Dear Patti, 

Two years ago I was told I was going through perimenopause. This news was very upsetting because I was still young and had always entertained the possibility of having one more child. I’ve always loved being a mother and wasn’t ready to give that role up yet. Last year my husband left me and started divorce proceedings. My oldest son, his wife and child moved back home with me (supposedly temporarily). My middle child is experimenting with marijuana use, my youngest is clingy and sad about her father moving out, and I’m in the process of moving my aging father closer to me so I can take better care of him.

This week my physician revealed I’m now in full-blown menopause. I was hoping the lack of a monthly menstruation was just due to stress. I’m having a really difficult time. My doctor is administering medications and over-the-counter supplements to minimize my symptoms and she explained that — due to hormonal changes — it’s common to have mood swings. Further, she recommended psychotherapy.

I wouldn’t necessarily say I’m depressed, but I’m extremely sad and embarrassed and fear that my time as a valuable female is over. My doctor says I need to take better care of myself. I really want to but I’m just so tired all the time.


  — Brenda

Dear Brenda,

Menopause is a natural biological event in every female’s life, yet it can be a painful time for some women to be able to still identify with their femininity, personal value and self-esteem when they experience aging and the loss of fertility. They often describe feelings consistent with bereavement in relation to the experience of menopause. Not only are there psychological issues, there is cultural conditioning as well in terms of commonly held perceptions and the high value ascribed to youth, sexiness and motherhood.     

One main goal of psychotherapy will be to help you process your feelings and shift from a loss-based framework to a new definition and sense of self. Hopefully, you can then discard any attachment to destructive gender-role stereotypes and learn to not only respect and value the wise and mature person you have become but also to act on it with appropriate perspective, empowerment and vision. Another therapeutic goal will be to experience menopause as a transitional passage to a new and more liberating stage in your life. By striving to help you view menopause as a natural, normal process, your therapy sessions will allow you to challenge the negative beliefs about women growing older.

You have a lot on your plate right now. Compounding the biological and emotional adjustments inherent in menopause is the fact that — like you — women at this time in their life are often taking care of dependent children as well as aging parents or grandchildren. In addition, they may be going through career changes or upheavals in their relationships. These high-stress scenarios often result in lack of sleep, fatigue, poor nutrition and lack of exercise. Not surprisingly, this leaves little time for recreation/relaxation activities and can actually exacerbate menopausal symptoms.

Accordingly, another goal of therapy will be for you to focus on your own needs and well-being rather than continuing to lead a hectic life of self-sacrifice in which you have traditionally taken care of everyone else first. A therapist can educate you on the resources and options available to you. It’s time to ask for help and value your own physical and emotional health, professional or academic pursuits, hobbies or interests, dreams and desires. To that end, it may be beneficial to learn how to delegate responsibilities and set healthy boundaries so that other family members can assume some of the household burden.

Keep in mind that the women of today are in a much more favorable position than their ancestors—many of whom died prior to ever reaching menopause. Given that a female’s average life expectancy is between late 70s and mid-80s, women will spend nearly a third of their lives postmenopausal. Not only does this mean they will live over 30 years beyond menopause, but they’ll also be more vibrant than ever before.

Patti Carmalt-Vener, a faculty member with the Southern California Society for Intensive Short Term Psychotherapy, has been a psychotherapist in private practice for 23 years and has offices in Pasadena, Santa Monica and Canoga Park. Contact her at (626) 584-8582 or email Visit her website,