Psychological therapies for early menopause

For many women, early menopause (EM) can be emotionally or psychologically challenging. The diagnosis and implications of EM, which include loss of fertility and concerns about premature ageing, may be distressing. EM symptoms, including hot flushes, poor quality sleep or vaginal dryness, can also be upsetting (see Women’s experiences of symptoms of early menopause – Part 1 and Women’s experiences of symptoms of early menopause – Part 2). The research on whether hormonal changes affect mood is unclear; some studies suggest they do, while others do not. To ease emotional and psychological distress associated with EM, women may seek counselling or psychotherapy, take antidepressant medication, seek support from health practitioners or their families and friends, or change aspects of their lifestyle (see Lifestyle changes to help manage early menopause symptoms and Impact of early menopause on relationships: Women’s experiences).

Experiences of psychological therapies

Most women we spoke with found EM to be an emotionally challenging experience. Women mentioned feeling distressed by loss of fertility, worries about premature ageing or body image, menopausal symptoms and their impact on other aspects of women’s lives, feelings of isolation, and feeling ‘out of sync’ with both their peers and older women.

Several women had seen a mental health practitioner (counsellor, psychologist or psychiatrist) for emotional or psychological support and found this helpful. Lorena, who was diagnosed with spontaneous EM at 25, said: ‘[my counsellor] was really helpful because I didn’t understand what was going on with my body, what was going on with my mind and my reactions. So she helped me (…) to control myself. Maybe if I didn’t have this support I would have gone crazy, because it was too much information to process.’

Alex, who experienced EM at 32 after a radical hysterectomy for ovarian cancer, explained why she found sessions with her psychologist helpful.

Kirsty, who experienced spontaneous EM at 31, valued her ‘therapist’ for providing her with a ‘really open and honest space’ to talk through difficult emotions.

A couple of women found counselling of limited assistance. Jenni, who experienced spontaneous EM and later had a hysterectomy for endometriosis, wanted to speak with someone who had ‘gone through EM’ and found an online forum for women who are childless by circumstance more helpful for emotional support.

For Sylvia, not being able to have children was one of the most difficult aspects of EM following a hysterectomy for uterine cancer. She did not feel counselling could help her ‘reconcile’ emotionally with this.

Use of medication for psychological distress

A few women were taking antidepressant or anti-anxiety medication for mood in addition to seeing a mental health practitioner. Mary, who was already taking antidepressants before she was diagnosed with EM, said: ‘…going through menopause I certainly did feel depressed and anxious and kind of – I just stayed on the antidepressants.’ A couple of other women with cancer-related EM who had been prescribed antidepressants for menopausal symptoms, Fiona and Nancy, noted they could be beneficial for mood as well (see Non-hormone based medications for early menopause: Women’s experiences).

During ovarian suppression therapy following breast cancer, Yen-Yi’s mood began ‘spiralling down’, which she linked to disrupted sleep and distress related to challenging work circumstances and a family member’s illness. She saw a counsellor but credited antidepressants for ‘changing [her] life around’.

Difficulties accessing psychological or emotional support

Several women commented that they had not been offered psychological support, which they attributed to what they saw as their health practitioners’ focus on the physical aspects of EM and lack of a ‘holistic’ approach to care.

Jacqueline felt neither her GP nor her gynaecologist appreciated the ‘huge change’ that EM (following a hysterectomy) represented.

Other sources of support

Health practitioners perceived by women as more empathetic towards emotional distress they experienced in relation to EM were an important source of support. Linda had a ‘brilliant’ GP who had reportedly also trained as a psychologist, while Mary described talking ‘quite a bit’ to her ‘amazing’ endocrinologist.

Alex appreciated her surgeon for her ‘caring bedside manner’ and understanding of what EM meant to her.

A few women did not feel the need to seek counselling. Some felt well supported by family and friends. A couple of women who were trained in psychology or counselling, or who could rely on someone with this expertise from their social network commented that they could cope themselves.

Naomi said having ‘a counsellor for a sister’, a supportive family, and being ‘fairly independent’ had helped her cope with the emotional and psychological aspects of medically induced EM related to ovarian cancer.

Debra, a mental health practitioner, reflected on the fatigue and anxiety she had experienced since being diagnosed with EM, and the strategies she used to manage these symptoms.

Others said they did not seek psychological support because they did not find EM emotionally difficult – whether because their symptoms were mild, because the diagnosis of EM had not been a shock, or because they had completed their family. Jessica, who experienced spontaneous EM, said: ‘I have two kids in primary [school] and I have a full-time job and I don’t have time to really sit around being morose about something that may or may not have changed my life.’

Melinda reflected on the reasons she had not feel the need to seek counselling after being diagnosed with spontaneous EM.

Further information:

Talking Points (women)

Talking Points (Health Practitioners)

Other Resources