Menopause and Therapy

Expressionist painting from Hokusai's Great Wave off Kanagawa in reds, yellows and black.

World Menopause Day 2021

Truthfully I don’t know how – or even whether – to celebrate World Menopause Day. What I do know is that if you are reading this, you may be seeking some clarity about your situation, whether for you or someone close to you.

Things are gradually changing for the better. Awareness-raising is increasing and more people are shouting about menopause, particularly those who are generally excluded from the mainstream narrative, for example: people who are LGBTQIA+, Black, neurodivergent, or who experience surgical or premature menopause. 

‘Why did nobody tell me?’ 

But there is so much more to do and, while society learns to adapt to the needs of this enormous population group, a lot of people are still floundering. Particularly those without the resources to have their voices heard via the media. But whoever you are, and whatever resources you have access to, you may still be wondering why no one ever said a word to you about peri/menopause.

Perimenopause is a Thing

I mean, you probably knew that – but if you’re in your 30s you need to be knowing about it now. If you’re in your mid-late 30s to early 40s and are experiencing changes in your mood or body, or exacerbations to existing conditions you may have, this may be peri and you need to know about it. You are not ‘too young’, no matter what anyone tells you. Looking back, mine started at 39 and possibly earlier.

Menopause is a Hormonal Transition

A hormonal transition means change. A change in outlook. A change in desire. A change in what you can tolerate. It may mean a shift in how you view your sexuality and your gender. I’ve spoken about this in a talk called ‘Menopause – Agent of Queerness?’

Menopause is Compounding and Multifactorial 

Whatever is already going on for you, whether connected to your identity or to your life experience, menopause is going to interact with it. If you are already affected by past or present trauma, mental and physical ill health, disability, financial concerns, domestic abuse, lack of resources, minority or minoritised identity, menopause will exacerbate it. (Eventually, it may help things too, but there is a lot to get through first.)

And the way menopause is promoted, and treated, in society mirrors systemic bias, whether ageism, racism, ableism, misogyny, or transphobia.

Menopause doesn’t only happen to Cis Women

Trans men and non-binary people also experience menopause. (I’ve written more here about the non-binary experience of menopause.) Seeing peri/menopause information, resources, discussions, social media posts, etc, addressed only to ‘women’ can actively hinder someone’s attempt to inform themselves and get support. There are negative health outcomes to this. Actually, lots of folks dislike the gendering of everything in healthcare particularly, especially being called ‘ladies’.

Menopause doesn’t only happen to White Women

As above, I could say the same about the whiteness of much menopause information and resources. People of colour’s experiences are barely being heard about or acknowledged. It’s not good enough.

‘I need help – but what kind of help?’

 In some corners of social media there is a certain pressure to be super positive about menopause. If you are seeking cheerleading, there are plenty of practitioners and they are easy to find.

But I’m thinking you came onto a therapist’s website because you need somewhere to talk about what’s going on for you on a number of levels. To name aloud what’s happening to you inside and outside. 

There may be anger, fear and shame. You may not feel able to talk about the things that are going on in your mind and body. Your working life and relationships may be in turmoil. You may be wondering who you ever were and realising that, looking back, it all felt like a costume. Parts of you may be opening up, and other parts may be shutting down.

You may be non-binary or trans or queer and have very few places to explore how menopause intersects with your life. You may be cis and straight but feel totally alienated by the mainstream menopause narrative. 

Whatever you need to bring, I can offer you a place to talk about it.

You can contact me here.

Queer Menopause now has its own website!

Blogging silence

First off, I’m aware that I haven’t been posting on here much during lockdown. I keep starting things, and then experiencing a sense of extreme pointlessness. Each time I decide to write about opening up relationships, or peak experiences, or sexual and non-sexual BDSM from a therapists’s perspective – (or for that matter, the urgency of queer haircuts in a time of Covid) – I remember that we have an incurable virus at large at the beginning of winter, people dying, fascism everywhere, and the earth going up in flames.

Menopause takeover?

A Martian dropping by might think this site was really all about the subject of menopause, or that menopause had somehow taken over. Perhaps, along with the murder hornets, walking sharks, and some nervously awaited geese, a further horror come true of 2020 will be the entire population being forced into menopause until a vaccine is found. This would be most interesting.

Queermenopause.com unveiled

Menopause has not taken over, but, while my research goes through the peer review system, I’ve been working on a project that I hope will be helpful in the future. The project is a new website which I am delighted to reveal: queermenopause.com.

Menopause happens to people. Trans men, non-binary people, and intersex people are excluded when menopause information is restricted only to cisgender women. The site has an LGBTQIA+ focus, but I also want to offer resources that apply to anyone whose experience of menopause is excluded from, or not sufficiently acknowleged by, the mainstream. There is a lot of work to do. First blog post here: Welcome to queermenopause.com. You can also find this project on Instagram @queermenopause.

I am also seeking to inform practitioners of all kinds about the LGBTQIA+ experience of menopause, and about menopause itself.

Queer Menopause in the media

I have been seeing my clients online all the way through lockdown, and I’ve also contributed to a couple of books. One is an interview for Still Hot!, a collection of 42 interviews about menopause experience. I’m also happy to say that Diva’s queer menopause feature from December 2019, which I took part in, is now available online: This is the end… of your period.

Moving forward…

I’m very glad to have this project off the ground, and I will be adding to it as time goes on. Please get in touch if your work is relevant to this project. I welcome suggestions of practitioners, trainers and researchers who are working in this area.

I hope to return to non-menopause blogging soon.

World Menopause Day 2019 – There’s a long way to go

It’s World Menopause Day today – 18th October 2019

If you have any interest in human welfare, and the welfare of those you love, please read.

I would love to go into detail about the results of my Queer Menopause study, (which I am about to start writing up), but in the academic world you are supposed to keep fairly quiet about everything until it’s coming out in a peer reviewed journal. At best this means likely a year’s time! And that assumes it’s going to be accepted by the journal I will be pitching it to.

So I will simply take this moment to thank everyone who participated in my study. I am very grateful to you for sharing so much on such a crucial topic.

However, it’s safe to say, from my reading online, personal experience, and conversations everywhere that menopause can have a huge impact on life. [Tip for happiness: If menopause has been easy for you, that’s great. But I’m not going to debate with you about why the system needs to change.]

The general response to menopause is a reminder that we are still living in an ageist, ableist, sexist, misogynist society.

Folks desperate for help are going to their GPs, but the response is a lottery. You may get lucky first time, or your GP may realise the limits of their knowledge and refer you on to a menopause clinic. But equally you may be dismissed, gaslighted, and lied to. You may be told ‘It’s natural, just get over it’, or fobbed off with antidepressants.

Of course, hormone treatment is not simple, and it carries health implications, but the implications of oestrogen deficiency are equally concerning. The fact that so little is truly known makes me suspect that if people took the time to look hard enough at hormone function, we would be less hung up on the gender binary, which would make a lot of us very happy, but some other folks, clearly, very upset.

PSA: hormones don’t have genders. All bodies need oestrogen and testosterone to function.

The whole thing is doubly stressful for queer/trans folks, who may end up having to do a huge amount of education work around gender and sexuality while trying to get help from the healthcare system. And the general media narrative about menopause is suffocatingly heteronormative and often incredibly infantilising. We can do better – on a number of fronts.

And if you’re in your 20s and 30s, don’t think it starts at 50 and you can forget about it for a while

Perimenopause (the phase up to when your periods stop) can start in your late 30s or earlier. My periods started to fluctuate when I was 39. Fluctuating oestrogen levels can affect mental health for years before your periods stop.

The effects of menopause can be inherited, so it’s worth finding out, if you can, how your biological mother experienced it. It’s also biopsychosocial, which means, put simply, it’s constructed within the body, the mind, and the world outside. If older women/AFAB (Assigned Female At Birth) folks were respected in society, I have no doubt the experience would not be as bad.

Things are starting to change

Workplace policies are being created, and campaigners are pushing for changes in the law. I would like being in menopause to be a protected identity. At worst it disables people to the point where they cannot work due to physical and mental ill health, and they lose relationships and careers. I think everyone should have the possibility of subsidised time off work. I would also like to see menopause pensions to cover this too.

If you run a workplace, please think about how it could be more welcoming to folks in menopause.

If you are struggling, don’t suffer in silence

Go to your GP armed with the NICE Guidelines 2015. If they won’t help you, find one who will, or ask to be referred to a menopause clinic.

I wrote this first thing this morning. As time passes I will add some links. Thank you for reading.

Queer Menopause – New research project

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Queer Menopause flag

This year, when I’m not working with my clients, I’m doing a Masters in Counselling and Psychotherapy with the University of East London.

In brief: I’m doing my MA dissertation on queer menopause, and how therapists can best support and validate their LGBTQIA+ menopausal clients. 

After looking at several dissertation ideas, this one stood head and shoulders above the rest. The idea crystallised after a day in December 2018 when I had conversations with about five different friends about our experiences. I sense a lot of excitement about the topic, especially as there is very little existing research out there.

UPDATE on 5th November 2019

I’m adding this for clarity, and making a few changes below. My call for participants has now ended and I am in the process of writing up my findings. Thank you very much to everyone who took part, and everyone who took the time to write to me.

I’m going to keep this post as simple as possible because this subject has many aspects to it. This is a qualitative study using Thematic Analysis. My aim is to open some doors, shine a light, and give a voice to those who have not yet been heard. I want to create a building block that will inspire others to doing further research in this area.

Call for Participants (now ended)

‘How can therapists best support and validate their queer menopausal clients?’

As my subject is counselling and psychotherapy, my research focus is on what queer menopausal clients would like their therapists to know. (‘Therapists’ could also extend to other health practitioners.) This question may evolve over time.

I am seeking to interview LGBTQIA+ identified people who have experienced perimenopause/menopause, and for whom my question above has resonance. I have ethical clearance from UEL.

You can contact me here.

First of all, what is menopause?

Menopause happens to people with ovaries, not all of whom will be women. (I am using a very specific definition of menopause in this section, and this is the main menopause to which my study refers, but not to the exception of all other experiences. More on this further down.) Put very simply, the body slows down oestrogen production and menstruation eventually stops. When menstruation has stopped for a year, the person is said to be post-menopausal. This all sounds quite straightforward. Many people might welcome their periods stopping and, if they were having PIV sex, losing the risk of getting pregnant.

In fact, fluctuating and diminishing oestrogen levels can have many different effects on the body and mind. People (and experiences vary widely) can experience hot flushes, night sweats, insomnia, anxiety, depression, weight gain, memory loss, reduced libido, and thinning of the tissues around the vagina and urethra, leading to stress incontinence and increasingly painful penetrative sex.

Some barely notice anything at all. Others are so badly affected that their relationships fall apart and they have to stop work. Most fall somewhere along a spectrum between these two points.

Perimenopause – it starts much earlier than you think

If you’re under 40 and reading this (or even under 45), this may feel like something you don’t need to think about. But, actually, menopause can start in your late 30s. (And earlier if your ovaries were removed.) The first phase of menopause is known as perimenopause. Previously regular as clockwork periods may start to become more random. You may bleed more heavily at times. You may experience mood swings, and as hormone levels start to fluctuate, this may exacerbate existing physical and mental health issues.

No, I hadn’t heard of it either, once upon a time. Well, I kind of had, but there was no ‘official’ info so I took no notice of the changes that, now I look back, were clearly going on in my body from the age of 39 and perhaps even earlier.

LGBTQIA+ Menopause – a subject in need of a spotlight?

Where menopause is concerned, the media narrative, overwhelmingly, concerns cisgender heterosexual women – who are generally married to men, and who are experiencing loss of capacity (and desire) for penis-in-vagina sex. It is frequently framed around increased self-hatred due to the visible signs of ageing, and the idea that someone should be locked in increasingly desperate combat with their own body as their perceived attractiveness to men is reduced.

There are a number of peer-reviewed studies of lesbian experiences over the last 30 years. However, there is (that I have found so far) next to nothing out there about everyone else on the LGBTQIA+ spectrum. Bisexual women may pop up in studies, but in numbers so small that they slip through the cracks. And what if you are non-binary or trans? Or intersex? Or asexual?

Unfortunately, despite cisgender heterosexual women representing a large percentage of the menopausal population, the variation in medical advice and appropriate treatment for them is nothing short of a disgrace. Too many experience gaslighting and dismissal from doctors, despite the NICE guidelines. So the situation for anyone not cis or not heterosexual, who is concerned about their symptoms, could be much worse.

For example, someone AFAB (assigned female at birth) and non-binary may have a struggle when trying to access medical help as perimenopause starts to kick in. There are multiple pressures: (a) explaining menopause symptoms in the first place and being taken seriously (and this assumes the person realises what is happening in their body), (b) having to explain non-normative gender, and (c) if a person has existing mental or physical health problems, they may be exacerbated by fluctuating hormones. There may be a lot of confusion that adds to the person’s distress.

The point is, we just don’t know. Mystifyingly, the academic journals devoted to menopause that I have seen so far (I stress so far) barely mention LGBTQIA+ experiences. And the journals devoted to older LGBT adults barely mention menopause. The therapy journals barely mention menopause either – whether in terms of clients or therapists.

If you are reading this and thinking, ‘Hold on, what about X study/project?’ I will be very glad to hear from you.

Ignorance about our own bodies

One of my concerns is that so few people know what the early stages of menopause look like – (and this is across the whole ovary-owning population) – that many may miss out on a chance to understand their bodies better, and perhaps avert a future health issue. It may be that a person isn’t having problems, but would benefit from knowing what their body is doing.

Not all bad

It’s really important to say that menopause is not necessarily terrible – for some it is a very welcome rite of passage. Culturally, it is seen more negatively among white people in the west than in many other cultures. (There are also differences in experience and responses between classes and races.) But we are not given the choice in knowing about it. Systemic (and internalised) ageism causes society to relegate this subject to ‘silly old women’ and at times to make fun of it. This is not helping anyone, other than those who profit from insecurity.

Hormones

I am wondering how the hormonal changes at menopause may interact with the hormones someone is already taking for gender affirmation/transition. At what point does the latter fully counteract the former? My sense is that this has not been studied much. I am also wondering about menopause, (or the idea of it), causing dysphoria for some transmasculine people – and not everyone wants to, or is able to, take hormones.

Queering gender – and sex?

If someone is living as a cis woman and then menopause comes along and removes her capacity to bear children and receive a penis in her vagina, is she still a woman? If the normative ‘rule’ is that the ‘only true sex’ involves a penis in a vagina, what does that mean for sex post-menopause, where this may cease to be viable? This embodied chronological ritual encourages a default queering of sex.

Other kinds of menopause

As above, my main focus is on the menopause that happens to people born with ovaries. However, it doesn’t feel right to talk about queer menopause and leave out people assigned male at birth (AMAB) who are taking hormones. Exogenous hormones can have a wide range of impacts on the body.

Who am I?

I’ve been in private practice in London for six years. I’m bisexual, and post-menopausal. You can find more about me and my work here.

Contact me

If you would like to find out more about this study, or if you have some information or knowledge you would like to share, I would love to hear from you. You can contact me here.