Person-Centred Therapy for the Menopausal Transition

Menopause is a significant personal transition that deserves exploration beyond symptom management. We're more open than ever about menopause and perimenopause. However, in Western society it is still mainly seen as a medical issue to be managed or a disruption to endure. High-profile menopause expert Dr Louise Newson has even called for it to be rebranded as “female hormone deficiency”, as she advocates strongly for the numerous benefits of HRT.

I welcome this growing attention to the menopausal transition, as it expands our knowledge and empowers us to make well-informed choices about managing any issues we're experiencing. However, many people may feel that the medical model misses the deeper emotional changes that come with this significant psychological and existential shift. They may feel clear symptoms like hot flushes and changes in their cycle. They might also notice hidden issues like mood swings, anxiety, and brain fog. Many will likely experience major changes in how they see themselves.

This evolving sense of self can be disorientating as people navigate a landscape that feels unfamiliar yet deeply personal. Given the vast range of experiences during perimenopause, support that acknowledges this complexity is essential.

While menopause is most often associated with women, it’s important to recognise that some trans and non-binary people also go through this transition, and may face additional barriers to being heard, understood, or properly supported.

FAQs

How does person-centred therapy accommodate the wide range of experiences in perimenopause?

A core strength of person-centred therapy is its inherent flexibility and adaptability. Perimenopause is a highly individual process: while some people may struggle with anxiety, low mood, or a loss of confidence, others may feel a newfound sense of freedom. Some may struggle with physical issues like fatigue and brain fog. Others might feel emotional ups and downs or question their purpose.

The person-centred approach avoids strict rules or set “solutions.” This makes it particularly well-suited to supporting people as they go through this time, recognising the variety of their experiences.

How does person-centred therapy help with the shame some people feel around menopause?

Several factors can contribute to feelings of shame during and after the menopausal transition. Although there is a more open conversation about menopause today, historically this has not been the case. Information-sharing between women has tended to be patchy, and many people note how little they heard about their own mothers’ experience of menopause compared to, for example, pregnancy. This cultural mutedness contributes to confusion, isolation, and a lack of preparation for the changes in both body and mind.

In addition, many of these changes and symptoms can be embarrassing. Lack of libido, vaginal atrophy, and urinary incontinence can be difficult to talk about, even with trusted partners and friends. As a result, some people can feel as though they're shamefully singular in these experiences.

The relentlessly negative framing of menopause in Western society further adds to feelings of shame and inadequacy. Midlife is rarely portrayed as a time of thriving for women. Instead, the emphasis is on loss of youth and desirability, and the “solution” so often is the demoralising, Sisyphean task of trying to stop the sands of time.

Person-centred therapy can be a powerful antidote to these varied incarnations of shame. It provides an environment in which everything is welcome, without judgment, stigma, or expectation. If someone shares something they’ve kept hidden - such as their worries about their changing body or their newfound rage - and is met with acceptance, their shame loosens its hold.

Likewise, as people start to articulate their feelings about the process of perimenopause, they often realise how much they have absorbed harmful societal messages around ageing and femininity. In the compassionate environment of person-centred therapy, they can think about and sometimes question these stories. This opens up the possibility of seeing this stage of life as a transition, not a decline.

How does person-centred therapy help people feel more centred during such a destabilising time?

Perimenopause often brings a profound sense of unmooring. Turbulent hormonal fluctuations can create distressing physical symptoms such as mood swings and disturbances, which are challenging in themselves, but in addition to that, people are often contending with the move from a familiar (if not always easy) menstrual cycle into unknown territory. We’re not in Kansas anymore! Psychologically, perimenopause can also often trigger an erosion or disintegration of previously robust components of one’s self-concept, leading to questions such as, “Who am I?”

At the same time, this phase of life often coincides with major gravitational pulls from the outside. Many people are part of the “sandwich generation,” caring for ageing parents while supporting teenage or adult children. Conversely, others might be adjusting to an empty nest and rediscovering who they are outside of a caregiving role. Both of these can leave those experiencing menopause feeling knocked off-kilter.

Person-centred therapy offers a rare space in which the individual’s needs, emotions and experiences are located firmly at its centre of gravity. This can be helpfully stabilising, allowing people to reconnect with their own heart and voice and make sense of who they are in this evolving stage of life. The therapy room can become an anchor in the inner and outer storms.

How does person-centred therapy help with the loss of control many people feel during perimenopause?

A common struggle during perimenopause is a profound sense of being out of control due to less predictable menstrual cycles and other physical changes taking them into unfamiliar territory. Signs of ageing become more apparent, and this can also lead to a heightened awareness of one’s own mortality and powerlessness to the passage of time. Cultural attitudes can further add to this, with people feeling that they are no longer bestowed the privileges of youthful looks and fertility, but instead becoming “invisible” and disenfranchised.

Person-centred therapy focuses on personal agency, offering an empowering experience. It believes that clients are the experts of their own lives. The therapist values and supports the client’s journey to self-discovery. This non-directive approach lets clients set their own pace. They can tune in to what feels pressing or important. It helps build a resilient sense of self-worth based on their own wisdom, not on societal ideals of womanhood.

By reconnecting with their inner compass, people can set boundaries, explore new interests, and re-evaluate relationships. They can also advocate for themselves more effectively at work and in medical settings. This can be a powerful antidote to the feelings of disempowerment that often come with perimenopause.

---

Menopause is so much more than a medical diagnosis – it's a real shift, a profound transition that can reshape how people see themselves and where they fit in the world. Significant progress has been made in destigmatising conversations around menopause and its symptoms, but we also need to pay attention to the emotional, psychological, and even existential changes that are experienced.

In his book Life is in the Transitions, Bruce Feiler describes how our lives are punctuated and shaped by “lifequakes”, forceful changes that lead to a period of upheaval and transition. Although the book makes scant reference to menopause, it is surely the quintessential “lifequake” – a multi-faceted, prolonged event that invites reconfiguration of the self. Feiler makes the case that "lifequakes" shouldn't be seen as glitches or aberrations to our “actual” lives. Instead, they are vital periods of re-evaluation and growth, and menopause is no exception.

The person-centred approach offers a compassionate and flexible space where people can explore all the complicated layers of this transition without feeling judged or told what to do. It encourages them to listen with warm curiosity to themselves, to reconnect with their own needs and desires, rather than seeing menopause as something to “fix”. It can help reframe menopause, not as an ending but as an evolution—an opportunity for growth and the resourcefulness to navigate this stage of life with more self-trust and a revitalised sense of who they are.

References

Feiler, B. (2020) Life Is in the Transitions: Mastering Change at Any Age. New York: Penguin Press.