Article summary:
- Many of the recommendations APS made in its submission into issues related to menopause and perimenopause have been included in a recent government inquiry report, released in September 2024.
- Some of these recommendations include: the development of a national awareness campaign, for all health professionals to receive training and ongoing professional development in (peri)menopause and a review of the costs associated with menopause hormonal therapy.
- APS continues to advocate for research, including long-term follow-up, into the psychological impacts of menopause;
- The provision of access to psychological care addressing the physical, emotional, existential and social impacts of (peri)menopause, and the integration of clear guidelines into psychological practice; and
- The integration of mental health support into existing healthcare initiatives, however, we do acknowledge the recommendation for GPs to refer to psychologists as part of a GP Management Plan to support the management and treatment of menopausal symptoms.
Menopause and its precursor, perimenopause, are among the most significant experiences of a woman’s life.
While each woman’s experience is unique, (peri)menopause often gives rise to a variety of common psychological, cognitive, emotional and physical symptoms, such as mood swings, depression, anxiety, ‘brain fog’, sleep disturbances, hot flushes, night sweats and disruptions to sex drives.
Psychologists are well placed to help women going through (peri)menopause, as well as their partners, kin and significant others.
This year, the Federal Government conducted an inquiry into issues related to menopause and perimenopause, which the Australian Psychological Society (APS) welcomed.
“In February, we made a submission, which included 11 recommendations based on evidence-informed and practice-based evidence from our members,” says Dr Catriona Davis McCabe, APS President.
“We’re pleased to see that many have been included in the inquiry’s report. However, there is still some way to go.”
The role of psychologists in supporting women through menopause
(Peri)menopause, which can begin in someone’s early 40s and often lasts many years, is complex. It causes fluctuations, and ultimately, a decline, in several hormones. The most significant of these is estrogen.
“We have estrogen receptors everywhere,” says Kirstin Bouse, clinical psychologist and founder, All About Her Centre, which provides multi-disciplinary care to those experiencing (peri)menopause.
“When it declines, it impacts us systemically, causing a range of symptoms, typically categorised as physical, cognitive and psychological.
“Psychologically, there can be big shifts in moods, anxiety can go through the roof, menopausal depression can rear its head, and prior mental health issues that were resolved or well managed can flare up again.”
Not only do such symptoms impact women personally, they also impact their relationships and capacity – both at home and in the workplace.
In working with clients experiencing (peri)menopause, psychologists may draw on a range of therapeutic approaches, such as cognitive behavioural therapy (CBT) – which can be effective in reducing many menopause symptoms, as demonstrated by a recent systematic review – acceptance and commitment therapy (ACT) and mindfulness.
For Bouse, a preferred model is schema therapy.
“Schemas are frameworks that inform how we see ourselves, others and the world. As such, they are akin to being our ‘personal blueprints’.
“For women going through the menopausal transition, schema therapy can be particularly helpful. Women typically wrestle with shifts in their identity, values and relationships and experience an increased need for autonomy as they navigate these years, all of which often bring old schemas and unhelpful patterns of relating to ourselves and others into sharp focus.” Schema therapy helps women identify these patterns, learn healthier ways of coping and how to best support the psychological and emotional growth that this stage fosters.
“The most common phrases I hear from clients experiencing menopause are, ‘I don’t feel like myself’, and ‘I don’t know who I am anymore’,” says Bouse.
“For women, there is a degree of introspection, because, to work out who you’re becoming, you need to turn inward. This can be particularly true for women who have caring responsibilities – whether that be as mothers, carers for elderly parents, etcetera – who’ve long had their attention on other [people].
“Schema therapy is a useful therapeutic model because it helps us to help them work out patterns they’ve been engaging in, and where and why those patterns have become unhelpful in this phase of life – then help them learn new patterns that align with their emerging self."
Access APS' online Scheme Therapy course to learn more about the basics of this practice.
When appropriate, Bouse also draws on attachment, somatic and trauma-informed somatic approaches, with a focus on how her clients relate to themselves and others.
However, Bouse says effectiveness is not so much about the model a psychologist applies, but the broader lens applied. With this, she refers to the importance of psychologists being trained to identify, understand and address menopause-related mental health challenges.
Key to this is an awareness that psychological symptoms are inextricably linked with biological, social and cultural challenges.
“We must make sense of how these four domains impact each other,” says Bouse. “For example, if a client is having 40 hot flushes a day, caused by hormonal changes, it’s likely her mood’s going to drop.
“She could then experience anxiety about when she’s going to have her next hot flush, and what will happen if she loses her words while giving a presentation that’s an inherent part of her job.”
For another client, psychological symptoms could be intertwined with financial concerns.
“If the client is really struggling with symptoms, can she afford to go part-time or stop work altogether? “Can she afford hormone therapy? Which means seeing the doctor as often as necessary, because it can take up to 18 months to get hormone treatment right – not to mention paying for the hormones.”
Ideally, a client should discuss every aspect of life, and, if she doesn’t, a menopause-informed psychologist should ask the right questions, such as:
- Are you experiencing symptoms like hot flashes, night sweats, or disrupted sleep? How do these affect your day-to-day life?
- How do you currently manage these physical symptoms? What strategies have worked, and which haven’t?
- What role do your thoughts about menopause and aging play in how you're feeling emotionally?
- Have you noticed changes in your social activities or interests?
- What adjustments or support might help you feel more balanced at work?
- What opportunities or positive changes do you see in this phase of life?
In some cases, a failure to recognise the link between psychological symptoms and (peri)menopause could lead to incorrect diagnosis – and even inappropriate treatment.
“For example, menopausal depression doesn’t tend to look like major depressive disorder,” says Bouse. “To get a diagnosis of major depressive disorder, you need symptoms every day for a couple of weeks – and for women they’re usually lethargy, teariness and sadness.
“But, with menopausal depression, because it’s driven by fluctuating hormones, a client is likely to talk about having low moods for many days, but then feeling fine, and about feeling irritable and angry, rather than teary and sad.
“A GP or psychologist might then prescribe antidepressants, or, if the client is already on them, try upping the dose or a different type of medication, where the [more appropriate] first line of treatment would be hormone therapy.”
The APS’s advocacy for women experiencing (peri)menopause
As well as being represented at one of the inquiry’s public hearings, APS submitted a submission to the Government’s inquiry, making 11 recommendations.
The inquiry’s recommendations addressed many APS recommendations and issues raised, including:
- Recommendation one, which calls on the Department of Health and Aged Care to commission research about the impacts (peri)menopause, including mental health impacts, and the needs of First Nations, culturally and linguistically diverse, and LGBTIAQ+ communities;
- Recommendation two, which proposes that the Government launch a national awareness campaign, echoing APS's call for an improvement in the community’s understanding, to reduce taboo, promote help-seeking behaviour and facilitate open conversation;
- Recommendations nine-12, which provide that all health professionals should receive training and ongoing professional development in (peri)menopause; and
- Recommendations 16 and 18, which suggest that the Department of Health and Aged Care should review the supply and costs of menopause hormonal therapy (MHT) to ensure universal access when medically appropriate for an individual.
- Recommendation 21, designed to support the development of more multidisciplinary women’s health facilities to provide, individualised evidence-based support.
"While these are impactful wins, it was disappointing that the report lacked more recommendations specific to mental health issues, and the role of psychologists in supporting women experiencing menopause," says Davis McCabe. “In addition, for example, psychological science could be used as a strong, evidence-base for successful public health campaigns to raise awareness of menopause and perimenopause.”
The APS continues to advocate for:
- Research, including long-term follow-up, into the psychological impacts of menopause;
- The provision of access to psychological care addressing the physical, emotional, existential and social impacts of (peri)menopause, and the integration of clear guidelines into psychological practice; and
- The integration of mental health support into existing healthcare initiatives, however, we do acknowledge the recommendation for GPs to refer to psychologists as part of a GP Management Plan to support the management and treatment of menopausal symptoms.
The intersection of menopause, work and psychological wellbeing
The APS’s recommendations emphasised the challenges that women experiencing menopause face in the workplace.
Menopause can ultimately impact income, career path and job satisfaction – and, for some women, the result is early retirement.
“There’s still so much stigma and embarrassment around it,” says Bouse. “Many workplaces don’t talk about it, so women don’t want to speak to their managers about symptoms.”
Psychologists can support clients by helping them recognise how their symptoms might be impacting them in the workplace and encouraging them to be assertive when asking for accommodations, such as flexibility, reduced hours and having agency over their environment.
Other strategies that might improve workplaces include fostering a supportive culture, educating managers and introducing a formal menopause policy.
Psychologists’ can also shed light on and provide support to manage issues in their personal lives, such as sleep disturbances or challenges with their personal relationships.
The APS supports recommendations four and five of the inquiry’s report, which urge the Government to commission research into the economic impacts of (peri)menopause, and to allow the Workplace Gender Equality Agency to re-commence collecting data on the ways in which employers support employees experiencing (peri)menopause.
In addition, we urge the Government to draw on psychologists’ expertise when designing workplace policies and initiatives.
The work continues
APS hopes that the Government will respond to the inquiry’s report by beginning work on its recommendations as soon as possible.
“In the meantime, APS will continue to advocate for more menopause-informed, mental health-specific initiatives,” says Dr Davis McCabe.
“Psychologists are essential to supporting women experiencing menopause, and to helping them optimise their wellbeing, ensuring they continue to live productive, contented lives.”