Can self-compassion help us better navigate menopause?

Transcript

Intro: This podcast was made on the lands of the Wurundjeri people, the Woi Wurrung and the Bunurong. We'd like to pay respects to their elders, past and present, and emerging. From the Melbourne School of Psychological Sciences at the University of Melbourne, this is PsychTalks.

Cassie Hayward: Welcome again to PsychTalks. I'm Cassie Hayward, and I'm here ready to explore the latest research in psychology and neuroscience with my co-host, Nick Haslam.

Nick Haslam: Hi, Cassie, great to be back here again. Today we're exploring something that affects about half the population, menopause. We're joined by Dr Lydia Brown, a senior lecturer in our school, who's done some incredible research on the role that self-compassion can play in enhancing mental health during this often tricky time.

Welcome to the podcast, Lydia. Great to have you with us.

Lydia Brown: Thanks, Nick. It's great to be here.

Nick Haslam: So, our main focus today is on your work on self-compassion in relation to menopause. Um, but can we start with just some quick definitions? What is menopause and what is perimenopause?

Lydia Brown: Sure. So, menopause is really a day in a woman's life when she stops having menstrual periods, um, but you never know when your last period is going to be, usually, unless you have, um, surgery, surgical menopause. Um, so it tends to be, or is defined retrospectively after 12 months of not having a period, then you're, um, known to be post-menopausal. But in the lead up to your final period, your menstrual cycles typically become less regular. And in that period where your menstrual cycles are not regular, that would be the perimenopause.

Of course, for some women throughout their life, they don't have regular periods. And so there are a lot of groups that you can't actually define, uh, menopausal stage very well because of, for that reason, for instance, or if you're taking hormone contraceptives, then some people may not know exactly what menopausal stage they are in.

But perimenopause is traditionally for most people, that time, um, leading up to the final menstrual period. On average, it lasts 4 years, but it very much varies between women. And menopausal symptoms, which we can talk about as we go on, they last for a longer period of time. So women typically have menopausal symptoms during perimenopause and also in the early post menopause.

Cassie Hayward: And Lydia, I'm a lot older than you, so my social media feed is full of perimenopause and menopause content these days. It certainly seems to be having a boom in social media and podcast, um, areas. But is it correct that it hasn't really received much scientific research until very recently?

Lydia Brown: Absolutely not. So when I started a PhD on menopause, I think that was back in 2009, and really at that time, it was very much a niche area of medicine.

I found it a really fascinating area, but I was told by a few people, it's going to be really hard to carve out a research career in menopause. Um, I was recommended to shift topics to a more supposedly mainstream topic like dementia or diabetes. They said it's just gonna be hard to get grant money to look at menopause and mental health research. So that was only 10 years ago. Now, we're very much trying to play catch up.

So in research, in policy, uh, in medical practise, there has been this big, um, uptick in interest about menopause, but we don't have that kind of research, high quality research from decades previously. So that's posing a little bit of a problem. So it's great we're getting the newfound interest, but we haven't traditionally had it at all.

Nick Haslam: I mean, one of the really interesting aspects of it is not just the menopause itself, but also the mental health implications. And that's an area that's getting a lot more attention now too, right?

Lydia Brown: Yeah. So, menopause is sort of, since it's been a medical, uh, topic, since it's been viewed as an area of medicine, we've always thought that psychological symptoms are a part of the menopause. And so if you look at menopause symptom rating scales, they tend to have some physical symptoms like hot flushes, night sweats, um, that could be joint pain, skin changes, and then they, they typically are the, the mental health symptoms as well on those menopause symptom lists. So it, it's always been thought that mental ill health is a part of the menopause.

Nick Haslam: I gather you wrote a sort of big review paper in The Lancet last year and you, I think, reviewed some of that evidence. I mean, can you summarise what you found there?

Lydia Brown: Sure. So, I am very interested in aggregating data from across different studies. So that is in the form of a meta-analysis or a systematic review. And it's a really powerful kind of research or methodology because you can integrate data from around the world to really understand at a higher level what's going on.

So when we were in the development stage for this work, we decided to focus just on prospective studies. So these are studies that look at women at baseline before they go through the perimenopause and the menopause transition, um, and to follow them up over time to look at changes in mental health symptoms and disorders.

So we limited our, our search to that, and we found that the relationship between depression and menopause is not necessarily as strong as previously thought. So, there wasn't a huge uptick in prevalence of depressive symptoms over perimenopause. And likewise, diagnosis of, uh, major depressive disorder, from our review of currently available evidence, um, we found that those women who have a prior history of depression may be at risk of relapse at that time, um, but there wasn't sufficient evidence to suggest, uh, new onset depressive disorder over the perimenopause.

Nick Haslam: Did that surprise you?

Lydia Brown: It really surprised me.

Nick Haslam: What about anxiety? So I think another common thing you'd say is people would report feelings of anxious or jittery or distressed in a non-depressive sort of way during that time. Was there evidence of that as well?

Lydia Brown: So, anxiety is a really common, um, symptom that women report. They might report feeling irritable, they might report feeling, um, more, um, like things that didn't bother them before are suddenly starting to bother them, and linked to the irritability can just be feeling keyed up or tense.

So women definitely report this, but again, when we look at the prospective data in terms of changes and anxiety over time, firstly, there was not a lot of evidence, and that doesn't mean that there is no connection. It means that menopause has been a neglected area of medicine. And so, some of these questions, we just don't fully know.

So there is a possibility that anxiety might increase, but not for all women. Um, so there's a lot of nuance there. Um, and I think that that nuance is different to a TikTok. When you hear a TikTok, you will get quite alarmed about the menopause and think, wow, I'm going to become really irritable, really rageful, potentially very depressed. So menopause, and we can talk about some reasons how it can impact mental health, but it's nuanced and not everybody is affected in the same way.

Cassie Hayward: And Lydia, I don't know if it's just my social media algorithm, but I'm sure a lot of women are in the same algorithm in terms of getting a lot of content around the physical things we can do around making sure we eat enough protein and doing strength training and strengthen our bones with jump training or whatever. But I don't see a lot about what we can do for the mental health side of things. And, you know, there's jokes about perimenopause rage, and you said that that's, you know, may or may not be a thing, but there's certainly a lot of advice out there in the kind of social media sphere about these physical things that we can do to improve our bodies over this time. But what would you say about the, the kind of mental health preparation we can do?

Lydia Brown: So I think first is that it's not a woman's responsibility alone, if she feels like I'm not, if, if, if you're not getting the right support from your doctor, and that's a whole another topic that a lot of doctors aren't necessarily well equipped to manage the menopause. Um, and like I've suggested that clients, when I've worked as a clinical psychologist, uh, I've been concerned that they had a lot of hot flushes and night sweats that were impacting their sleep, and they really needed to be addressed. I've suggested to clients to follow those symptoms up with their GP.

And basically, I, I've experienced recently, GPs kind of turn around and say, Look, there's nothing I can really do to help you. And then if you then feel the burden to try and sort of inverted commas, improve your mental health, there's a bit of a problem there and that you're not receiving the support as a baseline that you need. So before we think about what we can do for our individual mental health, I think looking to see what supports you have around you as a starting point is probably the first step.

And so, looking at your GP support, do you have a good GP that's aware of the menopause? So I've had, like, for example, a friend of mine who's training to be a GP, she was really interested to upskill in the menopause, and her mentor during her training said, Honestly, I'd recommend staying clear of that area. It's a very complicated area. Um, you can refer to a specialist clinic.

And my friend was just felt quite saddened by that. So this is all changing, and the Senate Inquiry into menopause that took place last year as part of that. We're now recognising that there's a huge gap in clinician training, and we're addressing these things, but, uh, it's a work in progress.

Nick Haslam: And is it just a training issue? Or is it also that GPs don't yet have a good evidence base from research such as the kind you do, um, on which to give advice?

Lydia Brown: So, there is a growing, and there's a lot of research looking into menopausal hormone therapy, um, also called hormone replacement therapy. And that's not my sort of direct area of expertise, but there's been a lot of research around that over time.

And there's been challenges around that too, in terms of, uh, misunderstandings or exaggerations of the link between menopausal hormone therapy and breast cancer that's now addressed. But because there's a lot of nuance and a treatment like hormone therapy has risks and benefits. I, I think sometimes doctors report feeling a little unsure. Um, so we're improving sort of access, not me personally, but we're looking into improving that training for GPs, and there are tools that GPs can use to help them decide.

So there is evidence, but there's also confusion as well. So, for example, I've heard in psychiatric wards, midlife women might come in in a mental health crisis, and I've heard of, um, psychiatrists there prescribing menopausal hormone therapy, having learned that hormone therapy might be helpful for mental health. And I would say that that's jumping too quickly. We don't have necessarily the evidence base for a treatment like that.

And yet on the ground, perhaps, a psychiatrist has done some sort of training and thought, oh, OK, great, this might help with mental health. So we do need to have, make sure that our clinical practise is informed by research, especially when it comes to mental health.

Nick Haslam: So that's a kind of medical treatment, um, hormone replacement therapy. How about more talk therapy or psychological therapies and, and including those that people can maybe administer for themselves. So you've done some important work on self-compassion. Can you tell us a bit about what that is and how it relates to this area?

Lydia Brown: Sure. So, again, going back to that caveat that I think the, the, the cornerstone of mental health and well-being for women should be holistic, and you can't separate the medical support, which may or may not include hormone therapy, from a broader support, which can include psychological therapies, but also interventions for all women to support their well-being at this time. And those two things have to go hand in hand.

Some of my research that I'm really excited about is looking at the possible role of self-compassion for women going through menopause. So, at midlife, it's a time when often women have a lot of different demands. So they may have gained seniority in work. They may have a team working for them. They may, um, have more responsibilities at work, or they may not. They may be at home with kids, juggling lots of different timetables, um, giving back to the community, ageing parents.

So life is quite complicated, and you can feel quite stretched in a lot of ways, and often there's not really the time for self-care. Your own well-being just goes to the bottom of the priority list.

And so self-compassion is about bringing, um, awareness of your own needs back, uh, onto the table and prioritising that. And we can talk about the formal definition of self-compassion. I think that's quite nice to talk about too. Um, but women at midlife, I think, might especially benefit from, um, a psychological resilience factor like self-compassion.

So just to go into what self-compassion means, so self-compassion involves treating yourself with the same kindness and support that you would extend to a good friend. So often we know how to be kind to others, and especially at times in need, when a friend needs us the most, if they're struggling, we, our heart goes out to them and we want to help.

But when we're struggling ourselves, we sometimes can beat ourselves up about it. So I'm a new mom myself, and if my 3 year old is having a tantrum, it can be a bit tricky to sometimes bring in that moment of compassion. I might think, Oh, gosh, I'm not a very good mother, or why is my daughter having another tantrum? Sometimes women, especially can, and men, but research shows that women are lower on self-compassion than men. Uh, that, um, we can struggle to be kind to ourselves, but it's a psychological resilience factor that we can train. So even though, due to, perhaps in part genetics, due to, um, our upbringing, self-compassion as a construct only really entered psychology back in 2002, when it was first introduced as a psychological construct. So it's relatively new. So that means that if you're an adult now, you probably were never taught how to be kind to yourself. So there's this big deficit there.

But through training, we can learn, little by little, how to be kinder to ourselves, in our thoughts, in our emotions, and in our actions. So at midlife, being self-compassionate can relate to the thoughts that you tell yourself. It relates to how you deal with your emotions, especially when you're feeling bad or anxious, or any kind of negative emotion, so your behaviours, your thoughts, and your emotions.

Cassie Hayward: Do you find much individual difference in how easy it is to train people in self-compassion as a, I think the women kind of going through perimenopause and menopause now are kind of typically Gen X and whatever you buy into the stereotypes of generations, but Gen X is kind of defined as being pretty tough and, you know, no pain, no gain, all that kind of stuff from, from growing up. So, do you think those women are trickier to teach self-compassion, because it's just so different to how they've gotten through life?

Lydia Brown: Yeah, I was thinking about cohort of, I was wondering about this, and I don't know about exact research, looking into how different generations are at being kind to themselves, but I do think that maybe Gen Z is a little better at this because it's part of their world a bit more.

But Gen X, um, I'm a Millennial, so same, Millennials, we were never taught about this. So it's really like a foreign language. It's like if you've always spoken English your whole life, and then you find yourself in China and people are speaking Mandarin, it can feel really foreign. And when you start to practise words of self-kindness or actions of self-kindness. It can feel jarring and influent, but just like any language, the more you practise it, the better you get at it.

Cassie Hayward: But I think also, as you said, a lot of women in that stage are also juggling kids and parents and work and trying to get their, all their protein and fitness stuff in that they're being told to do, and then finding time to be kind to yourself is really hard.

Lydia Brown: Yeah, it's so true. It's so true. And that's why self-compassion is not really a one size fits all idea. And if you add on, like, another item on your to do list, it can be a bit counterproductive. So it's about really kind of thinking for yourself, what would self-compassion look like to me in the week ahead. And it might be cancelling a social engagement, or it might mean, actually, um, you're thinking of going to, it can just mean different things to different people.

Cassie Hayward: But it's not something you say, OK, from 11 to 12 on Tuesday, I'm gonna do self-compassion. It has to be a more holistic way of looking at your week.

Lydia Brown: Exactly. And it doesn't have to take up time. So, something like, uh, your thinking patterns. If you are, for example, having menopausal hot flushes, again, this is part of a holistic treatment. It's not, uh, I'm not saying that, um, it's the only option, but if you were experiencing a hot flush, some women can have quite sort of negative thoughts around that. They might think, Oh my goodness, not again. Now I'm distracted from work. I'm not as efficient as I used to be, I've got to change my clothes, and some of that may be true, you, you know, you might need to change your clothes.

So there can be aspects of the inner dialogue that may have like a seed of truth to them, but if you can stop and think, Oh, wow, this is a moment of suffering. How can I be kind to myself right now? It might be, I'm just gonna take a moment to do a few slower breaths. I'm just gonna go for a 10 minute walk and stop what I'm doing at my desk, um, in the middle of the night, the same.

So last year, I had a baby, and after having a baby, you have a big rapid decline in oestrogen. And I kept waking up, having to have a shower and having to change my pyjamas, and I was like, I've got a virus. Like, I think I need to go back to hospital. And I felt quite kind of sick and I, and, and I was drenched in sweat. And it took me like a couple of, like, I think it was like a couple of weeks to realise, Hang on a second, this is oestrogen withdrawal related hot flushes. And they were worse than what I thought they were. Like, I'd studied hot flushes for years, but when I experienced it myself, and I had these kind of thoughts that probably weren't helping around, I've got a virus and maybe I have to go back to hospital. Um, that wasn't my fault I had those thoughts. It was a lack of education, even though I was an expert, during my pregnancy, nobody told me to expect that.

So again, it shows how mental health is not a woman's responsibility by themselves. Uh, and that could be a bit gaslighting at worst, if we kind of thought, OK, I, I'm experiencing hot flushes, so I have to, you know, uh, fix that or deal with my mental health all by myself. I really see it as a bit of a shared responsibility.

Cassie Hayward: And I think also, we can't ignore social media in this space, and I think you can get yourself into a spiral of all the bad things that are gonna happen, and you watch a couple of TikToks about someone having bad experiences, and then, of course, the algorithm just feeds you more of that. I mean, it's great to have more awareness and more content creators talking about this, but I think it can cause a bit of distress in women if all they're seeing is the bad side of what might happen. What advice do you have on, on that?

Lydia Brown: This is such a good question, and it's something that I'm also grappling with myself, because there is a lot of suffering relating to menopause. A lot of it is, I say unnecessary suffering, that's not quite the right word, but it's due to social factors, like the medical neglect, like even misogyny and ageism combined, so that women don't look forward to being an older, wiser leader in society, they worry about being invisible, or they worry about being past their prime.

So there are so many different reasons why we might sort of feel negatively about menopause, and also, the symptoms can wreak havoc on some people's lives. And as a psychologist, I've definitely seen this. Not just the symptoms, but the underlying hormonal changes can, like, very much, um, impact mental health. But at the same time, when you look at global data, you don't see a, a huge plummet in, um, mental health. You don't see huge rise in depression, huge rise in anxiety.

And so to try and balance the lived experience, um, and as I said for myself, I found a hot flush worse than what I could have ever expected. So there's a lived experience, and then there's a message that we want to share with younger women that menopause isn't necessarily a terrible, terrible thing.

So how do we balance that in practise? I mean, I guess having some of these conversations is part of it. Um, they're not necessarily very TikTok friendly because TikTok loves drama, and this doesn't have as much drama to it. Um, but I think that the nuance will really help advance the field and move us towards more holistic care and better support of women going through menopause now, but also future generations of women who will go through menopause in the years to come, building those more um, healthy attitudes towards, um, ageing women.

Nick Haslam: It's great that you bring up the societal factors and the sort of ageism and the stereotypes and the misogyny and sexism and all these uh things. Uh, are there differences in how women approach ageing in general and also menopause in particular? Is there sort of a mindset people have that might put them in, more risk of suffering or, um, conversely, that might help them get through it better?

Lydia Brown: Definitely. So there is longitudinal research on this topic. So, looking at a woman's attitude towards menopause and her attitudes towards ageing before she goes through menopause, and looking to see how that might predict mental health across the transition. And what we know is that a negative attitude towards ageing and or menopause does increase your risk of experiencing more menopausal symptoms and being more impacted by those symptoms, um, as you, as you go through the menopause. Um, so, and, and also some of my research has found that attitudes towards the menopause tend to be more positive, um, in older women, in post-menopausal women.

So again, there's this idea that menopause, we have this fearful, potentially view of menopause, but then as we go through it, and we're on the other side of it, we realise, oh, this is just a natural life transition, and it's not that scary thing that I thought it was.

Nick Haslam: How much is it just wrapped up in the dread of getting older?

Lydia Brown: It's hard to tease the two apart. And as a menopause researcher, the number of conversations I've had about disentangling the effects of age and menopause is huge because they do go together. I mean, in research, there are ways you can try and untangle those, but I think they're intertwined, really. And I think that traditionally, our culture has allowed, I mean, I think ageing men can, you know, have challenges too, but there are many leaders in the world who are ageing men, and they don't worry, I don't think, about their wrinkles. Maybe about their suntan, I don't know.

But we have a lot of ageing men who are in their prime and in their power in the post-menopause equivalent years. And I think that as we see more women take those positions of power, in their later years, again, this will help us to feel less fearful about menopause, um, without dismissing it as being a nothing, a non-event, it's certainly an event.

Cassie Hayward: Lydia, over the next few years, what kind of key themes or issues do you want to explore in your research in this space?

Lydia Brown: So for me, this is, I guess, going back to my kind of heart and my personal interest. For me, there are two threads to my research. So, I'm really interested in the, like, the big data stuff, the epidemiological understanding of evidence, medical evidence, meta-analyses, and given traditionally, menopause has been such a neglected area, and given, I see every week, um, examples of people saying things on a big platform that, to me, don't sound evidence-based. I'm very excited about contributing to the medical research in this space, and especially relating to mental health.

And then also, I'm very interested in the inner journey of midlife and how contemplative practices and psychological resilience factors like self-compassion might be relevant, self-compassion based interventions informed by cognitive behaviour therapy, with that particular lens of self-compassion and how might they might be relevant to women who perhaps can't take, um, menopausal hormone therapies, say, if they are breast cancer survivors, or if they're not tolerated, or if women choose that they do not want to take hormone therapy, but also as an adjunct, so you can take a hormone therapy and you can also cultivate self-compassion.

Cassie Hayward: Lydia, when it comes to social media, there's so much stuff out there on perimenopause and menopause, but I think it can be a bit overwhelming to know what's evidence-based and what's just an influencer or a content creator talking about menopause. How do you advise people to navigate that space?

Lydia Brown: It's a tricky question. And I think that social media, often by definition, you have to give something in a bit of a snapshot in a sentence or a photo with a tagline. Oftentimes, the messages can be a bit simplistic. So what I'd highly recommend is, um, you can use social media, um, to help inform your menopause journey, and then maybe complementing that with information from sources like the Australian Menopause Society, so that you're getting, um, messages from, you know, various voices.

So I think the Australian Menopause Society is a really great website and resource to use. They also have a list of members, and these are doctors and clinicians who have a particular interest and usually training in menopause.

Um, and so if you find that you are going through menopause and your doctor is not well equipped yet to manage that, I'd recommend having a look at the Australian Menopause Society, uh, website. Jean Hailes Centre for Women's Health also has great resources.

Cassie Hayward: Lydia, it's been so wonderful having you on the show. Just wondering if you can leave our listeners with one piece of advice on how to maintain their mental health and well-being through this stage.

Lydia Brown: So I think it starts before the menopause, uh, for all, uh, people, women, and, and those born with, uh, uterus, um, who will go through menopause. I think, uh, being prepared, but not alarmed about the menopause. So recognising it's a natural and normal transition that is part of life. Um, there's a lot of joy and happiness on the other side. So data shows that these are the happiest years of our life, post menopause. So knowing there's so much to look forward to, according to the data.

But then also being prepared. So that involves support from medical professionals, friends, a circle of women or a circle of others who are going through that journey can be really helpful.

And then finally, within yourself, using this midlife time as an opportunity to stop and focus some of your attention inwards towards building your own health and well-being.

Cassie Hayward: Oh, such good advice, and hopefully our listeners can go and take a moment and have some self-care themselves. Thank you for joining us.

Nick Haslam: Thank you to everyone for tuning into this episode of PsychTalks. If you enjoyed today's conversation, don't forget to subscribe, rate and review us on your favourite podcast platform. Until next time.

Cassie Hayward: This episode was produced by Carly Godden with production assistance from Mairead Murray and Gemma Papprill. Our sound engineer was Jack Palmer.