Counseling the Contemporary Woman. Suzanne Degges-White
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women can access for more information, it can be helpful for counselors to be prepared to discuss the ways perimenopause and menopause may be influencing clients’ health and well-being (Huffman & Myers, 1999). Helping clients understand the connection between their lifestyle choices and their health, especially in terms of addictive habits (smoking, drinking, and so on) or a sedentary lifestyle, may provide the motivation for clients to choose healthier behaviors.
While some symptoms of perimenopause and menopause, and associated hormonal and physical changes, can be controlled by medical means today, counselors should encourage clients to thoroughly review the benefits and risks of hormone replacement therapy (HRT), medical procedures, and other forms of treatment, including complementary and alternative treatments. In addition to the physiological changes, the passage into menopause and midlife are as much a psychological and emotional transformation for most women today.
Psychological and Emotional Changes
That May Occur during Midlife
In addition to the significant physical changes that occur during this period of life, hormonal changes along with health and appearance-related changes can lead to significant emotional disruption and psychological distress.
Mood Swings and Irritability
Women of all ages understand the connection between their menstrual cycle and their moods. During perimenopause and menopause, women’s moods are also labile and unpredictable. In addition to, and likely exacerbating, mood swings are the lethargy, fatigue, irritability, and difficulty concentrating that typically occur during this period of life (Inayat et al., 2017). Menopause is often accompanied by memory problems and forgetfulness as well (Devi, Hahn, Massimi, & Zhivotovskaya, 2005; Inayat et al., 2017), which can lead to additional frustration and irritation. Unfortunately, the middle adult years may bring about mood changes that are simply a normal aspect of hormonal shifts. Counselors should validate clients’ feelings related to noted mood swings or irritability while normalizing their presence in client’s lives. Some clients are happily surprised at their newfound ability to say what they think without worrying about consequences as they once might have. Counselors can encourage clients to share instances where their irritability might have been a positive force or surprising in a good way. In a culture obsessed with youth, or at least a youthful appearance, women reaching midlife may also express emotions and behaviors that are due, in part, to their changing bodies as well as the cultural messages and expectations they face. Combined, these symptoms may influence the development of depression.
Depression
While not every woman who experiences menopause is going to suffer from depression, it is true that depression is more common during the perimenopausal (Mulhall, Andel, & Ansley, 2017) and early postmenopausal period than at any other times in a woman’s life (Georgakis et al., 2016). A report from the Harvard Women’s Health Watch (2018) suggested that a woman’s risk for depressive symptoms is quadrupled during this period of life. Of note, however, is the finding that the longer a woman’s reproductive period lasted (the years from first period to menopause), the smaller the likelihood she will experience menopause-related depression (Georgakis et al., 2016).
Unfortunately, the emotional losses that midlife may present can also contribute to the incidence of depression during these years. Relationships and the family constellation can undergo significant transformations during midlife. Personal identities that have held great import may change as children exit the family home to create their own new family systems. Loss of parents or of others close to the client may be difficult to assimilate, as these deaths can often bring into focus a midlife woman’s own sense of mortality. When a woman’s primary role in life, whether it was mother, partner, or employee, changes dramatically, she may feel that the meaning her life once held has lost its value. For detailed information on counseling women experiencing depression, please refer to chapter 16.
Anxiety
For some women, the midlife years may bring on new levels of anxiety. Research indicates that symptoms of anxiety are increasingly prevalent during the postmenopausal period (Mulhall et al., 2017). The hormonal changes that trigger anxiety in some women can also be accompanied by the new challenges and concerns that appear in midlife and that would naturally heighten feelings of stress and anxiety. Just as losses can trigger depression, new expectations and responsibilities related to caregiving for others can trigger anxiety.
Perceptions about exactly what midlife should “look like” for a woman are often filtered through cultural messages and media representations of midlife, and the mismatch between these images and an individual woman’s sense of self can generate anxieties about exactly what midlife should look like for her. As noted in other chapters, cultural representations of the “ideal” female, regardless of age, can be detrimental to the development or maintenance of a woman’s healthy self-esteem and self-confidence. This can generate body dissatisfaction, which can generate appearance-related anxieties (McLaren & Kuh, 2004). For detailed information on counseling women experiencing body image concerns, please refer to chapter 14; for low self-esteem, please refer to chapter 15; and for anxiety, please refer to chapter 17.
Relational Challenges That May Appear
during Midlife
Midlife women have traditionally spent their adult lives employed, and the majority of them have also been wives and mothers. The role expectations that midlife women have experienced on the home front, on the work front, and in the community can be overwhelming and, over time, take a toll. Midlife women, too, tend to make up the bulk of a counselor’s client load (Shallcross, 2012), and it is important for counselors to be careful not to minimize the concerns of a midlife client. Many women are taught to bear their burdens and refrain from complaints, so these clients may be hesitant to share the full weight of the load that they carry. Understanding the physiological and emotional stressors that your clients may be facing will allow you to do a more thorough assessment.
Relationship to Self and Purpose in Life
While midlife women today have greater freedom in their life choices than generations before them, their lives are not without stress and their choices not without risk. While popular media likes to encourage ideas such as “fifty is the new thirty” or that “reinvention” of oneself at midlife is easily achievable, many women do not embrace this period in life as lustily as cultural messages suggest they might. In fact, there are harrowing statistics that suggest that midlife is an increasingly troubling time for women. The suicide rates for women aged forty-five to sixty-four has increased dramatically in the past two decades; in fact, the rate jumped 60 percent between 2000 and 2016 (Curtin, Warner, & Hedegaard, 2016). Although there is seldom a single reason that a person attempts suicide, it is known that approximately 60 percent of people who die by suicide suffered from depression. It is also true that menopause-related hormonal changes can trigger depression. Be alert to any warning signs or mixed messages that your clients might express regarding life purpose or life meaning or value to others. Every client’s experiences differ, and it is important for counselors to assess for client well-being and support systems in place. Assess for self-harm, and if the client is at risk and feels unsafe, ensure that your client is transported to a hospital or other in-patient facility.
Intrapersonal Concerns
The arrivals of perimenopause and, subsequently, menopause affect each woman in an individual and unique manner. Some women actually welcome the transition and perceive it as freedom from concerns about reproductive health. They are relieved to leave behind concerns about unplanned pregnancy and the hassles related to monthly menstruation. They may be grateful for the newly experienced “invisibility” that is typical of this new life stage. Being removed from the “sexual gaze” in the professional arena, due to their graying hair and aging bodies, can be perceived as an opportunity to be taken more seriously on the job (Isopahkala-Bouret, 2017). When working with clients in midlife, it is important to remember that