Like the circles in a tree trunk, we’re made up of many layers, each one making us stronger and more unique. The passing of time and the weather affects each layer, but our core is hidden and protected. It’s only when we dig deep or cut beneath the surface that this core is exposed and this can feel raw and debilitating.
The Perimenopause is one such time of upheaval that can affect us to our core and expose our insecurities and hurts. This is especially true and more likely to occur where we have experienced trauma. Research shows that higher incidence of Adverse Childhood Experiences (ACE) is linked to greater vulnerability to all mental health difficulties. This makes those with a history of trauma more at risk with their mental health during the Perimenopause. Additionally, throughout Perimenopause, the stress hormone cortisol is naturally higher in the body meaning that your fight or flight system is online more often and more easily triggered. This system dominates in the brain where there’s been trauma, so this added dose of cortisol during this phase may be additionally distressing and destabilising. With trauma, we know that any matching trigger in the here and now can trigger post traumatic symptoms. Triggers can include situations (eg feeling helpless or out of control), characteristics of people, something said or done, illness, pain, sights, smells, sounds or anything that evokes or taps into the original trauma. Survivors of complex trauma (where long term, relationship and attachment trauma has occurred, and this can be emotional, physical and sexual in nature) may suffer with wide ranging difficulties, not just the stereotypical flashbacks that you read about or see glamorised on the TV. Instead, complex trauma manifests as emotional sensitivity, relationship and sexual difficulties, addictions, dissociation, self harm, feelings of worthlessness and shame. Perimenopause brings its own challenges and new symptoms but can heighten or resurface previous symptoms like depression. Many may be unaware of the link between their difficulties and the trauma, especially if no one has ever asked, and sadly because the medical model often still prevails, many have been diagnosed with lots of other things like anxiety disorder, depressive disorder, chronic pain, eating disorders, psychosis, and personality “disorders”, (I use inverted commas as I struggle with the word disorder in any capacity really but especially related to personality. I prefer to think that behaviour and relationship style are survival focused and therefore adaptive to the individual as it helped them survive their experiences). Survivors of trauma will potentially struggle with trust and you may be guarded and cautious, making it difficult to seek and receive help. It can be a massive hurdle for women to overcome, to go and seek help and we must make sure that services and clinicians are ready and compassionate. Once you understand and develop a compassionate and trauma based narrative around your difficulties, this can be very therapeutic and the start of your healing journey.
Mercifully, in recent years there has been a drive towards trauma informed care, not just within mental health services, but within physical health services too, as we start to appreciate the affect of long term chronic stress on the body. This is making its way into education, prison and the care sectors but there is still much work and education to be done. There is even less recognition of the links between trauma and peri/menopause. It is extremely important for clinicians trying to help any woman with managing Perimenopause, to take a comprehensive history, including asking about adverse experiences in childhood and throughout the whole of her life. This will help to shape the intervention plan, keeping it safe and constructive and will prevent any iatrogenic damage that may occur. Paula Rastrick is a Psychotherapist with lived experience of trauma, seeking to help other women during menopause. She talks about her experience of being prescribed a very high dose (200mg) of HRT at a private clinic and this triggered her trauma symptoms. She is campaigning for practitioners to screen for trauma and to start HRT on low doses increasing gradually as needed. This is the best practice anyway and it is recommended that women are managed on the lowest effective dose.
Follow mrspaularastrick on Instagram or visit
https://thebrainbodymethod.com/
What does this mean for me if I acknowledge that I’ve experienced trauma and am now in Perimenopause?
At the moment, it might be the case that you need to let any practitioner that you’re working with know, as for now it is unlikely that you’ll be asked. Whilst this might seem a bit cringe, it will be better to address this at the outset, plus any practitioner worth their salt should thank you for letting them know and ask you what you need or to let them know at any point if there is anything they need to do / not do. Don’t feel you need to share your story at the outset or at any point, in fact waiting until you’re with the right person and you’re ready would be advisable. You don’t need to divulge the whole story nor all in one go. A short statement such as, “It’s important for me to let you know that [ I have PTSD from events when I was young]… or [Something bad happened to me when I was young and it’s effected me in different ways….] This will be less overwhelming for you and the other person.
Once a history of trauma has been identified, there might be several things that could help.
1. Firstly the treating clinician (whether a GP, dietician, coach, psychologist etc), should be able to work with you in a trauma informed way. This approach acknowledges that certain situations might trigger distress, for example if a physical exam is needed, whether it be an invasive exam or might simply involve touch, consent would be sought tactfully, respecting boundaries and checking as the assessment progresses. Asking what would help you feel safer and calmer can massively help here.
2. Validating any concerns, listening and developing trust are always important but even more so where there is a history of trauma.
3. Crucially preventing any re traumatisation, through lack of care, lack of choice or options or through medication regimes not carefully planned, is essential. If you’re concerned or feel triggered by anything, don’t feel afraid to raise it. Take control so that you’re in the driving seat. This might mean that you take advice, consider and research all your options (be this medication, dietary, life coach) so that you are informed but in charge when you move forward. Bear in mind that sudden changes in medication might evoke a trauma reaction and discuss this with your clinician.
4. Regular reviews would help communication and to identify any issues. Clinicians should be empowering women to make their own decisions (within the limits of best practice) and be fully involved in their intervention plan. They should be holding in mind that recovery both from trauma and the complications of the Peri/menopause, can be overcome, understood and managed. If you don’t get a good vibe, go and see someone else, you have the right to choose and not all personalities work well together.
5. Ideally a clinician should help you to link up current difficulties with the trauma, but if not they should recommend you to see a trained professional like a trauma trained Psychologist or counsellor, to help you to make sense of this. If you have compartmentalised and shelved your trauma, which would be very understandable given the demands placed on women, this might be the life stage where you have the time and resources to focus on this should you choose to. EMDR and cognitive therapy are clinically recommended approaches to working with trauma, both for complex longer term and acute PTSD. Trauma focused Compassion Focused Therapy would also be extremely beneficial. Finding a clinician you can trust and feel comfortable working with is essential so if you’re going private, don’t worry about seeing a couple of people before settling. If you’re on the NHS, this is trickier but certainly if the vibe isn’t right you should say this and don’t give up just because you don’t gel with the first person you see.
6. As we’ve said the brain is survival focussed, and where you’ve experienced trauma this might be your default mode which is extremely tiring on the body. The good news is that growth in the brain is always possible thanks to its neuroplasticity, so practicing ways to tap into your brains calming/ safety system, would help to manage the survival response. In terms of self help, the grounding techniques in my last post will help in the moment. Developing self compassion offers a way to self soothe in moments of emotional overwhelm and gradually developing a kinder relationship with the self. One of the most helpful exercises in compassionate mind training is an imagery exercise where you develop the idea of a Perfect nurturer. You are supported to conjure up the qualities of a being (can be human or non human), considering the physical qualities yes, but more importantly trying to connect with the feeling of being cared for by this person. Examples of perfect nurturers from some of my past clients include a tall, calm Native American Indian who is wise and steady and loving, a little old lady in a cosy cottage by the fire who makes you tea and listens with empathy and smells like lavender, Hermione from Harry Potter offering courage, strength and calm, and a giant furry polar bear who envelopes you in its fur and protects from harm. You might like to think about what your perfect nurturer would look like, sound like, feel like and how they would make you feel. Try to project into this being all the qualities of compassion – love, wisdom, strength, kindness, empathy, and spend some time in its presence. What might they say to you? You could do this with your eyes closed or open if you prefer. An amazing thing happens when you activate your imagination in this way. It switches on your brain’s soothing system which calms and regulates stress, releasing oxcytocin into your blood stream via the parasympathetic nervous system. The more often that you do this, the stronger this system will become. So whilst the exercise is useful in the moment, it is also a bit like physio for the brain, building and strengthening this system.
For more information read Debra Lee’s book recovering from trauma using Compassion Focussed Therapy.
7. Lastly, there are many different lifestyle options that could massively benefit you, for example trauma focused yoga, getting outside and nature therapy, etc. Finding the right balance and addressing your needs is really important, making sure that life suits you, not the other way around. Friends of Shanti Bee, in Heaton Newcastle upon Tyne, is a community health scheme offering holistic health support to people struggling with their mental health. Sessions aid improved well-being with numerous health benefits – importantly they slow the parasympathetic nervous system, deeply supporting rest and allowing individuals to feel calm and happy. Check out their website ….
https://www.shantibee.co.uk/friends-of-shanti-bee/
Remember just how far you’ve come, with your amazing strength and courage. You can overcome this challenging phase too, and we’re in this together. Stay tuned for more trauma informed posts! ❤️
Sea change 