The menopause can be a difficult and challenging experience for many women, whilst others enter and leave this phase of their hormonal life relatively unaffected and symptom free. This can also be a time of many life changes, with various physical, social and emotional changes to try and circumnavigate - children leaving home, or staying at home (which may not have been in your long term plans!), weight gain, hair thinning on your head but growing in areas where you’d really rather not have hair, wrinkles, saggy bits, thread veins, varicose veins, stress incontinence, the list goes on and all of these can have a significant impact on your self-esteem. And then to top it all, as if life couldn’t get any more challenging, the five horsewomen of the hormonal apocalypse ride into your life - hot sweats, sleepless nights, fatigue, vaginal dryness and lack of libido. And of course, all the above often have an emotional impact - negative feelings about yourself, low mood, irritability and anxiety.
Whilst specialist doctors can help with the physical changes, offering a range of treatments and medications including hormone replacement therapy, non-hormonal alternatives, vaginal moisturisers and dietary advice; psychotherapy can help you to adjust to some of the emotional challenges that the menopause brings, and put things in perspective.
Cognitive behavioural therapy
Cognitive behavioural therapy (CBT) can help you to develop coping skills by challenging the negative beliefs associated with the physical and emotional changes you are now faced with and substituting them for more balanced beliefs.
CBT is based on the idea that what you think and what you do affects how you feel. Sometimes people get stuck in vicious cycles and develop behaviours which are not helpful, and what they do to try and solve a problem inadvertently keeps the problem going. CBT helps you to understand how your thoughts, feelings, body sensations and behaviours all interlink, while it’s difficult to change your feelings and body sensations, you can change your behaviours and thoughts to more helpful behaviours and more balanced thoughts, which is the main focus of this therapy, and once you’ve mastered the art of changing your behaviours and challenging your thoughts the changes in how you feel about things will follow.
Let’s look at an example…
Situation – you’re at a work meeting, and start to have a hot flush accompanied by palpitations
Physical sensations – hot, sweating, heart racing (prompted by hormones)
Thoughts – everyone is looking at me, it’s really noticeable, people will think I’m incompetent and not able to cope with my job, they will replace me with a younger person
Feelings – embarrassed, anxious, not in control
Behaviour – make an excuse and leave the meeting and avoiding future meetings as much as possible
Now in this example the physical sensation was the starting point, which then prompted the negative thoughts, feelings and the unhelpful behaviour. The behaviour of this person was unhelpful as her avoidance, in turn is more likely to prompt colleagues to think that she is not able to cope with her job.
Let’s look at another example…
Situation – partner says “let’s have an early night”
Thoughts – he’s going to expect us to have sex, I’ve put weight on, he doesn’t find me attractive anymore, I’ll be expected to get ‘turned on’
Feelings – anxious, upset, worried
Physical sensations – difficulty concentrating, heart racing, hot, sweating (prompted by anxiety)
Behaviour – go to bed but keep nightdress on and thick duvet on so her partner can’t really see her body, just concentrate on touching him during foreplay and not letting him touch her
Now in this second example the negative automatic thoughts started off the vicious cycle of negative feelings, physical sensations and behaviours. The behaviour of this person was unhelpful as trying to keep her body covered means she is more likely to overheat and become even more hot and sweaty, and her avoidance of being touched herself means she is less likely to feel sexually aroused, and less likely to lubricate naturally.
Compassion focused therapy
Compassion focused therapy (CFT) can also be helpful in addressing self-critical thoughts and feelings of shame. CFT is based on the idea that humans have three different systems which manage their emotional states, each with different motivations and each associated with a different part of the brain. These three systems are the threat system, the drive system and the soothing system. Ideally there would be balance between these three systems, all are essential for a balanced life as a human, however, because of upbringing and previous life events, for some people their threat system is dominant and their soothing system has not been fully developed, these people are more likely to be self-critical and avoid situations that are challenging and make them feel threatened. CFT can teach you to develop the soothing system (self-compassion) and start to be more empathic and less judgemental towards yourself.
Whilst CBT can be great for helping you to develop more balanced reality tested thoughts, and whilst you may start to believe these more balanced thoughts at a rational level, sometimes it can be difficult to actually feel these new more balanced beliefs because of the tone of your self-critical inner voice.
Let’s look at an example….
You’ve been on a night out, had a curry, a couple of glasses of wine and are feeling guilty as you’ve been trying to eat a healthy diet and take regular exercise.
Client – “I’m disgusting, I have no self-control, I’ve let myself down”
Therapist – “So if a friend was in this situation, what would you say to them?”
Client – “of course you’re not disgusting…everyone’s allowed to let their hair down once in a while…you try so hard most of the time to eat a healthy diet and exercise…you have a great figure and you can’t expect to be the same size as you were in you twenties”
Therapist - now I want you to say these statements to yourself, firstly in a neutral tone, then in a critical tone, then in a compassionate tone and notice how each feel to you. Which tone of voice do you usually hear when you’re being tough on yourself?
CFT helps you to realise that the things that have happened to you during your life are not your fault, they have been influenced by your genes, the family you were born into and often events that have happened that are beyond your control. However, you do have some responsibility, that being to try and alleviate your own suffering and be the best version of yourself that you can possibly be.
The menopause and getting older is an inevitable process, it’s as natural as sleeping and breathing, try not feel threatened by it, you can’t fight it, you can’t run away from it, but you can reframe how you feel about it and reach the other side as a confident, wise and self-compassionate woman.
About Emma Mathews
Emma is a cognitive behavioural therapist, EMDR therapist, psychosexual therapist and relationship therapist.
She is a BABCP and COSRT accredited psychotherapist and has extensive experience working within the NHS as a psychosexual therapist and specialist midwife within perinatal mental health services. Emma also worked for Relate as a psychosexual and relationship therapist for a number of years.
She has completed a BSc in reproductive and sexual health, a postgraduate diploma in psychosexual therapy, a Relate certificate in relationship therapy, a postgraduate diploma in cognitive behavioural therapy (CBT) and EMDR Europe Accredited training in eye movement desensitisation and reprocessing (EMDR). In addition she completed an MSc in psychological trauma and has a special interest in the treatment of post-traumatic stress disorder (PTSD), particularly in the treatment of PTSD following childbirth.
Her private practice at Beehive offers psychosexual and relationship therapy, CBT and EMDR.