When the body won't stay quiet: menopause, identity and midlife

We tend to think of ourselves as minds that happen to have bodies. The mind is taken seriously. Feelings, perhaps rather more reluctantly, are allowed into the conversation. But the body can remain a kind of third-class citizen: expected to carry us around, keep functioning and preferably not make too much trouble.

For women, the relationship with the body can be even more complicated. Long before menopause, we have absorbed messages about what our bodies should look like, how desirable they should be, what they should be capable of and, increasingly, how successfully they should resist ageing. And then, at midlife, the body may refuse to stay quiet.

Perimenopause and menopause can affect sleep, temperature, energy, concentration, mood and sexual experience. A body that once felt familiar may suddenly seem unpredictable or alien.

These are real physiological experiences and deserve proper medical attention. HRT and other treatments can be enormously helpful, but understanding the hormonal dimension of menopause does not necessarily tell us everything about what it means to experience it. A symptom happens not simply in a body, but in a life.

The body does not speak English

We can be surprisingly incurious about our bodies. When something changes, the understandable response is often: How do I stop this? How do I get back to normal?

Sometimes alleviating the symptom is exactly what is needed. There is no psychological virtue in enduring unnecessary suffering, and psychotherapy is not a substitute for appropriate medical care, but therapy can introduce another kind of curiosity alongside it.

The body does not speak English. It speaks through sensation, tension, fatigue, appetite, heat, pain, pleasure and sometimes symptoms. That doesn't mean every symptom contains a hidden psychological message waiting to be decoded. Nor should we interpret physical symptoms instead of having them medically assessed. But we can also become interested in the images, memories, fears, desires and meanings that gather around our bodily experience.

Instead of asking only “How can I make this go away?”, we might sometimes ask: “What else is happening in my life while this is happening in my body?”

There may be no way back

A woman in her early fifties repeatedly described wanting her “old self” back. As we became curious about the woman she was mourning, something more complicated emerged. Her old self was younger and thinner, certainly, but she was also endlessly energetic, useful and available. She had been very good at meeting everybody else's needs.

What exactly did she want back? The phrase “I want to get back to normal” is understandable, particularly when menopausal symptoms have been debilitating. But psychologically, it can contain an assumption worth examining. There may be no way back.

Menopause belongs to a developmental transition, and development travels in one direction. We are not supposed to remain 25, or 35, forever, however insistently the surrounding culture may invite women to behave as though successful ageing means disguising the evidence that it is happening.

Somewhere inside can live the ghost of an idealised body-self: the woman I once was, the woman I thought I would become, or the woman I believe I ought still to be. The actual woman standing in front of the mirror can then feel like the disappointing version. But what if she isn't?

Who I was, who I hoped to be, who I am

Midlife has a way of bringing several versions of ourselves into the room at once. There is the person I was. There is the person I imagined I would become. And there is the complicated reality of who I am now. The differences between them can require mourning.

By midlife, some possibilities have closed. Fertility may have ended. Parents may be ageing or have died. Children may need us differently. Relationships, careers and friendships may not resemble what we imagined decades earlier. Our bodies carry time visibly. And the future no longer feels limitless.

That can be disturbing, but it can also be clarifying. There may be things we have postponed, compromises we have stopped noticing, creative lives we haven't lived or parts of ourselves we have neglected. The awareness that time is finite can give these yearnings a new urgency.

This doesn't mean every midlife longing should be obeyed. Some need to be acted upon. Some may be understood symbolically and lived in another way. Others need to be mourned because they genuinely cannot now happen.

The therapeutic question is not necessarily “How do I get what I want?” It may be: “What is this longing asking me to pay attention to?”

When irritation deserves curiosity

Another woman described herself as having become “bad-tempered and difficult”. There were hormonal changes, poor sleep and genuine exhaustion in the picture. But as we became curious about what she called her irritability, another possibility emerged.

She had spent decades being extraordinarily accommodating. Perhaps the question was not simply why she had suddenly become so angry. It was also why she had previously found it so difficult to be angry at all.

This is not to romanticise menopausal anger or give every mood change a psychological interpretation. Hormonal changes can affect mood, and menopause can coincide with significant psychological symptoms. These deserve appropriate assessment and treatment.

But our physiology changes and our relationships have histories. Hormones can affect mood, and anger can contain information. We can seek relief and remain curious. Psychotherapy doesn't have to decide which explanation is the “real” one.

Becoming less governed by the gaze

There is now considerable encouragement for women to “embrace” ageing. Even this can become another demand: apparently we must now age magnificently, rebelliously and with tremendous confidence. Perhaps women don't need another ideal to fail at.

Wildness needn't mean blowing up one's life. It might simply mean becoming a little less domesticated internally: less governed by how we imagine ourselves being seen, and more able to discover what is actually true.

That might involve sexuality, creativity, anger, solitude, ambition, pleasure or simply the growing recognition that one no longer wants to organise one's life around being endlessly useful to other people.

Medical treatment and the life it cannot treat

I know something of this territory personally. My own menopause followed surgery and brought abrupt and, at times, dramatic changes in mood. I chose to take HRT, which helped significantly. Like any medical treatment, HRT is something to discuss and review with an appropriately qualified healthcare professional as needs and circumstances change.

I am not interested in setting medicine and psychological exploration against one another. But HRT could not, and was never intended to, answer another disturbance that had become more insistent: the knowledge that the time ahead of me is shorter than the time behind me, and that some of my own yearnings for a different life have consequently become louder.

Some may be realisable. Some may have to be lived differently. Others may need to be grieved. No prescription can decide that for me.

Perhaps what matters is conscious intervention: caring properly for the body we have now while remaining curious about what we are asking treatment to do. Are we improving our quality of life, or are we also, perhaps without knowing it, asking to turn back the clock? Both desires can coexist. Human beings are rarely psychologically tidy.

An embodied psychological transition

Menopause is a biological event, but it happens within a psychological, relational and cultural life. For some women it passes with relatively little upheaval. For others it coincides with profound physical or psychological disturbance. There is no morally superior way to have a menopause.

Psychotherapy cannot and should not replace appropriate medical care. But it can offer something medicine is not designed to provide: a place to become curious about the experience of inhabiting a changing body and a changing life.

There can be grief in that process, and anger. There can be fear about ageing and mortality. There may also be unexpected desire, creativity, freedom and a growing unwillingness to continue living according to inherited expectations.

Perhaps the task is not to decipher what every symptom is trying to tell us. It may be simpler, and harder, than that: to become more willing to listen to a body we may have spent much of our lives expecting to remain silent.

And rather than asking only how we can get back to normal, perhaps we can begin with a different question: What in me is ending, and what is asking to live?