Midlife Musings

Thoughts, reflections and recommendations for Midlife

March 2024

Last week we celebrated International Women’s Day. A day to recognise all the amazing women in our lives. Apparently International Men’s Day is in November, we don’t seem to say much about it. Maybe we should? I think it is time for a revolution on masculinity. But that is not the focus on this post.

Last week a group of Physicians released a series of documents in Lancet Medical Journal online, headed up with an option piece titled Time for a balanced conversation about Menopause. These series of linked articles were created by a multi-disciplinary team lead by Professor Martha Hickey. Hickey is a OBGYN at The Royal Women’s Hospital in Melbourne, Australia, a Professor of Obstetrics and Gynaecology at the University of Melbourne, and an adjunct Professor of Obstetrics, Gynaecology and Reproductive Sciences at Yale University, USA. Martha Hickey is also a Clinical Psychologist. Yes, she started out in Psychology and went back to study medicine.

Hickey’s focus of her work is Menopause and she runs a multi-disciplinary clinic at the Royal Women’s Hospital to treat individuals going through it. She is a fierce feminist and advocate of squashing the anti-ageing rhetoric. She organised the most amazing Art Exhibition, called Flesh over Fifty a few years ago, that I got to go and see. It was a celebration of women’s body post 50 and 500 strong women had their photos taken, nude for the exhibition. Including one of my closest friends. It was truly fabulous and I posted about it on social media.

I was super happy to see these series of articles because they challenge a number of practices. In particular the over prescription of Menopause Hormone Therapy (MHT formerly called HRT) to heal a multitude of Menopause related symptoms when there is no evidence that they do. Lets be clear MHT has its place it and it can be really good for some symptoms, vasomotor symptoms in particular. But it is no silver bullet. If you would like to understand a bit more about this, this article by the MenoClarity group is excellent. Known facts about HRT. MenoClarity is a UK based group of Physicians, allied health, coaches and one journalist who are dedicated to Menopause Clarity and not scaring the crap out of people.

The articles have been controversial to say the least. Many people have loved them, lots of Doctors, not so much. Many Doctors, OBGYNs in particular have gone a little crazy in their criticism. Some allied health professionals too. It has been a bit disappointing to be honest, some of them have got pretty nasty in their criticism. In particular, over the opinion piece which is the starting article. It is an opinion piece not a piece of research.

One of the other things that has many of them in uproar is the suggestion of Cognitive Behavioural Therapy (CBT) as a possible treatment for symptoms. At first pass this may seem ridiculous, to be honest CBT is a bit overused in my opinion. However I can understand the suggestion for it as a mode of treatment. When we are feeling dysregulated because of constant hormonal swings, we will inherently feel unsafe in our bodies. Our Autonomic Nervous system will probably go into one of the responses below (diagram). This will then drive a behavioural response. If we are afraid of our symptoms, our body is likely to be in a very constricted state and a nervous system state of flight. When we are constricted, our blood pressure rises - because our body feeling under threat, it unconsciously thinks, a ‘saber tooth tiger’ is after it. When that ‘tiger’ is inside of us we can never escape it, there is not relief. We become stuck in a constant state of flight mode, what is going to happen to our symptoms? In particular our hot flushes. if we are stuck in flight, in constant restriction, you guessed it, they will become more severe.

So whilst I don’t agree CBT is the silver bullet on therapy I get her reasoning. I would suggest any therapy whether it be body based like somatic experiencing or sensory motor psychotherapy, or art therapy, equine therapy, even walking in nature is going to help you a lot more with these symptoms. So I understand Martha Hickey’s suggestion. The Doctors calling her the patriarchy, I don’t think they understand what she is getting at. Some of them have criticised her for suggesting it because not everyone can afford therapy. Sorry but in my opinion, that doesn’t mean you don’t include it as an option. Treat people like adults, they can work out what they can afford and what they can’t. Give them the options to make the decision rather than you deciding what they need to know.

It is no surprise that our nervous system loves choice too. See the connection :)

Hickey and team are also pushing back on all the menopause marketing out there. That is a whole other discussion, I am not going there in this newsletter but it needs to be said.

If you want to read the articles for yourself, head over the Lancet, you can sign up for free to read them all. They are short and interesting reads and include: Time for a balance conversation, An empowerment model for managing menopause, Optimising Health after early menopause, Managing menopause after cancer, Promoting Good Mental Health over the menopause transition, Martha Hickey opinion piece on responding to the complexity of Menopause.

Menopause is a complex and multi-faceted journey. It will impact you physically, mentally and how you orient in the world. If you want to pursue a range of treatments do it. If you need MHT, take it. If you want to explore a range of holistic alternatives, do it. It is your body and your decision as to what you need. There are an amazing range of practitioners out there who work with women around sexuality, identity, exploring the next phase of your life, trauma, the list is long. MHT is not a silver bullet and it is ok for you to explore what you need.

Menopause is a unique journey and that is why it is difficult to work out. You are unique, your life experience and story is unique. It is a healing journey, so your journey of it will be unique to you. As I say to everyone the big question is “How can you set yourself up to live well in your next half of life?”. What do you really want?

Great Books to read

Hot off the press is another great book coming out to coincide with International Womens Day. The Menopause Brain by Dr Lisa Mosconi, arrived in my Kindle on Tuesday. Lisa Mosconi is a professor of neurology and nuclear medicine. Her career is focused on researching the female brain and how it changes through our lifetime.

I have only read a few chapters of the book so far but I can tell you that I am loving it. Lots of useful information. Mosconi is broad in her thinking and has set the book out in different sections so you can read it like a reference book and jump around it you want to.

She also has a podcast out with Rich Roll that is worth listening to. Menopause, Hormone Health and Alzheimers Prevention.

Coaching and Somatic Experiencing

I am now offering both Coaching and Somatic Experiencing services. Somatic Experiencing is a trauma resolution methodology that is body based where we work with the nervous system directly accessing the body through sensation. It is not a talk therapy, we don’t talk about the old trauma, we access the body through sensation whilst staying in the present moment. It is an incredible therapy that is slow and supportive and offers profound results for people. We work session by session. If you are interested book in a time for a complimentary clarity call.

The beauty of coaching is that it is uniquely tailored to you and the path we follow is unique as you are. I integrate all of my modalities I am trained in and can work with trauma. We take a 360 approach to your personal growth and you will walk away with many new skills and tools to use but the most beautiful part of this is you start to find new parts of yourself. Coaching is an exploration of you and driven by your goals.

My unique coaching methodology combines traditional coaching and somatic coaching, cutting edge neuroscience, relationship coaching and modern adult development, so that you have a completely embodied experience of your coaching and transformation. We work at the level of the unconscious and the nervous system, to create new ways of being and interacting. This is top down and bottom up change in us. This is sustainable change.

I work with people of all genders

If you are curious to explore coaching, book a complimentary clarity call with me, where we can see if we are a good fit to work together.

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