Another Day Talking About Sex, Meaning and the Menopause

This time the workshop took place in Sailsbury with a group of 16 therapists and counsellors. Five (including the only man – thanks again, for being there) were in their fifties and (apart from the male therapist) well into the menopause. Ten were in their forties, and one – a pregnant counsellor who worked with people with learning difficulties – was in her thirties.

Of course, many similar themes emerged to those I wrote about in my previous blog, so I won’t go over old ground.  However, I will outline different issues that this particular group raised.

Again, this was very much a day of exploration.  The day was split  into two sections.  During the morning, we looked at the personal experience of the menopause. In the afternoon, we discussed different ways to improve working with older female clients, couples, and younger women with early onset menopause.

Women are often completely unprepared for the menopause

Several participants in their forties had not considered that they may be peri-menopausal.  Some were in denial of the menopause. ‘It will happen to other women, but not to me,’ while others were very apprehensive about the changes they were facing. Several participants had not considered that the menopause is a process, which may take years to run its course.

But, it was generally agreed that since the menopause is such an individual experience, it is difficult to prepare for it. Even so, these participants were clearly hungry for information about the emotional and psychological changes that may happen as they approach it.  One participant said, ‘I don’t want this to happen. I really don’t. But I know this isn’t about choice. So, it’s time I faced up to what is going to happen to me, too.’

GPs often fail menopausal women

Several participants expressed concern about the lack of information and support from the NHS and GPs.   They felt their GPs had no interest in the menopause, and they were often ‘fobbed off’ with unwanted prescriptions for HRT.  The problem is,’ said one participant, ‘menopause isn’t an illness or a disease. It’s much easier for GPs to treat depression with a medical prescription.  They can measure that.  But they don’t seem to accept that this depression may be caused by fluctuations in hormone levels caused by the menopause.’

Early-onset menopause, and coming off HRT

One participant who had experienced early-onset menopause told the group that it was wrong to assume it was automatically a difficult or traumatic experience.  For years she had suffered from menstrual problems, which caused her considerable distress. As soon as she was diagnosed with early-onset menopause, she was put on HRT.  This was enormous relief for her.

However, eight years on her new doctor was concerned about her health, and was encouraging her to come off it. The participant had been given very little information about what to expect when this happened, and was even under the mistaken impression that she would not go through the menopause. She was horrified to find out that in most cases, women experience menopausal symptoms as soon as HRT is reduced or stopped.

This highlighted the lack of information that is available for women on HRT.

Most partners don’t have a clue

Several participants spoke about poor support from partners, principally because partners ‘didn’t have a clue about the menopause.’  One participant suggested that GP surgeries needed to have free leaflets explaining the menopause to husbands and partners. ‘At least they would know that other women were experiencing the same things too.’

Similar to the group from last week, participants discussed the aging process, and how the menopause can act as a catalyst in marriage.  Poor relationships tend to break up. Good ones tend to strengthen their bond.

Sex and the menopause

Lots of talk went on around this thorny subject.  In the afternoon, one participant spoke about an older couple they had been working with.  The wife was going through the menopause and had lost interest in sex.  Her husband experienced this as rejection.  They had come to therapy to ‘deal with their sexual problems.’

The couple had had a difficult history, which, of course, needed to be taken into account.  However, the therapist admitted that since they had no idea about the symptoms of the menopause, or that libido can change, they had suggested psycho-sexual counselling to the wife.  The couple had never come back.

Having spent the morning talking about different aspects of the menopause, and how sexual changes are normal, the therapist realised that the wife had probably felt very misunderstood, and even angry. The therapist expressed a great deal of a shame and regret about the way they had handled the couple.

Lack of training

This case history emphasises how the menopause is never mentioned during counselling and psychotherapy training.  ‘It’s shocking to realise that the menopause was never once discussed,’ said one participant.  Another said, ‘But why isn’t it? It’s such an important part of a woman’s life’.  A couple’s therapist was equally alarmed that the menopause had not been included in her training either.  ‘I now realise it’s vital to recognise how the menopause affects the relationship between older couples.’

Working as a therapist with the menopause

Participants also discussed how going through the menopause themselves, might affect their work with clients.  They agreed that self care was paramount.  Following are points they made:

• Sleeping patterns change. Insomnia can affect alertness, and the ability to remain present.
• It’s important to know when to take a break, and use the time to recharge batteries. Perhaps create a schedule that does not include working with clients every day.
• Exercise and good diet is vital to maintain energy levels, and stabilise mood.
• Perhaps practice meditation and take naps between clients when possible.
• Over empathising with older women. For example, a client struggling with their aging process could bring up issues for the therapist.
• Be aware of feeling increasingly sensitive. This may include feeling more tearful.
• Memory can be tricky.  Important to keep good notes, and make lists.
• Be aware of any added stresses that can happen at this time of life, such as marital difficulties, children leaving home, and ailing parents.  It’s too easy to give to everyone else and forget yourself.
• Managing symptoms such as hot flushes.  Quite a heated (apologies, no pun intended) debate took place about whether to admit this to clients or not.  Some participants thought it inappropriate to draw attention to their hot flushes. One participant said,  ‘I wouldn’t want to know if my therapist was having a hot flush.’  Another said, ‘I think this would detract from the work with my client.’  Others said they were happy to mention it when appropriate. ‘My clients must see I’ve gone beetroot, and am throwing off my cardigan. I think it’s perfectly okay to mention it,’ said one therapist. Another one said, ‘We’re all human after all. I don’t think admitting to it would affect the way I work with clients at all.’

Menopause, a positive experience.

The day ended with a review of how the menopause can also be a very positive experience. For example, women may feel relieved to be free from the fear of pregnancy, and liberated from their monthly menstruation cycle. An older woman can acquire a sense of authority, and many enjoy a different status in life, such as grand-parenting.  ‘We make much better grandparents than we ever did as parents,’ said one participant. Women are often more financially secure, and have the time and energy to explore different interests. Many find a sense of inner peace as they grow older. This is also the time when many women are drawn to finding meaning and purpose in their lives.

As I mentioned in my previous blog, please do add any comments or experiences you may have.  Whatever you have to say is important as we continue to break down the taboo of talking honestly and openly about the menopause.