Mental Health Challenges For Women At Perimenopause & Menopause
I just finished reading “Women Have Been Mislead About Menopause” in the New York Times. As a licensed psychotherapist with a private practice in New York City, this is one of the best articles that I have read about menopause in a very long time. Because as a psychotherapist, I see women who are menopausal, or soon to be, suffering from impactful mental health symptoms related to these hormonal changes. Of course women have other life events that may coexist with any hormonal changes, and that’s why it’s important to let a professional help you sort things out, and this can inform your counseling and wellness plan. Because, when your hormones are all over the place, unbalanced or deficient, it also makes it harder to cope with the usual demands of life. I have had my own personal experience with hormonal changes and failing ovaries, and my own ongoing journey has opened my eyes and informed my psychotherapy practice.
Did I learn about mental health and hormones in graduate school? Absolutely not. And this means that patients seeking counseling help are likely not receiving education and comprehensive care from their psychiatrists, psychologists and other mental health professionals who should be knowledgable about the impact of hormonal changes and mental health.
According to the article, about 85 percent of women experience menopausal symptoms. Rebecca Thurston, a professor of psychiatry at the University of Pittsburgh who studies menopause, believes that, in general, “menopausal women have been underserved — an oversight that she considers one of the great blind spots of medicine. It suggests that we have a high cultural tolerance for women’s suffering,” Thurston says. “It’s not regarded as important. Women’s symptoms are often minimized or dismissed; they are told it’s “just a natural part of aging” and they will have to learn to “deal with it.”
Because women have been invalidated and even gaslit about their experience, many have had to educate themselves on the role of estrogen and other sex hormones in the body. Armed with data and a boatload of symptoms, they have become their own patient advocate. I’m a proponent of research, I actually enjoy it, but many do not. They do however rely on Western medicine and the presumed knowledge of their doctors to inform them about their experience and provide next steps to ameliorate their symptoms. Unfortunately, many of their physicians are relying on very flawed data and debunked theory. As such, women have been terrorized to avoid or discontinue natural hormones because they fear cancer, when perhaps, they should be more afraid of developing dementia, osteoporosis and cardiovascular disease—just three of the many health challenges that occur, no surprise, for women post-menopause.
Women begin to experience “mystery” symptoms beyond the four typical symptoms of perimenopause that are most common: hot flashes, sleep disruption, depression and vaginal dryness. Many women report ringing in the ears (tinnitus), tingling in extremities, dry mouth and eyes, gum and teeth problems, just to name a few. They don’t know what’s happening to them because the medical community does a poor job of acknowledging the impact of perimenopause and menopause on women’s health. Without guidance and information about hormones, women are unable to connect the dots on their own. Women at mid-life regularly reach out to a mental health professional for counseling because they are unable to manage their lives. They have new or worsening symptoms of anxiety and even panic attacks. They are edgy, weepy and sad. They’ve lost their hair and gained weight in new places. They flush with heat in the boardroom as their desire in the bedroom cools. Sex, once pleasurable, has become something they avoid because it hurts. They report that they can’t concentrate. They struggle to function at work. They worry that they have developed dementia. They crave alcohol because it increases whatever estrogen is still lingering in their system. They have palpitations. They can’t remember when last they had a night without insomnia. They don’t recognize their skin or their body contours. They’ve lost their resilience. They feel old. They have a multitude of new health complaints. They visit their doctors and are given expensive and unnecessary tests, in addition to unnecessary prescriptions. It’s almost as if there are estrogen receptors on every cell of the body, and without estrogen, the whole system is failing. No, you aren’t hysterical, neurotic or crazy, it’s your hormones.
It seems that perimenopause and menopause is finally coming out of the shadows. Some have called it the menopause “me too” moment. In fact, the menopause community is exploding online. If you have a Facebook or Instagram account, you have no doubt noticed the uptick in hormone savvy MD’s or nutritionists educating their followers about hormone imbalance, as well as products offering vaginal wellness (aka plumpness) in a jar. Sure, the demographic is growing, but women are, it seems, stepping away from shame and suffering and opting for knowledge, empowerment and treatment. They are questioning their doctors. They share the latest research with their doctors. They are choosing quality of life over fear and suffering. They don’t want to endure 7-10+ years of menopausal suffering. Many women who have muscled through for several years are also discovering that it’s really very difficult living without hormones, especially if they are to live 40 years in a state of hormonal deprivation.
Rarely are women getting help from medical professionals who seem to think that the symptoms of menopause are limited to just hot flashes and night sweats. And once she toughs it out, all will be well and she’ll love her life again. Women are regularly invalidated by medical professionals who do not know about the devastating consequences of menopause for so many women. Heck, women do not connect the dots that these new and strange symptoms are related to ovarian failure. Agree, it’s a major blindspot for doctors to think that the suffering of women should be minimized and that women should just tolerate the suffering because it’s just a part of aging. Just because it’s a natural occurrence does not mean that it’s acceptable or desirable.
Women are searching for medical professionals, specialists, clinics, telehealth providers who take their symptoms seriously, and are willing to allow their patients to choose how they would like to live out their lives post-menopause. If you are suffering with hormone-related anxiety, depression, insomnia, heart palpitations, or something else, don’t feel resigned to just bear the burden. Educate yourself; learn as much as possible so that you can make an informed decision. Learn about the many ways that estrogen deficiency is affecting you. Prepare to arm yourself with studies. Understand the deeply-flawed Women’s Health Initiative (WHI) study that changed the course of women’s health, and know that your doctor may still be following this faulty guidance. Find your courage to advocate for yourself. No, you shouldn’t have to, but this is where we are at the moment until things change.
You may be wondering if therapy and counseling can help improve your mental health during menopause and hormone-related transitions? Absolutely, therapy with a mental health professional who understands the role of reproductive hormones on the body, can help premenopausal and menopausal women feel better and find solutions to their health concerns. Research suggests that CBT can help with the management of insomnia, night sweats and hot flashes. CBT also helps women manage negative thoughts and emotions that surface at this time. EMDR therapy is very effective at helping women resolve trauma(s) that have resurfaced at this time. Support with lifestyle changes, nutrition and resources are an integral part of menopause counseling and coaching.
If you’re suffering with mental health complaints, bring your concerns, and your research, to your therapist, psychologist or psychiatrist. If your psychotherapist or counselor is unwilling, for any reason, to acknowledge your health concerns, it’s time to find a more flexible and educated practitioner.
Some helpful getting started resources to learn about menopause and mental and physical health and discover lifestyle and treatment options that can help you thrive…
Menopause: 50 Things You Need To Know
It’s not just estrogen, progesterone and testosterone that delines at this time. Many other important hormonal systems are disrupted during this very stressful time, including changes in cortisol, thyroid and more. What follows are some Common complaints At Medical Menopause, Premature Menopause, Perimenopause, Menopause And The Years Beyond The Transition: (You May Have None Of These, Many Or Nearly All)
Hot flashes, flushes, night sweats and/or cold flashes, clammy feeling
Irregular heart beat, palpitations
Irritability
Mood swings, sudden tears
Trouble sleeping through the night (with or without night sweats)
Irregular periods; shorter, lighter periods; heavier periods, flooding; phantom periods, shorter cycles, longer cycles
Loss of libido
Dry vagina
Crashing fatigue
Anxiety, feeling ill at ease
Feelings of dread, apprehension, doom
Difficulty concentrating, disorientation, mental confusion
Disturbing memory lapses
Incontinence, especially upon sneezing, laughing; urge incontinence
Itchy, crawly skin
Aching, sore joints, muscles and tendons
Increased tension in muscles
Breast tenderness
Headache change: increase or decrease
Gastrointestinal distress, indigestion, flatulence, gas pain, nausea
Sudden bouts of bloat
Depression
Exacerbation of existing conditions
Increase in allergies
Weight gain
Hair loss or thinning, head, pubic, or whole body; increase in facial hair
Dizziness, light-headedness, episodes of loss of balance
Changes in body odor
Electric shock sensation under the skin and in the head
Tingling in the extremities
Gum problems, increased bleeding
Burning tongue, burning roof of mouth, bad taste in mouth, change in breath odor
Osteoporosis (after several years)
Changes in fingernails: softer, crack or break easier
Tinnitus: ringing in ears, bells, 'whooshing,' buzzing etc.
Accelerated aging
(Symptom excerpt from Project Aware)
About Holistic Psychotherapy & Wellness Manhattan
Kimberly Seelbrede, LCSW is a New York State licensed Psychotherapist, EMDR Practitioner and Couple Therapist with a private practice in New York City, Montana and virtually. As a wellness psychotherapist and holistic consultant, she has receive advanced, extensive training in Psychoanalytic Psychotherapy, Internal Family Systems (IFS), Eye Movement Desensitization Reprocessing (EMDR), Cognitive Behavioral Therapy (CBT), Dialectical Behavior Therapy (DBT), Somatic Experiencing (SE), and Nutrition & Integrative Medicine For Mental Health. She is passionate about honoring the exquisite interplay of the mind-body connection. Kim Seelbrede specializes in anxiety, depression, trauma and women’s mental health. She brings over 20 years of counseling, coaching, and healing experience to her holistic practice and transformational work.
In addition to online therapy for anxiety, depression, trauma and relationship struggles, Holistic Psychotherapy & Wellness offers a wide variety of online services to fit the needs of busy professionals. New Yorkers often lead fast-paced and complex lives, which makes work-life balance and managing career, family and social obligations a challenge. Psychotherapy and wellness practices provides the support to help clients cultivate resources, resilience and enhanced emotional health, as well as uncover conflicts and obstacles that may interfere with having the life they desire.