Not another article about the menopause – was that your first thought when you read the headline? The amount of coverage the menopause is receiving in the mainstream media is a radical shift, even from a couple of years ago. Menopause has now entered politics, with the cross-party House of Commons Women and Equalities Committee recently calling on the UK Government to amend the Equality Act to introduce menopause as a protected characteristic under it, and to include a duty for employers to provide reasonable adjustments for menopausal employees.
Despite this, I wonder how well prepared therapists, society, and our workplaces are to fully respond to this life stage? And, how can the therapeutic space really be a place where the myriad of physical and emotional ‘symptoms’ (at least 38 at the last count, according to the Balance App) are witnessed and explored in service of our clients’ growth. How do we make sure we don’t inadvertently silence those we work with or homogenise them with generalisations?
I’m asking as a counsellor with a special interest in ageing and later life transitions, and also as a middle-aged woman in the throes of my own perimenopause. I believe that the middle stage of life, if witnessed, navigated and supported well, can be one of growth and ultimately of coming into a new, more abundant version of ourselves. However, I’m not convinced that as a society we yet appreciate that midlife is such a time; one of regeneration as well as of loss, of liberation as well as of dependency. Just look up the word ‘menopause’, and you will find a plethora of news stories on how many women are leaving work and how debilitating it is to live through. As practitioners, can we help to strike some kind of balance?
Perhaps what we can do is offer a place to find the right, distinctive narrative for each client within the counselling space. I’d argue it’s imperative that we do, as in 2020 it was estimated that one in three British working people were over the age of 50,1 making it a vital area of focus for workplace wellbeing. Consider too, that the latest figures reveal 73% of counsellors are women, and the majority are over the age of 50,2 so many of us will be charting our own journey through the menopause. What a perfect storm of personal growth this could be, if navigated well.
Next in this issue
This article explores what typically happens in our midlife and how we might experience it, drawing on information about the menopause as well as developmental theory and philosophy, to support us in our work with ourselves, our clients, supervisees and organisations.
The big picture
Approximately 13 million women in the UK are currently either peri- or postmenopausal,3 and by 2030 it is estimated that there will be over 1.2 billion menopausal women, with 47 million entering the menopause annually4 – a process lasting on average around 15 years. Given that employment rates have risen the fastest in women aged 55 to 64,5 clearly, these are statistics that neither employers nor workplace practitioners can ignore. It becomes even more compelling from a therapeutic perspective when we understand that over 60% of menopausal women experience symptoms resulting in behaviour changes, almost half say they feel depressed, a third say they suffer with anxiety and a great many also report feeling as though they are ‘going mad’. Strikingly, approximately two-thirds of women say there is a general lack of support and understanding for what they are going through.5 At the same time, our life events stack up: children mature and leave home, our partners face their own midlife, and often existential, challenges, our careers peak, our parents become dependent on us or die.
73% of counsellors are women, and the majority are over the age of 50,2 so many of us will be charting our own journey through the menopause
In 2020 it was estimated that one in three British working people were over the age of 501
Men and midlife
The process of the male menopause, or andropause, where hormonal levels decline, seems more likely to be far more gradual than the menopause and only affects a small proportion of the male population, according to research.6 In her book, Understanding Men’s Passages, Gail Sheehy perceptively highlights how women have a lifetime’s experience of being governed by changes in their role and their bodies, whereas men’s lives are usually linear and based around strength, virility and moving forwards.7 However, midlife causes men to confront these norms, and this is often where crisis occurs. Unapologetically, much of this article focuses on women’s experiences of the menopause, as all women will go through it – and as an antidote to the marginalisation of women’s experience that persists within the workplace, society and culture.*
What is the menopause?
According to the NHS, the menopause is when women no longer have periods, due to falling hormone levels, and perimenopause is when these symptoms arise before the periods have stopped. Women are in menopause once they have not had a period for 12 months. This all usually happens between the ages of 45 and 55, but can happen earlier. During this time, women can experience anxiety, mood swings, brain fog, hot flushes and irregular periods, among others,8 but all women experience the menopause.
However, to represent the menopause as purely biological is reductive and misses a large part of the picture. It is also a narrative that drives the medical profession and wider society to view it as an illness rather than an experience. This is captured by the words of one woman I spoke to, in her late 40s, who told me: ‘I work among a sea of brilliant young 20-somethings. My peers are all men, around the same age as me. I need to beat this dark cloud and celebrate being old enough to have experience and not so old that I’m no longer relevant.’
Pause and reflect
In the cycle of life, I’d suggest the menopause is more than the ‘falling off’ of hormones. It is the threshold between our youth and our older age, it is the waiting room within which we grieve the loss of our reproductive years and our body as it used to be. It is a looking glass through which we begin to decipher our identity for the next phase of our life, where we examine ourselves in a myriad of new roles in our family and in society.
I love how the use of the term ‘pause’ at the end of the word ‘menopause’ is directing us to a more reflective relationship with what is happening. After all, it is a long experience, for some lasting 10 to 15 years, and it doesn’t stop after our last period. It is: ‘…the biological marker which demands that women recognise where they are in life… women who take time to evaluate where they are physically, psychologically, spiritually are the ones that move ahead’.9 This extract resonates for me as it draws our attention to how the midlife changes in our biology become the launch pad of our ‘self’ as we enter the next phase of our life, rather than simply being an ending of our youth.
If we look to traditional developmental theory, our midlife tends to find us grappling with our place in the world, contributing and being connected to life through being productive and essential. Being in my own midlife, I feel I’m drawing into myself, not out of myself, feeling a contradiction of giving to others and finding some self-focus too. I like the explanation offered by Gail Sheehy,9 who writes tirelessly on life transitions, and who calls this phase of life ‘the second adulthood’ (flourishing 40s and flaming 50s, specifically!). It is when we move from the age of mastery into the age of integrity, in which the landscape has many pits and peaks as well as internal crises around our mortality, meaning and purpose. This more colourful and unpredictable landscape feels real to me. Similarly, the ideas offered by Abraham Maslow on human development maintain that as human beings we are always motivated towards leading a fuller life and a unity of our personality and self, and that this journey, inevitably, takes us through crisis, tragedy and pain as well as through joy.10
Jane, a successful professional in her late 40s, tells me how she feels pulled and pushed between experiences that ultimately propel her forward, but are not always comfortable: ‘I find at this stage of my life that everything gives and takes in equal measure. I am more confident and grounded, liberated to make choices that are right for me, and in other ways, I am crippled with doubt and anxiety. My children are grown up and I enjoy watching them leading their own independent lives. And yet the joy and pain of their childhoods being over, the quietness of the house can sometimes overwhelm me. And so it is in most areas of my life: joy and pain, with very little between them.’
Counselling in practice
I think Jane’s words are important to attend to, because if those of us around perimenopausal and menopausal women – families, friends, work colleagues, counsellors and supervisors – view the menopause as one dimensional, we are not only missing the rest of the picture, but we are dismissing a large part of their (indeed our) lived experience. This can be isolating, confusing and anger-inducing. It is even worse when we don’t acknowledge it at all. I asked Jane about her experience of the menopause itself: ‘It’s a relief to know my periods are ending, but it’s like I don’t know my body any more or what it’s going to do or feel like next.’
Despite the fact that the menopause happens to all women, it’s not unusual for women to not even recognise the possibility it is happening for them. Kate, a woman in her early 40s, who came into my counselling practice many years ago, began suddenly to notice new feelings of hopelessness, despair and of a loss she couldn’t describe. We explored whether something in her life was triggering her to grieve for old losses. She also began to feel disinclined to meet friends socially or have work meetings in person and seemed to be hiding from the world. In our meanderings through her experience, I asked her who she might be hiding from and what might she be grieving, and the answer in both cases, perplexingly for her, seemed to be her own self.
Kate was also being supported by a Pilates teacher, and as we began to look more holistically, exploring her biology and her physicality, patterns related to her hormones revealed themselves, and she subsequently sought the support of her GP and other supplements. She was beginning her perimenopausal and midlife journey. Her response? Quite simply, it was one of relief and one of healthy challenge – where was this journey going to take her next?
Approximately 13 million women in the UK are currently either peri- or postmenopausal3
By 2030 it is estimated that there will be over 1.2 billion menopausal women, with 47 million entering the menopause annually4 – a process lasting on average around 15 years
By remaining curious and open to all of our clients’ experiences, we can wander alongside them. For example, consider a counsellor working with a woman in her 40s who, inexplicably, begins to feel anxious and low in confidence. Or a woman who feels her husband doesn’t understand her anymore, who feels the distance between them widening week by week – if the counsellor doesn’t open the conversation to midlife, menopause and biological changes, then we are perpetuating the taboo or shame that can surround this aspect of womanhood.
Conversely, if we go straight to discussing the idea of menopause with a client who suddenly feels out of control and angry, we risk succumbing to the well-worn stereotype of a hysterical woman being simply ‘hormonal’. And we may risk alienating the client in the process. Research has also shown that a woman’s physical pain is more likely to be assumed to be emotional than physical in its basis, than it is in a man.11 We have a responsibility to our clients not to assume anything, not to generalise and not to respond in ‘the usual’ way. In fact, it is our task to be something other than ‘the usual’.
It is a minefield, but one that can be easily managed by one simple grounding principle: listen, honour the whole, unique person you are with and offer the possibility that all parts of their experience are welcome and safe to bring and explore. In the end, counselling, and any supporting or helping environment, is about amplifying personal power; it should be socially and politically freeing.
By contrast, workplaces are rarely a place where menopausal women have power, which is one reason why the workplace counselling space is so needed. In her groundbreaking book, Invisible Women, Caroline Criado-Perez states that: ‘…the modern workplace doesn’t work for women, it has been designed around the lives of men and it is no longer fit for purpose’.12 It’s for this reason that The Chair of the Women and Equalities Committee, Rt Hon Caroline Nokes MP, is now lobbying hard for the menopause to be a protected characteristic. It’s widely known that a lack of support by employers for menopausal women is driving women out of the workforce, and a report produced by the committee cites both taboo and lack of support around menopause as the central reasons for this.13 We are, hopefully, on the bow wave of meaningful change.
It isn’t just at work that this happens. We live within a healthcare system largely designed by men that fails to keep women safe, something which has been identified by several independent inquiries, such as the ‘First Do No Harm’ Report and the Paterson Inquiry.11 This is created by and perpetuates the stigma around women’s health. This year, the UK Government had to appoint a Hormone Replacement Therapy (HRT) Tsar, Madelaine McTernan, due to an ongoing shortage of a range of products that the estimated one million women rely on to alleviate the crippling symptoms of menopause, such as lack of sleep and migraines. There continues to be a chronic shortage of these products, without which many women struggle to be well enough to work. One report, by The Fawcett Society and Channel 4, found that 10% of women had left their job because of symptoms of the menopause.13
Without a regular and consistent supply of HRT medication, menopausal symptoms, already challenging from a personal and professional perspective, can become debilitating. Women are statistically more likely to take more long-term leave from work than men12 and, while this is undoubtedly due to a myriad of factors (including being disproportionately responsible for child and elder care), not having ready access to menopause medication will also be a factor. This in turn makes career progression and prospects harder to navigate.
As counsellors, we can help our clients to address this power balance, starting by looking at how we can best support them in the counselling environment. We can collaborate with clients on what it is that they need, both physically and environmentally, ‘in the room’ and in the therapeutic relationship, and work with our clients to help them express and negotiate this within both their home and work environments. We can model this for our clients by being authentic about our own needs and non-judgmental about theirs.
My own counsellor, unwittingly, made this very easy for me as she was deliberately authentic about her experience. In one session, she calmly took off her cardigan and asked if I would mind if she opened the window closest to her as she was having a hot flush. She did this naturally and seamlessly, and it paved the way for me to notice my own needs and not be embarrassed or ashamed to mention them. She also allowed space for my menopausal self to appear. In reflecting something back to me one day, she said, ‘I can hear you are very angry about that’, to which I flashed back, ‘I am not angry; I am, in fact, rageful’. ‘Ah, it is rage,’ she replied mildly conspiratorially, but without any prejudgment or assumptions about why, ‘and that distinction feels important’. This straightforward affirmation of my lived experience without any stereotypical framing, felt powerfully important. Never have I felt more seen in a counselling session.
Beyond all the clichés and stereotypes, the menopause is as unique as a thumbprint, and generalised workplace policies will only get us so far. HR, occupational health professionals and counsellors have a responsibility to listen, affirm and support this large proportion of our workforce as we navigate the menopause. In this way, those finding the midlife transition challenging can seek their own narrative and path through, while maintaining relationships around them and their career. In a world where others around them, their workplaces, their healthcare system and society at large may be ignoring or homogenising this experience in women’s lives, the counselling space can be a welcome relief and antidote.
*Helen Kewell will be writing a series on the menopause for future issues of BACP Workplace, which will also focus on men’s experiences of midlife, andropause and unravelling the meaning and experience for male partners, husbands, friends, bosses and decision-makers.
1 http://www.fom.ac.uk/wp-content/uploads/Menopause-Focus-Infographic.pdf (accessed August 2022).
2 Brown S. Counselling is women’s work. Therapy Today 2017; 28(2): 8–11. https://www.bacp.co.uk/bacp-journals/therapy-today/2017/march-2017/is-counselling-womens-work/ (accessed August 2022).
3 https://menopausesupport.co.uk/?page_id=60> (accessed July 2022).
4 Birmingham B. Midlife women rock: a menopause story for a new generation. Ireland: Orlay Kelly Publishing; 2021.
5 https://www.peoplemanagement.co.uk/article/1745147/number-tribunals-involving-menopause-triples-in-three-years-research-finds#gref (accessed August 2022).
6 https://www.nhs.uk/conditions/male-menopause/ (accessed July 2022).
7 Sheehy G. Understanding men’s passages: discovering a new map of men’s lives. London: Ballentine Books; 1998.
8 https://www.nhs.uk/conditions/menopause/ (accessed August 2022).
9 Sheehy G. New passages. New York: Random House; 1995.
10 Maslow AH. Toward a psychology of being (2nd edition). New York, NY: Van Nostrand Reinhold; 1968.
11 https://www.gov.uk/government/consultations/womens-health-strategy-call-for-evidence/womens-health-strategy-call-for-evidence> (accessed Aug 2022).
12 Criado-Perez C. Invisible women. London: Random House; 2019.
13 https://www.fawcettsociety.org.uk/menopauseandtheworkplace (accessed August 2022)