Navigating Menopause: A Mindful Approach to Managing Symptoms and Embracing Change

Menopause doesn’t mean you have to suffer. Mindfulness teacher and physician Christiane Wolf, MD, explains how your practice and an open-minded perspective can help support you.

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While this article was originally published in support of a paid partnership between Mindful and Winona, it was independently researched and written by the author. 

Do you remember your first hot flash? I most certainly do. I was walking through the airport in Barcelona, on my way back home after teaching a retreat. I was browsing a store with beautiful ceramics, looking for some souvenirs for my daughters, when suddenly, without any notice or trigger, I found myself breaking out in a sweat. Not a sweat like when something embarrassing happens, but just this weird, emotionless, unannounced heat on your skin, and then dampness. That had never happened before, and it took almost a year before I had another one and recognized it as a hot flash. I’m not one to remember airport stores, but this one I did remember. 

Maybe you are one of the lucky few who don’t experience hot flashes, but most of us do. “Us” means women around a certain age, mostly 45 years and up; it also includes all “bodies with intact ovaries,” as one of my transgender male friends was so kind to remind me recently when I and some other women were commiserating in his presence. 

About 85% of people who go through menopause will experience some peri- and menopausal symptoms such as hot flashes, night sweats, sleep disturbances, increased pain, anxiety, and depression, as well as urogenital and sexuality-related changes. Everyone will experience the length and intensity of peri- and menopausal symptoms differently. So let’s expect some symptoms to happen. Change is upon us, as per usual, which is exactly why the practice of mindfulness comes in handy for navigating menopause.

Midlife Fear or Midlife Freedom?

Before I get into the details of symptom management, I would like to take a step back and look at the bigger picture of how we perceive menopause. After all, this could easily be the longest part of our life: Women live on average another 40 years after the start of menopause

Our body needed a few years to transition us through puberty into fertility—pimples, mood swings, and irregular periods included—and now it also needs a few years to phase fertility out of our system. We celebrate girls when they get their first period, but we don’t celebrate the end of the fertility cycle in the same way. Long before reaching mid-life, we learn to associate menopause with something annoying and unpleasant. We focus on the hot flashes, the night sweats, the sleep difficulties.

We focus on the hot flashes, the night sweats, the sleep difficulties. Why don’t we instead celebrate this new chapter of life that is free of menstruation, cramps, PMS, and birth control?

Why don’t we instead celebrate this new chapter of life that is free of menstruation, cramps, PMS, and birth control? Why not welcome this phase in life where we get our energy back? For many of us the kids are (almost?) out of the house, and we are established in our job. We have learned who we are, what we want, what we need—or don’t need—to be happy. We have learned what we like in bed and how to ask for it. The life phase often defined by juggling and compromising is coming to an end. If we look at the symptom cluster from that perspective, it can already help us embrace this part of life with more ease and equanimity. 

Can Mindfulness Ease Menopause Symptoms?

What’s the research saying on mindfulness and menopause? At present, there are not that many studies. As with all areas of women’s health, menopause research has not been adequately funded, either in the US or in other countries around the world. (This is beginning to change: In his recent State of the Union address, President Joe Biden announced the largest, most transformative women’s health and research investment in US history: $12 billion. This initiative, led by First Lady Jill Biden, will start to close the huge gender gap in women-specific research.)

What the existing research points to is: People who are more mindful seem to navigate the symptoms of menopause better, with an increased quality of life, compared to those lower in mindfulness during these years of transition. Higher levels of self-reported mindfulness and lower stress were independently correlated to a lower score on a scale that rates menopausal symptoms. But for women who had high stress levels, more mindfulness was strongly associated with lower symptoms. That means mindfulness is particularly helpful to navigate symptoms during periods of more stress. 

One study on hot flashes and night sweats shows that while the number and the intensity of hot flashes during the study period did not decrease, how much the study participants were bothered by them did. Which makes a lot of sense, as most hot flashes are not triggered by an external stimulus but through sinking estrogen levels, and mindfulness helps by decreasing how annoyed we are by the hot flashes. This recalls the second part of the Serenity Prayer: If you can’t change it, learn to accept it. We can apply this principle to all menopausal symptoms. It’s not the experience itself that makes something unpleasant and annoying, but how we relate to that experience. Mindset matters.

For women who had high stress levels, more mindfulness was strongly associated with lower menopausal symptoms.

But these days, the first half of the Serenity Prayer also applies, as there are a lot of other pathways we can choose to go with treating menopause symptoms. For example, there are herbs, there is acupuncture, there is hormonal yoga, and there are different forms of hormone replacement therapy (HRT). During my residency in gynecology, HRT was almost forbidden, based on a research study that later turned out to be flawed and inaccurate. Our mothers and grandmothers didn’t have options (including mindfulness!) to ease the symptoms of menopause. They learned to grit their teeth and suffer through the discomfort. We might have taken up that attitude from them, but we don’t have to do that anymore.

So, in a nutshell: You don’t have to just suffer through the symptoms. Approach them with curiosity, see how much they bother you, use mindfulness so they bother you less, and get help if needed. Don’t let your mind make things worse with the challenging symptoms. Be compassionate with yourself as your body is changing yet again, and look for and embrace what’s positive and exciting about this phase of life.

How to Practice Mindfulness During a Hot Flash

  1. As the hot flash is starting, first bring your attention to the actual sensations of the hot flash. Where exactly do you feel it? What are the exact sensations? Can you follow the changing flow of the sensations until it subsides? If that is too unpleasant or too intense, stay with a more neutral sensation in the body, like your breath or your feet on the floor. 
  2. Second, notice how your body might be reacting to the hot flash. Do you notice a kind of tensing or bracing against what’s going on? Maybe your shoulders are tense or you’re clenching your jaw. Can you soften that? 
  3. Lastly, what thoughts are going through your mind? Thoughts will influence how you feel about the hot flash, which will create tension and make the experience more unpleasant. Seeing this loop, you can disengage from the thoughts, release th