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Empower Your Menopause Transition: How Mind As Medicine can Transform Symptom Management

Representation of the female reproductive system using flowers

Image by pikisuperstar on Freepik

In November 2023, The National Institute for Health and Care Excellence (otherwise known as NICE) updated their guidance on the ‘Diagnosis and Management of the Menopause’. 

This guideline plays an important role in raising awareness of menopausal symptoms, and in clearly setting out the treatment options that should be made available to women.

The idea is that the Guideline gives healthcare professionals evidence-based information upon which to base their recommendations to their patients, and also enables women to better make informed choices about their treatment.

The British Menopause Society says that the ‘menopause affects all women and can have significant consequences both on impact of symptoms and later health problems. Despite this, many women are unaware of the effects and are confused about benefits and risks of treatment options.’

The New NICE Guidelines and Cognitive Behavioural Therapy (CBT)

In previous versions of the Guideline, NICE identified CBT as a treatment option for managing depression and anxiety associated with the menopause.

But in this most recent update, they go much further, and suggest that CBT can also help to reduce additional menopause symptoms, including hot flushes, night sweats, and problems sleeping.

That’s not to say that CBT is being recommended as an alternative treatment to Hormone Replacement Therapy (HRT), but rather, as the Menopause Society points out, that it is an effective option which can be offered in addition to HRT. 

And of course, it can provide a treatment strategy for women who choose not to take HRT, or those who have medical reasons to be cautious about HRT use. 

In order to maintain my accreditation, I have to undertake continuing professional development activities and, with the new guidelines in mind, I jumped at the chance of attending a whole day workshop led by clinical health psychologist Dr Melanie Smith.

In this post, I’m going to cover the following key areas to help you navigate menopause effectively:

Menopause 101: Key Symptoms and What to Expect

Menopause is a natural transition in a woman’s life, marking the end of menstruation and fertility, and typically happens between the ages of 45 and 55 years old (the average being 51 in Western societies).

Image by freepik

A hand throwing a clock and flowers into the air to represent the passing of time for a woman

Menopause is defined as the point at which a woman has gone 12 consecutive months without menstruating.

Perimenopause is the time leading up to that day -the transitional period- and it can take up to ten years of perimenopause for some women to actually reach the menopause.

This means that some women will start to experience the onset of symptoms as early as their late 30's, which can come as a bit of a surprise, and perhaps means that menopause isn't really on their radar as a potential cause for their symptoms.

This is why raising awareness is so important!

Everyone’s experience is different, with some women seemingly making a relatively straightforward transition whilst others find that they really struggle.

The stereotypical menopausal woman experiences hot flushes and brain fog - certainly that is how they are portrayed in popular media - and yet there is a long list of different symptoms that can be attributed to menopause, with any one individual experiencing a different combination compared to the next.

So it’s common for women to not recognise that they are perimenopausal if their particular combination of symptoms doesn’t include those that are classically associated with going through 'The Change'; and also, as I've already said above, if they have not yet reached the age that they associate with menopause.

Image by wayhomestudio on Freepik

A menopausal woman pointing to her left

For a comprehensive list of symptoms (and an extremely useful resource for all things menopause) check out the ‘Balance’ website of Dr Louise Newson.

Exploring Societal Attitudes

During the workshop, we conducted a free association exercise to capture perspectives on, and attitudes towards, menopausal women which was visualized through a word cloud.

Here’s a screenshot of the word cloud: 

Picture of a word cloud  of descriptors of menopause

What do you notice?

Looking at that, I wonder how significant, and important, societal misconceptions and stigma must be in a woman’s experience of menopause - certainly amongst the attendees of the workshop (not all female by the way) the consensus was that there would likely be a psychological impact which could then feed back into exacerbating some of the symptoms, such as anxiety and depression. 

A not-so-nice little feedback loop!

In recent years there have been a number of high profile individuals, most notably Davina McCall, who have made great strides in improving awareness of the menopause and HRT.

Whilst this is a good start for working towards overcoming some of the stigma attached to this phase of life, there is a danger that it sends the message that menopause is a problem to be solved by the medical model of treatment, and that HRT is 'the' solution - i.e. losing the message that menopause is a normal life transition and instead framing it like a medical disease that needs curing with medicine.

But where does that leave people for whom HRT isn’t an option (e.g. someone with a history of breast cancer) or that eschews medical intervention?

Mind Over Medicine: The Essential Role of Psychological Approaches in Menopause Care

Original Image by wayhomestudio on Freepik

A menopausal woman lost in thought with the caption "I shouldn't be feeling this way, I should be coping better!"

This is where the new guidance from NICE can be really helpful because it recognises that there is a place for psychological strategies in providing effective symptom relief by addressing the emotional and cognitive dimensions of menopause, either alongside medicalised treatments or as a stand-alone intervention.

The psychological approach to menopause aims to empower women by offering them tools to manage symptoms and improve their overall wellbeing by focusing on mental resilience and coping mechanisms.

“But” I hear you say, “how can a psychological approach make a difference to real physical symptoms?” - remember, your mind is a product of your brain and your brain is part of your body!

The mind-body connection is extremely powerful and can be leveraged to influence your perception and experience of menopause.

How the Mind-Body Connection Affects Physical Menopausal Symptoms

There are several ways in which our mind-body connection can be involved in menopausal symptomology.

The Thermoregulatory System:

We have a complex system for maintaining our internal body temperature, called the thermoregulatory system, that ensures it stays within a narrow, optimum range of around around 37°C (98.6°F); this is the thermoneutral zone (our comfortable temperature range).

Image by brgfx on Freepik

A graphic of the cross section of the brain indicating the hypothalamus and pituitary gland

Deep inside our brain is the hypothalamus which acts like a thermostat - i.e. it keeps our bodies balanced in a stable state (called homeostasis) and does whatever is necessary to return us to the thermoneutral zone.

It detects changes in our core temperature via signals from receptors located in our skin and internal organs; when temperature deviations are detected, it employs various mechanisms to achieve homeostasis:

  • sweating and widening of blood vessels to dissipate heat for an increase in temperature; and

  • shivering and narrowing of blood vessels to conserve head during cold exposure.

It will also trigger behavioural responses in our brains, leading us to take action such as looking for shade or adding layers of clothing.

Oestrogen is involved in the thermoregulatory process and because oestrogen levels drop during the menopause transition, there is a knock on effect of a narrowing of the thermoneutral zone which makes our bodies become more sensitive to temperature fluctuations.

Stress-Induced Hyperarousal:

The hypothalamus is a very busy bit of the brain!

As well as taking care of the thermoregulation system, it is also involved with regulating the body’s way of managing stress.

It is in communication with the pituitary and the adrenal glands, forming what is called the hypothalamic-pituitary-adrenal axis (HPA axis). 

Image by brgfx on Freepik

A graphic representation of the HPA axis

Think of it as being like a chain reaction that starts in your brain and ends with your body getting ready to deal with something that you have perceived as a threat (even if only subconciously). 

When you are facing something stressful, your hypothalamus sends a signal to your pituitary gland, which then tells your adrenal glands to release cortisol, a hormone that helps your body respond to stress by giving you more energy and alertness. 

In everyday language we're talking about the fight or flight response.

However, as well as charging up your body to deal with whatever the perceived threat is, this activation also disrupts your normal thermoregulation process.

Once the stressful period is over, your body stops making cortisol so that everything can return to its normal balance. 

But if you’re experiencing chronic stress, then it’s as if this system is stuck on always being switched on to some degree, and that will cause problems in the long run.

In the context of menopause, you’re more likely to experience hot flushes when your normal thermoregulation is disrupted, so it starts to make sense that strategies designed for stress management could improve a physical symptom such as hot flushes.

How the Mind-Body Connection Affects Psychological Menopausal Symptoms

The Importance of Oestrogen

A picture of a neuron

Serotonin is a key neurotransmitter* that is involved in regulating our mood, and many of the medications that are used for treating depression are what are called Selective Serotonin Reuptake Inhibitors (SSRIs) - the idea behind them being that the drug stops the Serotonin from being absorbed, or ‘taken up’, by the nerve cells in the brain which then leaves it free to continue passing messages between nearby nerve cells.

*this just means it’s like a messenger carrying information between nerve cells in your brain.

As Oestrogen levels fall during menopause, there can be a knock on effect for Serotonin.

Oestrogen normally enhances Serotonin production and also increases the sensitivity of Serotonin receptors in the brain, so as Oestrogen declines not only can levels of Serotonin fall but also the ability of the brain to detect it may also be blunted.

This can then contribute to the mood swings, irritability, anxiety, depression, disrupted sleep and brain fog that are experienced by some people during menopause. 

As well as Oestrogen, another hormone that we hear a lot about in connection with the menopause is Progesterone.

The Importance of Progesterone

Progesterone helps calm the nervous system by working with another kind of receptor in the brain (GABA receptors).

A finger pressing an off button

These receptors are like the brain's "off switch" for stress. 

When Progesterone levels start falling it can affect how well these calming "off switches" work, meaning that you could have a greater potential for feeling stressed and/or anxious - this is yet another way in which the biology can be involved in the psychology!

In the past I’ve done a whole series of posts about negative thinking patterns because they are such an important thing to be aware of, due to the significant impact that they can have on our quality of life.

So it’s not surprising that I’m going to bring them up here when we’re talking about menopause.

As I showed you above in the word cloud, there are a lot of negative connotations around menopause and that will invariably impact upon individuals moving through this transition.

Many people in the workshop highlighted shame as a common and impactful emotion that can be experienced in connection with the menopause, and it doesn’t take a psychology degree to work out that this is going to influence a person’s experience and self-perception.

Image by cookie_studio on Freepik

A menopausal woman with her hands on her head to represent that she is experiencing negative thinking

Thoughts only have as much power as we are prepared to give them, but unfortunately many, many, many people don’t realise that, and feel that their negative thinking patterns are ‘in the driving seat’ with all the control.

So our view of menopausal symptoms will be seen through the lens of whichever unhelpful thinking pattern is the brain’s favourite for the day.

For example, an individual experiencing a hot flush might begin to think:

“This will never end; I’ll be suffering like this forever”

which pulls them into hyperfocusing on the physical symptoms that they are experiencing. 

This is an example of the catastrophising thinking pattern. 

When we are super focused on something, it intensifies our experience - try it out…spend a moment focusing all your attention on the big toe on your left foot.

A foot and a hand

What did you notice?

When I do this exercise with people in sessions they often tell me that they became very aware of physical sensations in that toe which they weren’t aware of moments before when our attention had been on our conversation.

When I was little, my mum intuitively knew this because if I complained to her that I’d hurt myself, say bumped my knee, she would tell me that she’d stamp on my foot and then my knee wouldn’t hurt any more (she had a dark sense of humour!) 

So our hypothetical woman who is hyperfocusing on her hot flush is likely to be unintentionally exacerbating her feelings of anxiety and stress; as we’ve seen above, due to the mind-body connection, this heightened emotional state can increase the frequency and severity of hot flushes.

So, unintentionally she is creating a vicious cycle where their negative expectations manifest more severe symptoms. 

Another common negative thinking pattern associated with menopause is black and white thinking.

Believing that there’s no middle ground between feeling perfectly fine or utterly unwell can make even minor discomforts seem totally overwhelming! 

This unhelpful thinking habit can very easily lead to avoidance behaviours, such as withdrawing from social activities, due to the fear of being embarrassed by symptoms:

“I don’t want everyone seeing what a hot mess I am”

A partial view of a menopausal woman's face dripping with sweat

But this reinforces a sense of isolation and helplessness, which then feeds back into the stress cycle. 

It’s probably not surprising then that numerous studies have shown that there is a significant correlation between our emotional wellbeing and the management of menopausal symptoms.

Research shows that individuals who manage to maintain a positive emotional outlook during their menopause transition tend to experience fewer and less severe symptoms compared to those who don’t.

These findings underscore the importance of psychological health, reinforcing the idea that enhancing emotional well-being and reducing stress can be key strategies in mitigating the physical challenges of menopause.

Harnessing the Power of Mindset to Ease Menopause Symptoms

Hopefully I’ve been able to give you a rationale for a psychological approach to menopause that is plausible and makes sense, so what can you do now to help yourself?

Techniques for Fostering a Growth Mindset to Handle Menopausal Changes.

Ways of cultivating this mindset include:

  • Reframing Challenges as Opportunities: If we view the symptoms of menopause as opportunities for growth and learning, rather than as insurmountable obstacles, it can help us to start reducing our feelings of helplessness (e.g. experiencing a hot flush can be seen as a chance to practise and refine a new stress management technique).

  • Emphasising Our Self-Compassion: When we treat ourselves with the same kindness and understanding that we would offer a friend in similar circumstances, it helps us to overcome self-criticism (another classic negative thinking habit!) and reinforces our emotional resilience. Self-compassion practices like journaling positive affirmations or practising self-care routines can enhance this process. If you’d like some ideas then check out the website of Dr Kristin Neff, who is one of the leading authorities on Self-Compassion.

  • Setting Incremental Goals: When we break down larger wellness goals into smaller, achievable steps it can make them seem less overwhelming and more achievable. As we start engaging with them they provide us with a sense of accomplishment and that then helps us to maintain motivation. For example, starting the day with a short mindfulness exercise, or making gradual changes in nutrition and movement can create a manageable path to better health. Check out this previous post of mine about the four pillars of health

  • Celebrating Progress: Acknowledging and celebrating small wins, such as successfully managing a stressful situation without a severe hot flush, helps us to reinforces positive behaviours and will encourage us to continue investing in the strategies. To super-charge this, try keeping a journal of your successes as this provides a tangible record of progress to counter any negative thinking habits (e.g. mountains & molehills or the mental filter) and boost your confidence.

  • Learning from Setbacks: When we view setbacks as learning opportunities rather than failures it really helps us to foster a growth mindset. When symptoms do flare up (as they invariably will), we can gain valuable insights by reflecting on what might have triggered them and exploring alternative coping strategies. This can really help strengthen our resilience!

  • Continuous Learning: Keep yourself informed about menopause through books, podcasts, workshops, and talking to other people who are also going through this transition. This can really help you foster a sense of control and feelings of preparedness. I’ve written this post because I believe that knowledge about the biological, psychological, and social aspects of menopause empowers women to make informed decisions and actively participate in their own care, and this is my way of trying to promote that.

  • Seeking Support: As mentioned in the previous point, talking with others in the same/similar situation, whether with friends or perhaps through a menopause support group, provides social reinforcement, and having a shared experience not only reinforces a growth mindset but also goes a long way to overcome feelings of isolation and not being heard. Additionally, hearing how others are perhaps successfully navigating similar challenges can offer you new strategies that you’ve not thought of previously trying.

  • Mindfulness and Meditation: These words tend to get bandied around a lot these days with the implication that they are a bit of a ‘cure all’, but incorporating mindfulness and meditation practices can be really beneficial for some people. It can help you to stay present focused and respond more calmly to menopausal symptoms, which will have a positive impact of any feelings of anxiety. Regular mindfulness practices can help you to build a more balanced perspective of things and to reduce your reactivity to stressors.

Conclusion: Empowering You to Navigate Menopause with Confidence

As I said at the start, this was a whole day workshop and really I have only scratched the surface in sharing the learnings from the day. 

A menopausal woman confidently taking a selfie

One of the key take home messages from the workshop was just how powerful the mind-body connection is, and that by understanding the biological changes that you are going through, whilst developing a growth mindset, you can become an active participant in managing your own experience.

Really, this post has just scratched the surface! Look out for future blogs where I will revisit this topic to share more insights with you - to dive deeper into specific aspects, please let me know in the comments what resonated most with you, and I'll prioritise those areas in future posts!

If you have found this post helpful then please consider sharing it so that others can benefit too.

You can also check out previous posts that I have written about lifestyle/psychological approaches to menopause:

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