common symptoms associated with menopause?
Many of the symptoms associated with menopause tend to be as a result of hormone imbalance and lack of oestrogen. These symptoms can affect how you feel. You may find that you become stressed, anxious and irritable, suffer with low energy levels and experience mood swings. This change in emotions can lead to feelings of low mood and depression. All of which can be made worse if you are fatigued and experiencing symptoms such as disturbed sleep or insomnia due to night sweats.
In addition, you may experience difficulty concentrating, suffer with ‘brain fog’ and poor memory which can negatively affect your confidence. During this period, the body begins to use energy differently, fat cells change, and women may gain weight more easily.
It is likely that you will also experience some of the following physical symptoms: hot flushes, vaginal dryness, digestive problems, itchy skin, breast pain, loss of sex drive, sensitive bladder (an increase in incontinence) and headaches. Bones also become less dense, causing joint aches and pains, making women more vulnerable to fractures.
However, the menopause does not happen in isolation. Women’s lives are complex, particularly at midlife – changes in family dynamics, health problems and significant life events may coincide with menopausal symptoms. Trying to balance work life with domestic responsibilities, where women may be caring for young children, teenagers, grandchildren, ageing parents, and in some cases their partner. Maybe supporting teenagers through exams, and coping with children leaving home only to return at some stage to fill the ‘empty nest’. Throw bereavement, chronic illness and disease, divorce, financial concerns and other factors into the mix and all this can exacerbate symptoms and add to the burden of uncertainty, anxiety and stress women often feel around the menopause.
Creating a more positive approach with CBT
Fortunately, it’s not all ‘doom and gloom’ (phew!) We have far more influence over our menopause journey than we are led to believe. Taking time for yourself, challenging negative attitudes and expectations about menopause and midlife can be helpful.
In addition to medical treatments, such as hormone therapy, many women prefer non-medical options such as Cognitive Behavioural Therapy (CBT). The National Institute for Health and Care Excellence (NICE) guidelines recognise that mental health issues can be symptoms of the menopause and have recommended CBT as an effective approach.
CBT is a well-researched and effective treatment for menopausal symptoms such as anxiety, depression, and sleep problems. More recently it has also been demonstrated to be effective in reducing the impact of hot flashes and night sweats. It is based on the concept that our thoughts, feelings, and actions are linked. Consequently, how we feel and think affects how we behave. It makes sense, therefore, that our negative thoughts and feelings can trap us in a vicious cycle of thinking and acting in a certain way. For example, if your night sweats and insomnia are keeping you up at night, you might feel irritable and angry the next day, which could negatively impact your performance at work, leading you to feel even more upset and angry by the end of the day which in turn keeps you awake with anxiety. CBT will help you to understand these links and other negative thought processes that lead to low mood or anxiety.
How might CBT help with Menopausal symptoms?
Using an educational approach, CBT will address problematic symptoms via a number of strategies and techniques. The menopause happens to every woman and it is easy to become lost in the ‘I’m menopausal’ mindset. There is light at the end of the tunnel and it is possible to feel good about yourself. Changing the way in which we think about the menopause is the first step. CBT will help you to:
- Identify unhelpful underlying thoughts that are self-perpetuating and may negatively impact your quality of life and self-esteem.
- Reduce ‘catastrophising’ and self-critical thinking.
- Review and challenge unhelpful behavioural responses to anxiety and stress. For example, are you working longer hours? Are you eating or drinking too much? Are you avoiding certain people or activities? Are these healthy responses? Could you find a more appropriate response?
- Challenge negative social images and negative attitudes about menopausal women (which can negatively impact our self-esteem) with the goal of becoming more compassionate to ourselves.
- Address low mood by increasing activity, engaging in pleasurable activities, developing a structure to your day and reducing self-critical thinking.
- Reduce stress which exacerbates vasomotor symptoms such as hot flushes and night sweats
- Address sleep disorders, sexual concerns and depression by working through negative thought patterns, establishing positive behavioural changes and reframing the experience.
- Manage sleep and night sweats by creating good habits to optimise sleep behaviour and environment
Alongside, and in addition to, the above cognitive solutions, CBT offers a number of practical behavioural steps you can take to help with problems associated with menopause. For example,
- Relaxation and paced breathing – to calm your body’s physical and emotional reactions. Breathing from your stomach will reduce physiological arousal and allow focus to shift to neutral calming thoughts rather than on self-critical or other unhelpful thoughts. This is an important part of the CBT approach for hot flushes.
- Good sleep hygiene – train your body’s natural rhythms to facilitate sleep. Limit light in the bedroom (including light from mobile phones and laptops). Limit caffeine and alcohol which can impact sleep onset and quality. Develop a good bedtime wind down routine to help you relax before going to bed. Maintain a regular sleep pattern.
- Hot flushes – keep cool and avoid possible triggers such as spicy foods, caffeine, alcohol, smoking or stress. Dress in layers so you can remove items if you feel too warm.
- Regular exercise – may help reduce hot flushes, improve sleep and lift your mood.
- Pelvic floor exercises – squeezing and releasing the muscles that support your bowel, bladder and vagina can help strengthen your pelvic muscles and may improve your bladder control.
While CBT may not be for everyone, the benefits can certainly be worth it. CBT teaches life skills that once learned can be applied in situations long after ‘treatment’ has finished.
Don’t suffer in silence! If you’re struggling with symptoms of the menopause and think you could benefit from CBT, give me a call!
Siobhan Graham Psychotherapy – www.siobhangraham.com – 07863 546421