Supporting women through a complex life transition
Menopause is a profound biological, psychological, and social transition. For many women, it marks the end of fertility, but it also overlaps with a period of life already full of responsibilities, raising children, supporting ageing parents, career pressures, relationship shifts, and renegotiating identity. Despite its universality, menopause is still surrounded by silence, minimisation, and misunderstanding.
Women frequently arrive in therapy saying things like:
- “I don’t feel like myself anymore.”
- “I think I’m going mad.”
- “I can’t tell if this is menopause or anxiety or burnout.”
- “I’m grieving parts of me I didn’t even know I would miss.”
ACT offers a compassionate and practical framework for supporting women through this terrain. It recognises that menopause isn’t something to “fix” but rather a transition to move through with awareness, acceptance, values, and intentional action.
What is menopause?
Menopause is defined as the point 12 months after a woman’s last menstrual period, signalling the end of natural reproductive ability. Most women reach menopause between ages 45 and 55, but the transition, perimenopause, often starts years earlier. During perimenopause, hormone levels fluctuate significantly, and this fluctuation is often what drives the intensity of symptoms.
It’s helpful to think of menopause as a process with several phases:
- Perimenopause: Hormones become irregular. Periods may change in frequency, flow, or predictability. Symptoms often begin here.
- Menopause: The point 12 months after the final period.
- Post-menopause: The years following menopause, where some symptoms ease while others (e.g., bone density changes) may persist.
Every experience is different. Some women barely notice the transition. Others are stunned by how disruptive it can be. Therapy becomes an important space to normalise, educate, validate, and support women through this change.
What symptoms do women experience?
Symptoms can be physical, cognitive, and emotional, often interacting in ways that make functioning feel unpredictable.
Common physical symptoms
- Hot flushes and night sweats
- Sleep disturbance or early waking
- Fatigue and low energy
- Muscle or joint pain
- Palpitations
- Headaches
- Changes in weight or appetite
- Vaginal dryness, discomfort during sex
- Bladder changes
- Changes in skin or hair
Cognitive symptoms
- “Brain fog”
- Trouble concentrating
- Forgetfulness or mental fatigue
- Slower processing
- Feeling overwhelmed by tasks previously manageable
Emotional symptoms
- Irritability
- Anxiety
- Low mood
- Feeling overstimulated or “on edge”
- Loss of confidence
- A sense of grief or identity disruption
For some women, symptoms can feel frightening, particularly when they appear suddenly or unpredictably. Many also describe a loss of trust in their bodies.
The psychosocial context: the “bigger picture”
Menopause rarely happens in isolation. It often coincides with, or amplifies, existing stressors:
- Workload and burnout
- Parenting adolescents
- Caring for ageing relatives
- Relationship changes
- Grief or loss
- Reevaluating purpose or direction
- Worries about ageing or visibility at work
Understanding this context is essential. ACT sits naturally here, because it weaves together biology, behaviour, environment, and meaning making; all of which are active in menopausal transitions.
How ACT can support women through menopause
ACT doesn’t aim to eliminate symptoms driven by hormonal change. Instead, it helps women respond in ways that reduce struggle, build flexibility, and reconnect them with what matters. Below are the ACT processes that often prove most helpful.
Present-moment awareness: creating stability during unpredictable symptoms
Mindfulness practices help clients meet symptoms with more steadiness. Hot flushes, for example, can feel overwhelming partly because of the story around them: “This is terrible… it’s going to happen again… people will notice.”
Bringing awareness to the body by noticing the heat rising, the breath quickening, the mind racing invites a gentler response. Instead of battling the experience, clients can learn to ride the wave with more grounding.
Acceptance and willingness: reducing the secondary suffering
Women often fight their symptoms:
- trying to hide them,
- pushing through exhaustion,
- blaming themselves,
- feeling guilty for needing rest or adjustments.
This “struggle with the struggle” amplifies distress. Acceptance — in the ACT sense — allows space for uncomfortable sensations, emotions, and thoughts without needing to eliminate them first.
A conversation might sound like:
“What happens when you stop trying to win the battle with your hot flushes, and instead shift your energy toward caring for yourself during them?”
Willingness reduces shame and opens the door to more workable choices.
Defusion: loosening the grip of menopause stories
Menopause is full of culturally reinforced narratives:
- “I’m getting old.”
- “I’ve lost my value.”
- “Everyone else seems to cope, — it’s just me.”
- “This isn’t me, — I’m broken.”
Defusion helps clients step back and see these as mental events rather than hard facts. The goal is to change how the thought lands, not to argue with it. Sometimes this means slowing the thought down, saying it in a different tone, or gently adding “I’m noticing the thought that…” so it becomes something they can relate to with a bit more space.
This is not about dismissing real struggle. It’s about creating enough room for choice, rather than letting the story tighten around them.
Self-as-context: anchoring identity when everything else feels shaky
One of the most powerful pieces of menopause work is reconnecting women with a stable sense of self that exists beyond symptoms and shifting roles.
Many clients say something like:
“I don’t recognise myself anymore.”
ACT helps explore the part of them that notices all this, the consistent observer who has lived through many chapters already. This brings reassurance: “I am still here, even if my body and emotions are changing.”
Values: rediscovering what matters in this stage of life
Values work can be transformative. Menopause often invites big questions:
- What matters most now?
- How do I want to care for this body?
- What kind of relationships do I want?
- What do I want my work life to look like?
- What feels meaningful in the years ahead?
Some women reconnect with creativity, rest, authenticity, or boundaries. Others re-evaluate priorities shaped by decades of caregiving, obligation, or external expectations.
ACT can help to channel these values into choices that support wellbeing.
Committed action: building a workable life with symptoms present
Intervention plans often involve a blend of:
- Adjusting routines (sleep, nutrition, movement)
- Speaking with GPs about HRT or other medical options
- Making realistic work or home adjustments
- Introducing pockets of rest
- Strengthening relationships and communication
- Building supportive habits shaped by values
It’s not about perfection. It’s about living in alignment with what matters, even when the body feels unpredictable.
How this work shows up in therapy sessions
In practice, ACT for menopause might include:
- Mapping out the interplay between symptoms, behaviour, and avoidance.
- Identifying the rules women feel they “should” live by and gently unhooking from them.
- Normalising the emotional changes, especially any loss of identity or control.
- Small grounding practices for riding out moments of discomfort.
- Values clarification exercises to help shape a new direction for this life stage.
- Exploring grief and loss, whether for their youth, energy, fertility, or past identities, all without pathologising it.
- Reframing menopause not as a decline, but as a period of growth, recalibration, and possibility.
Why ACT is particularly suited to menopause
ACT is well-suited because it:
- treats distress as understandable, not pathological
- addresses the internal struggle that worsens symptoms
- honours the reality of what cannot be controlled
- invites flexibility, compassion, and self-kindness
- helps women reconnect to identity and meaning
- emphasises living well now, not waiting for symptoms to disappear
Menopause is not a problem to solve, but a chapter to move through with support, wisdom, and clarity. ACT enriches this process by helping women build a life guided by values rather than by fear, shame, or avoidance.
