Some women sail through menopause, while others finds it takes over their lives. Either way, we all face it eventually, so this week I have decided to give a quick overview of menopause with some thoughts about how to survive it. It is a big change in any woman's life, so don't feel you have to downplay it or allow loved ones to make you feel it isn't worthy of a little extra TLC from time to time. You can also read the article at English Informer in France or listen to me talking about it on Ex-Pat Radio tomorrow morning.
Coping with Menopause
Menopause is a normal event that every woman goes through which marks the end of her reproductive phase. It is caused by a change in the hormone balance, which is triggered by the ovaries as they move towards cessation in the release of eggs.
Menopause usually occurs as part of the aging process, typically occurring after the age of 40, although the average age can vary by race and country. In India for example, the average age of menopause is around 44, whereas in countries in the West such as England the average age of the last period is 51. If a woman starts her menopause before the average age range for her community it is said to be a premature menopause, and of course a woman who has her ovaries removed for any reason, such as hysterectomy, will find herself plunged into sudden and dramatic surgical menopause, without the long lead in that most women experience over the perimenopause period of several years.
So why am I talking about menopause today? Well it is something that affects every woman and generally we women just put up with the symptoms regardless of how challenging they are. These symptoms can include fatigue, irregularity in the menstrual cycle, sore joints, sudden hot sweats that can be so severe a woman has to get up and change her sheets in the night, insomnia, urinary problems, headaches, painful breasts, back pain, poor concentration, memory problems, changes in sexual function and desire, and mood swings. While symptoms vary from woman to woman, if any woman is unlucky enough to experience multiple and severe side effects then you might imagine she could feel overwhelmed at times.
From a therapy perspective, there are several areas around menopause that are less often discussed, but that are nevertheless important to consider. These include:
* Body image. For women who enter menopause at midlife, there is often an accompanying change in weight, skin and hair condition and a general sense for many women that their body is changing. This can have a negative effect on a woman’s self-esteem as she sees evidence that her body is aging.
* Life stage changes. Women in their 40s and 50s are often juggling multiple roles such as work, caring for older children and caring for parents, thus making everything feel more challenging than usual when perimenopause starts. Midlife women are also facing the psychological reality of their own mortality as they transition from fertility to bridging the gap to older age.
* Partner reactions. The reaction of the woman’s partner at this time is very important, as is the reaction of those close to her like her kids. If everyone just thinks mum is going crazy or passes it off as ‘that time of life’ then she may feel she is struggling alone. Partners need to help by asking what the woman is going through and showing support and understanding.
So if you are a woman who is going through menopause, then know that you are not alone, and you do have a right to ask those around you to show some TLC when you need it. Take time to think about what this life change means to you. Even if you didn’t want more or any kids, how do you feel now that the choice is being taken away from you? You might have spent your adult life wishing you didn’t have to suffer through your menstrual cycle each month, but what is it like not to have a period anymore? It is okay to grieve and shed a tear if you need to, and it is also a good idea to have some kind of ritual to mark this transition in your life. And then when you feel you are through the worst, remember that you are still a valuable and awesome woman with loads to offer, so get out there and show the world what a baddass you are!
If you are finding life challenging or feel your relationship could use some help, then counselling can be helpful in providing support and a non-judgmental space to explore your options. For more in-depth help and counselling, consider contacting Dr Jules in person
Panic attacks are not uncommon, but they can be terrifying and can take over your life if they are allowed to develop into panic disorder. Read more about panic attacks, what they are, and what you can do to stop them, in this week's blog post, as featured on English Informer in France and Ex-Pat Radio (Friday mornings).
This week I want to talk about panic attacks and panic disorder. A panic attack is a sudden surge of intense feelings of fear and impending doom or danger that typically lasts for a fairly short time (about 15 minutes or less) but it can feel as though it lasts forever. You know you are having a panic attack when you feel symptoms such as the following:
Doesn’t sound like fun does it? Panic attacks tend to be sudden and unexpected, and can leave you feeling you are possibly having a heart attack or losing your mind. Sometimes people just have one panic attack, while others may have several a week that seem as though they are taking over their life.
Perhaps you have suffered from panic attacks, or you know someone who has? Surveys suggest that in a 12-month period anywhere from 2 to 6% of the general population will experience panic attacks, and they often start in your 20s, so they might be more common than you think.
A panic attack is different from a normal reaction to something frightening or anxiety provoking, as it usually happens without there being an apparent real threat to your well-being. Unfortunately, if you go on to have recurrent panic attacks you can develop panic disorder, which is where you begin to worry when the next attack will happen, or you start changing your behavior or routines to try and avoid an attack happening. I once had a client, for example, who avoided shopping in a certain supermarket because he had a panic attack there, but gradually what happens is your world starts to shrink as you plan your life around the possibility of an attack. At worst people can develop agoraphobia, which is a fear of the world outside their home. This fear of fear can take a toll emotionally on the sufferer and those around them.
The causes of panic attacks are unclear. Some believe there could a genetic predisposition to being more anxious, but what I have seen is it often seems to be maladaptive thinking patterns that drive the panic reactions, or a reaction to trauma or ongoing stress in your life. I experienced panic attacks in my 20s when I was going through a stressful period of a long commute to a job I hated every day, but the attacks went away when I finally took back control of my life.
Panic attacks can be helped in the first instance by giving strong reassurance to the person you know who is suffering. Help them to slow their breathing down and focus on something in front of them, and eventually the panic will subside. If the attacks have happened more than once or twice then it is a good idea to visit your general practitioner. They are easy to diagnose but your doctor needs to rule out the possibility of health concerns such as low blood sugar or a reaction to another medication you might be taking. After that the treatment of choice is usually a series of visits to a good counsellor or psychologist, possibly with some medication to help you get over the worst of the symptoms.
While panic attacks can seem terrifying, the good news is that therapy alone (particularly cognitive behavioral therapy) is successful in 85% of cases. Supplementing your therapy with life changes and treatments such as mindfulness training, yoga, regular physical exercise and a good diet can help to bring lasting relief from panic disorder.
If you are feeling anxious or have experienced panic attacks, then counselling can be helpful in providing treatment, support and a non-judgmental space to explore your options.
For more in-depth help and counselling, consider contacting Dr Jules in person.
Many of us have something about our appearance that we might change if we could, but we don't become preoccupied with it. Sometimes, however, the thoughts we have about ourselves are entirely focused on how we look, forcing us to change our behavior or seek some medical intervention. This week on English Informer in France and Ex-Pat Radio I have been talking about body image:
Dear Dr Jules
I have a large birthmark on my face and I don’t like to go out anymore because I feel people are constantly staring at me, or even worse, they try not to look and they turn away. Can you help please?
I feel your distress as I read your question. Sadly, we are brought up equating perfection in appearance with goodness and success. We only see certain body types in children’s stories and in the media. It is always the slim princess who gets swept off her feet by the handsome prince, while dolls are impossibly thin with pretty painted faces. As we grow up and get more exposure to the media we are then bombarded with images that fulfill the current standard for perfection, always slim, toned and beautiful. Of course these images are digitally altered before we see them, reinforcing the ideals that not even the models themselves can attain. It is rare for us to see positive role models who fall outside of this norm: people who are carrying more weight, who are differently abled physically, or who have something unusual about their face such as a birth mark or a noticeable scar.
In therapy, I focus on helping people to differentiate between whether the problem is their appearance which must be fixed before they can move forward with anything else in life, or if it is their preoccupation with their appearance that is the problem, i.e., is what you see in the mirror what you feel about yourself? Once the client can accept that the issue is an emotional and cognitive problem, then we have something solid to work on.
As we grow up we have external and internal influences on how we feel about ourselves. The external includes things that other people did to us, such as bullying, teasing, staring, humiliating, rejecting and medical interventions which may have been expensive and painful. The internal are the resulting thoughts and beliefs we develop about ourselves that we repeat in our head over and over, or images of ourselves that we play out in scenarios in our minds that are distressing. Both of these are like audio tapes and DVDs that we keep playing, even though they are painful. Unfortunately, the constant repetition only serves to reinforce those old external influences in our mind.
Think back, did you get bullied or teased as a child over your appearance? When you remember your younger self, does it upset you to recall what that child went through? If so, some inner child therapy could be helpful, where you comfort that child and remind it that children are often cruel but without the ability to understand the repercussions of their actions. You may have had constant experiences of teasing or negative reactions that have reinforced your negative feelings about yourself, and that have built up over time until you can’t get those thoughts out of your head, and then your defense system starts to break down and you become caught in a negative cycle of expectations and beliefs, leading to low self-esteem and a sense that perhaps you don’t even want to leave the house.
Here is the key: don’t let your body image become the bully that continues to chase you around now, because that is what those old internal tapes and DVDs are – the bully that is still chasing you and humiliating you. Think about how much time each day you spend checking your appearance, or focusing on your perception of other people’s reaction to it? What do you think other people are thinking about you, what do you fear in their reactions? For example, do you fear they won’t like you or won’t want to interact with you? All of this is the continuation of the external and internal influences on how you are living your life now.
What we want to do in therapy is to help you change those old tapes and DVDs, and to learn to keep your attention focused outside of yourself so that you are less preoccupied with your appearance. Some people might have a problem with how you look, but remember that the problem is theirs not yours, and their questions might be exactly what you would be wondering if you saw yourself for the first time. As you make progress, I hope you come to experience your uniqueness as something to celebrate, in all aspects of yourself, such as your character, your achievements and your appearance. Those who know and love you do so because of who you are, and that is what matters.
I recommend finding others with similar experiences to yourself, and networking with them. It is really important to know that you are not alone and to see what has helped others to cope. A couple of good websites I found are: http://loveyourmark.com/meet-beverley/ https://www.changingfaces.org.uk/
Overall, don’t let your thoughts about your appearance develop into something more serious such as a preoccupation that stops you from living your life. Find the help you need to move forward and get out into the world again.
If you are feeling stuck with your life and can’t see a way forward, or if you are distressed about your appearance to the point where it starts to occupy your thoughts, then counselling can be helpful in providing support and a non-judgmental space to explore your options and make positive change. For a free consultation and to access the counselling service consider contacting Dr Jules in person
While many of us hate to sleep alone, sleeping with a loved one can come with its stresses. A good night's sleep is so important for our mental health, so if you find your sleep is interrupted by your partner or kids (or pets!), then this week's article could be helpful. The article was written for English Informer in France and we will discuss it on Ex-Pat Radio on my regular Friday morning spot next week (10.30-11.15am). Don't forget to contact me if you have a problem you would like me to respond to, and remember that I will keep your identity confidential.
Sharing Your Bed
My parents have been married for the best part of 50 years. Lately my mother has been dealing with some ill health, the symptoms of which have kept both her and my father awake. Rather than both of them be constantly sleep-deprived she offered to make up the spare room for him so he could get some sleep, to which my father replied that he would rather be awake at night and next to her than awake because he was away from her.
So this lovely story got me to thinking, when we share our bed with others how do we juggle our need for sleep with our need to feel close? And what can I as a therapist suggest to help the situation?
Sometimes your bed can feel like a war zone. By this I mean that many of us can struggle to get a peaceful sleep with our partner present. We like to think that falling asleep in each other’s arms is deeply romantic, but at some point one person’s arm goes numb and you start to yearn to just relax enough to sleep. Think about the reality of sleeping together: the struggles for the duvet, the snoring, the bouncing around as the other person tosses and turns, the fact that you feel you are sleeping in a furnace if they get too close in the night, and then the next morning you are crabby and exhausted. So much for romance!
And yet, research suggests that while women tend to bear the brunt of the problems that come with sharing a bed (argue about that one later) sleeping with a loved one can help you to decrease stress hormones and feel more protected, so should you stay put in the bed or should you go elsewhere to sleep? Maybe there are some practical solutions you can discuss and try out, such as:
Co-sleeping or having a family bed – this is another kind of bed sharing where young children sleep in close sensory proximity to their parents. It is common in many parts of the world where cribs are not used as often, and bed sharing of young siblings together is also common in many cultures. In countries such as the U.S., however, the official stance of the American Academy of Pediatrics is that while room sharing is okay, bed sharing is not recommended as it has led on some occasions to the death of children through accidental suffocation (often attributed to drug and alcohol use by the parents).
When you turn the couple bed into a family bed, problems can occur with lack of intimacy for the parents, especially if one partner is less keen on having the kids so close 24/7 and would prefer to have their partner to themselves at night. I also see problems in therapy where one partner tries to reduce intimacy by deliberately bringing a child into the bed or regularly going off to sleep with one of the children complaining that the child is unable to sleep alone.
My advice here is to talk to your partner about how to balance the needs of the couple relationship with the needs of the children. Co-sleeping can bring a lot of comfort for everyone when the children are small, but don’t be afraid to put a boundary around the couple’s need for private time. One compromise is having regular date nights where the children sleep over with grandparents or friends, or you can become more inventive about how you find quality time together. I once visited an elderly couple who lived in a small apartment on a housing estate in London. They told me they had raised all their kids in the apartment which was once the family home, and I commented that I wondered how they ever managed to find time for intimacy. They both just chuckled and said where there is a will there is a way!
So don’t let your bed become a place of stress. Sleeping with others, whether it be your partner or young children, should be a comfort. If it becomes a battle-zone then work together to find a solution. If problems in the bedroom are indicative of deeper problems in the relationship, then consider seeking counselling and don’t let small niggles turn into bigger issues.
If you are feeling stuck with your life and can’t see a way forward, then counselling can be helpful in providing support and a non-judgmental space to explore your options. For more in-depth help and counselling, consider contacting Dr Jules in person