Starting the Discussion: Supporting Clients Going Through Menopause.

The speaker was Helen McGillivray, a dedicated professional with over 25 years of experience working with people. She initially worked as a nurse, but now, as an accredited cognitive-behavioural therapist, she supports people facing various challenges. She actively supports women navigating the challenges of peri- and menopause, using Acceptance and Commitment Therapy (ACT) as her primary approach. The workshop tackled this often-taboo topic head-on, and attendees welcomed it with open arms. They praised the workshop for its clear and effective delivery. Interactive practices and videos were attention-grabbing; this knowledge was more than needed for their expertise. 

Understanding the Biological Aspect of a Woman’s Reproductive Transition

Helen McGillivray initially highlighted different stages of women’s reproductive transition. The first stage is puberty, marked by regular menstrual cycles and fertility. This is followed by a transitional phase known as perimenopause, which is characterised by irregular cycles. Menopause occurs when menstrual periods stop completely. Around the age of 55, postmenopause begins, marked by lower levels of estrogen and long-term changes in health.

Menopause and Its Challenges

During the workshop, the speaker focused particularly on the menopause stage. Menopause represents a long-term hormonal deficiency that affects all women in middle age and persists until death. This period is full of changes that result from a hormone drop. Hot flushes, night sweats, loss of bladder control, sleep problems, vaginal health issues, and mood changes appear. 

Women are also more susceptible to health risks, such as cardiovascular diseases, osteoporosis and mental health issues. 

In addition, this period poses a greater risk of burnout due to balancing career and caring for children and older parents, the so-called sandwich generation. The tabooisation of the topic in society is another reason it is harder for women to speak about their issues. 

Menopausal Depression

Biological shifts and societal barriers increase vulnerability for the development of menopausal depression. Typical symptoms are paranoid thinking, social isolation, low self-esteem, heightened anxiety, weight gain, poor memory, tiredness, headaches, and low libido. Menopausal depression is different from major depressive disorder because it is mainly related to estrogen drop and imbalance of the hypothalamic-pituitary-adrenal axis (HPA). HPA regulates stressful responses over cortisol release, while estrogen blocks HPA. When the level of estrogen drops, the level of cortisol increases, and alongside this, heightened sensitivity to stress appears.

Hormonal Replacement Therapy (HRT) as an Approach to Menopause Symptoms Treatment 

Since hormonal shifts mainly cause menopausal struggles, the treatment usually focuses on hormonal and stress regulation. Nowadays, NICE (National Institute for Health and Care Excellence) guidelines recommend hormonal replacement therapy, which includes replacing hormones with the aim of decreasing menopausal symptoms. Early research encouraged the misguided belief that HRT poses the same risk for breast cancer, cardiovascular disease, stroke and blood clots for all users. As a result, doctors prescribed HRT less frequently. However, later studies have found that the risks associated with HRT depend on individual factors such as age. HRT is today recommended as one of the most effective forms of treatment. It can improve cardiovascular health and sleep, prevent osteoporosis, etc. However, it is a worrying fact that, globally, only 5% of women experiencing menopause receive HRT. Alongside HRT, CBT is also recommended as a complement or alternative to HRT.

Mental Health Professional Assessment 

The speaker also addressed the question of how to approach the treatment of a client experiencing menopause as a mental health professional. She mentioned that the professional should enquire about hormonal health throughout the client’s lifespan, e.g., the presence of premenstrual syndrome. 

It is similarly crucial to check a client’s beliefs about midlife to see if they are experiencing a midlife crisis. In addition to this, it is also necessary to look at CBT areas: how are the client’s situations, thoughts, feelings, and behaviours related? Having as much insight as possible into the patient’s medical history is essential when making a diagnosis. The Balance app is also recommended, as it monitors symptoms, making it easier for the specialist to tailor treatment to the client.

Acceptance Therapy and Commitment as a “Promising” Approach to Menopause

Helen McGillivray also suggested ACT as a treatment option. ACT represents a form of the third wave of CBT, where the client learns how to live as well as possible with the symptoms rather than suppressing them. Happiness is not a normal human condition. ACT thus helps the client be more mindful, follow his/her values, and increase psychological flexibility. 

During the workshop, the speaker also demonstrated some engaging ACT exercises and concluded with tips your grandmother would have given you. Still, we often forget how important they really are: eat regularly and well, exercise, get enough and good-quality sleep, stop pleasing others, and be brave.

Barbara Gungl holds a master’s degree in psychology from the University of Maribor and is currently expanding her horizons as a Psychology Trainee at Willingness. Passionate about helping others, she has experience working with youth and adults as a scout and through other organisations. Her endless curiosity drives her current interest in neuroscience research and communication dynamics in relationships. At the same time, she strongly believes in the power of kindness, honesty, and the desire to grow, igniting a small spark that can turn into a flame. After all, it’s the little things that count.

Willingness delivers CPD trainings throughout the year, featuring internationally renowned speakers from various fields. These workshops are designed to equip professionals with practical knowledge and tools to enhance their work and better support the communities they serve. View upcoming workshops here.