Exploring Menopause: Insights from The New Menopause by Dr. Mary Claire Haver

Did you know that a significant percentage of women experience cognitive and/or emotional symptoms during the menopause transition? Some experts in the field believe this number to be as high as 70% (Dr Theodora Kalentzi, a GP and menopause specialist at Medical Prime). And, an analysis published by Harvard Medical School (July 2024 in the Journal of Affective Disorders) found that women going through perimenopause are 40% more likely to experience symptoms of depression. Considering the vast number of women experiencing mental health symptoms during this phase of life, which often begins in a woman’s 40s, it is imperative that as therapists we understand how these hormonal changes are impacting our clients’ lives and relationships.

I recently read The New Menopause: Navigating Your Path Through Hormonal Change with

Purpose, Power, and Facts by Mary Claire Haver, MD, to deepen my understanding of the

challenges many of my clients face. Published in 2024, Dr. Haver’s book offers a thoughtful

exploration of the history, science, and societal perceptions of menopause.

Historically, women’s health concerns—including menopause—have often been marginalized or misunderstood. Dr. Haver addresses this gap by providing a thorough and compassionate explanation of menopause while dispelling harmful myths, such as the dismissive notion that it’s “all in a woman’s head.”

Her book outlines the three distinct phases of menopause:

1. Perimenopause: Often starting in a woman’s 40s (although it can begin as early as the mid-30s), is characterized by fluctuating hormones and irregular periods.

2. Menopause: Defined as 12 consecutive months without a menstrual cycle, is a specific moment in time. Most women experience menopause between the ages of 45 and 55.

3. Post menopause: This phase begins after menopause and can last for years. Hormonal

   shifts may lead to symptoms persisting or evolving, often peaking during this time.

   
   

Dr. Haver also delves into the history and evolving research on Hormone Replacement Therapy (HRT), clarifying its potential benefits and risks. While HRT isn’t within the scope of mental health providers to prescribe or recommend, being informed about it allows us to guide clients in conversations with their physicians.

Why Therapists Should Understand Menopause

In reading The New Menopause, I discovered insights relevant to any therapist working with

women aged 40 and older. Perimenopause often begins at this stage of life, bringing physical, emotional, and psychological changes that can significantly impact mental health.

Dr. Haver highlights that menopause significantly increases the risk of mental health challenges such as depression and anxiety, noting that shifts in mood, cognition, and emotional well-being are common. Hormonal fluctuations can cause many symptoms—66, to be exact! These range from hot flashes and sleep disturbances to brain fog, depression, irritability, anxiety, reduced sex drive, TMJ, and chronic fatigue.

Unfortunately, many of these symptoms are dismissed by doctors or attributed to unrelated

causes. As therapists, we have the opportunity to normalize these experiences for our clients by exploring where they are in their menstrual life cycle and encouraging conversations with their healthcare providers.

Tools to Support Clients Through Menopause

To better serve clients experiencing perimenopause or menopause-related challenges, I’ve

created a checklist in my practice management software. This self-screening tool helps clients identify potential symptoms and can serve as a conversation starter with their doctors. Knowing the symptoms or creating a similar resource could be beneficial for your practice as well.

Moreover, as therapists, we can support clients in several ways:

• Teaching stress management skills. As we know, stress increases the production of

hormones such as Cortisol, which can increase inflammation and lead to a variety of

menopause related symptoms, such as anxiety, sleep disturbances, and TMJ.

•  Offering couples therapy to help partners understand and navigate these changes

together. Mood changes, irritability, reduced sex drive or physical discomfort with

intercourse are just a few of the possible symptoms of menopause that can impact a

relationship.

•  Using CBT techniques for symptoms like depression, hot flashes, irritability, anxiety and sleep issues.

•  Recommending daily exercise to optimize restful sleep, reduce anxiety, mood swings,

brain fog, and depression. Some studies have also shown that exercise may reduce the frequency and severity of hot flashes.

•  Taking a trauma-informed approach, A particularly striking study, published in

Menopause in 2022, revealed a connection between intergenerational trauma and early menopause. This study found that trauma can accelerate the onset of menopause by up to nine years, emphasizing the importance of addressing unresolved trauma in therapy.

• Providing psychoeducation to reduce anxiety and empower clients with knowledge.

 Sharing educational resources like The New Menopause by Dr. Haver, Come As You Are by Dr. Emily Nagowski, or Dr. Kelly Casperson’s podcast, You Are Not Broken.

• Referring clients to their gynecologists or psychiatrists for discussions about HRT or

medications like SSRIs, which have shown efficacy in managing hot flashes for some

women.

Dr. Haver’s Menopause Toolkit is another valuable resource featured in this book. It contains

practical strategies for understanding and managing symptoms, which can be transformative for clients navigating this phase of life.

By fostering open conversations about menopause and providing tools for emotional and

physical wellness, we can empower our clients to navigate this journey with confidence and

resilience. Dr. Haver’s work is an excellent reminder of how interconnected the mind and body are, and how vital it is to approach menopause holistically.