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In this episode of When Work Hurts, I’m joined by Clinical Psychologist Dr Momotaj Islam to explore her personal and professional experiences of menopause, and the insights behind her book Coping with Menopause.
Momotaj draws on a biopsychosocial understanding of menopause, exploring how biological changes interact with our psychological wellbeing, relationships, work and wider social and cultural contexts. We discuss the importance of looking beyond symptoms alone, and the role that humour, gratitude and self-compassion can play in navigating this stage of life.
We also explore the impact of menopause on professional identity, including experiences of cognitive changes and brain fog, the challenges these can present at work, and the importance of supportive workplace cultures, policies and practical adjustments.
Our conversation considers how psychological approaches can help us respond to difficult experiences with greater understanding and compassion, and what health professionals can do to better support people experiencing menopause.
Finally, Momotaj reflects on the process of writing her book, the vulnerability involved in sharing personal experiences, and how menopause can also offer an opportunity to reconsider our priorities, reconnect with our values and reflect on what matters most.
Useful links:
- Buy Coping with Menopause (use code Momotaj25 to get 25% off until 31/10/26)
- Momotaj’s website
- Momotaj on LinkedIn
- Momotaj on Instagram
- Employment Rights Act – Menopause Action Plan Guidance
- Royal College of Psychiatrists’ position statement on menopause and mental health
- Royal College of Psychiatrists’ Women’s Mental Health Strategy
I’d love to connect with you so please come and say hi on LinkedIn or via my website.
The Coping With series is available via Sequoia Books and Routledge. ACP-UK members receive a discount on all ACP-UK titles – details are in the monthly members’ newsletter, The Buzz.
Do check out the ACP-UK and everything it has to offer.
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Transcript
Paula Redmond (00:04)
Hi, I’m Dr Paula Redmond, and you’re listening to the When Work Hurts podcast, which is brought to you by the Association of Clinical Psychologists, the representative professional body for clinical psychologists in the UK. In this series, I’ll be exploring the intersection of the personal and professional through conversation with clinical psychologists who have written about challenging life events and circumstances that they faced in the Coping With book series. We’ll be thinking about how these experiences affected them as professionals and how their professional roles and identities have intertwined with these challenges, as well as the wisdom, expertise and guidance they’ve shared with readers.
In this episode, I’m joined by Dr Momotaj Islam, clinical psychologist and author of Coping with Menopause. Drawing on both her professional expertise and personal experience, Momotaj explores menopause through a biopsychosocial lens. We talk about the impact of menopause on our working lives and professional identities, and the role of humour, self-compassion, and psychological strategies in navigating the stage of life. I began by asking what motivated her to write the book.
Momotaj Islam (01:25)
So I think I’ve always liked writing and wanted to write at some point, but I don’t think my younger self ever thought I’d be writing a book on menopause in my 50s. So it kind of came about unexpectedly really. There was a call from the Association of Clinical Psychologists, ACPUK, for people to write for the Coping with series, which was an idea developed by another clinical psychologist, Sarah Swan, who had written about her journey with breast cancer. And the idea was that it was about psychologists combining their professional knowledge with their lived experience of some life challenge. And so I think, I mean, I just saw the email and then I remember I was right in the middle of perimenopause at the time. And I remember thinking like, this is having a huge impact on my life, but somehow I am coping. And when I reflected on how I was coping, I kind of realized it was a combination of things like drawing on my psychological skills, relying on my Islamic faith and seeking the appropriate help, medical help when needed. And it just occurred to me that perhaps my experience both as a clinical psychologist, as a woman living through perimenopause, it might be useful for other people too. So that’s when I kind of proposed a book on menopause and it was accepted. And then almost immediately I started thinking, my God, what have I let myself in for? How am I going to write a book whilst I’m going through all these perimenopausal symptoms? But I just kind of thought, well, I’m in it now. I’m just going to have to do it. And then actually, when I was doing a bit more research around it, I kind of got more convinced that the book was needed because I found like excellent medical information about hormones and treatments and I found books on personal stories but what I found was much less of, was something that brought together the biology, the psychology and the social context of menopause and I think as psychologists, you know, that’s how we naturally think isn’t it? We don’t just ask you know, what’s happening biologically, what’s going on in your body, we also ask how is this affecting your identity, your relationships, your work, your confidence, you know, and beliefs, and your sense of self. So that’s the kind of book I wanted to write, something that I wish I’d come across when I needed it, and I was going through it and I needed that kind of support. So that’s it. So that’s what I was, you know, conscious that menopause resources didn’t quite reflect all of those things. And the other thing also to me personally was that didn’t see, it was quite narrow in terms of the cultural perspective. And so coming from my cultural background, South Asian Muslim background, I became curious about how different cultures understood menopause as well. I think a lot of cultures kind of see it primarily as a period of loss, but I think some cultures, they see it as a new and respected stage of life. And I found that quite fascinating, how we’re shaped by our cultures in terms of aging and our sense of womanhood and so on. So that was also another factor in what I wanted to bring to the book as well.
Paula Redmond (04:53)
Yeah, great. And it’s really a lovely book, and just to kind of summarize the structure, I guess you’ve got the introduction around, you know, sort of introducing your approach and particularly as you were just saying there, a kind of bias, psychosocial, spiritual model that was really important and I guess filling a gap really in terms of what else is out there. And then you go through the kind of a range of different symptoms and how you experience those and advice for coping with that. And then kind of thinking about how that relates to broader contexts at the end. And I think what I really liked about the book is the way you really weaved in a sense of humour, you know, and and particularly to something that, you know, has quite a lot of negative press really, an experience that that you know it’s can feel quite negatively loaded. So I really appreciated your humour and also all the charming drawings. That was really lovely as well. Were they your drawings?
Momotaj Islam (06:04)
The drawings, they’re actually, they’re my son. So he was at university at the time and he loves drawing. He’s quite creative. He writes poetry, songs and then he hadn’t done any cartoon drawings or anything. He likes, you know, to turn his hand to new things. So I was talking about looking for an illustrator and he was like, well, I’ll have a go. And so they’re quite amateur, but you know, I think I liked having that connection that was coming still from within my circle. So actually, he had a go at drawing. I basically explained what my chapter was about and gave him a sense of what I was looking for. And I said, I can’t draw, but this is like, I just kind of gave him a sense with stick pictures. And then he created them. And I’m glad you picked up on the humor actually, because that’s what I think I wanted to, I mean, menopause is a serious topic, obviously, but I think I’m very conscious of not pathologizing it and trying to keep it in perspective, I suppose. And I think I always find humor, even in my clinical work, I think sometimes, when you can share a humour with a client, it kind of helps you to engage, it helps you to connect on a different level. And I kind of feel sad that because the title is ‘coping with’ and it sounds like it’s really serious. And I feel like until you read it, you don’t see the humour. And so I feel a bit sad sometimes I can’t get people to say, I can’t say, this is a funny book. I think it reflects my personality. I tried to kind of just be how I am, you know, with, and I’ve had that feedback before where people say I feel like you’re chatting with me or I feel like I’m in therapy with you and I do, and I do feel pleased with that.
Paula Redmond (07:50)
Yes, that does come across. It’s really nice. One of the other things that I think is, and I’ve noticed, you know, reading all the books that everyone, all the authors have a different way of doing things. And one of the things you’ve done at the end of each chapter is like, done a little summary like, of the key points, which is always helpful. But also a section about sort of a gratitude kind of bit. So you’ve got things, sort of your points that you were grateful for. And then there’s space for the reader to kind of add theirs. And I wanted to ask you about that because I guess I was, I had two kind of points of view. Like from my psychologist hat was like, yes, you know, gratitude is, you know, that’s a really helpful intervention. And then my 40-something woman self was like, you know, what is this? So it’s yeah, say a little bit about that, well I guess like that sense of I must be grateful.
Momotaj Islam (08:56)
I think that’s a typical reaction we often get to the idea of gratitude, don’t we? And I think that’s the thing, it’s not about dismissing what we’re going through. Yeah, I think that’s what sometimes people might feel a bit dismissed, like just be grateful for everything you have. But it’s more I think, as I talk about it, and the reason I do it in that way and do my little gratitude box as well is because I wanted to model it. Obviously, I did it specific to about writing the book, but just everyday life modeling, because as you know, with gratitude, that’s the thing we kind of feel like we should only be grateful when big things happen to us. But it’s the noticing the little things, isn’t it? And that practice of noticing the little things. And we know that’s what the research has shown, hasn’t it? That, you know, that practice of gratitude is good for our well-being. It’s good for our… because we’re always, somehow we have this tendency to focus on the negative. Somehow we always complain when something goes wrong, but we don’t praise when things go well. And that was the point. It’s not about dismissing, you know, it’s valid. I think the whole chapter is about validating what we’re going through, but it’s about picking out the little things that we can also be grateful for as well.
Paula Redmond (10:13)
I noticed as I was going through the book, I was able to kind of like settle into that idea more. So that was yeah, really lovely. So thinking particularly about this podcast as you know, a platform for thinking about the impact of work on us and vice versa, what would you say about how your experience of this stage of life of going through the menopause impacted you as a professional in terms of both the kind of functioning in your role, but also in terms of your identity.
Momotaj Islam (10:55)
Yeah, I think the main thing to kind of start off with is that the first challenge is that, like a lot of women, I didn’t even realise I was going through perimenopause. In fact, I hadn’t even heard that term until a few years ago. And it was hardly ever mentioned, it’s something that’s become in recent focus. So I didn’t know I was going through it. And that’s actually one of the hardest things because you’re going through lots of stuff and you can’t work out what it is. So I kept going to my GP with different symptoms, because as you know, menopause has a whole range of symptoms, never connecting that it’s anything to do with menopause. And it was also never mentioned to me by the health professionals I was going to see. I was being sent off to different hospital departments. And actually, when I look back on it, I feel a bit angry about that because I feel I was at that classic age in my late 40s and no one was actually mentioning there’s this thing around that could be causing these symptoms. So at the time I was just being a typical kind of professional working mum life, if you know being busy. I had several jobs or roles. I was working in the NHS in the community mental health team. I was teaching at university, youth supervising trainees on an IAPT course. I had a small private practice and I was a trustee in a mental health charity and I was juggling family life. So I just kind of thought it’s just stress, you know, the thing is I’ve always been busy and I always enjoyed being busy, but things started to feel like, different now. It started to feel harder to manage it. And so in addition to the hot flushes and the night sweats, which were pretty bad for me, I think the most difficult symptom was the cognitive changes, what we now call brain fog, because along with exhaustion from poor sleep, because like night sweats, I thought would make you wake up just like we’ve just had this heat wave, haven’t we? You know, during the heat wave you wake up, but when you have hot flushes, night sweats are similar to hot flush. You kind of, I used to wake up drenched and then having to change my night clothes and so you can imagine that disrupts your sleep. So then you have poor sleep and then the impact of that the next day and then the impact of never knowing when your symptoms would appear because they kind of… you don’t know when the hot flush is going to suddenly hit you. You know that sort of thing can be really difficult to manage, it can cause you anxiety because you don’t know when you’re going to have a hot flush in a meeting or something. And then with the brain fog I actually thought I was kind of developing early onset dementia and I heard that’s a common thought people have and again that’s quite frightening, you know? So I kind of include a lot of anecdotes in my book, which I call Meno Moments. And a lot of those kind of happened around work, actually, as well. So, you know, like I spend a morning supervising trainees, then walk into a meeting straight afterwards, we’d be discussing the trainees. And I sometimes couldn’t recall some of their names when I’d just seen them, like an hour ago. And then like I’d be giving lectures sometimes, and then completely lose my train of thought, you know, halfway through a sentence and one day, I think I put that in my book as well, like after a really terrible night’s sleep I was so exhausted, I was giving a lecture and I sat through most of that lecture which isn’t engaging, isn’t the way I would normally do things and then that was the first lecture, you know, in a long time that I’ve been supervising where I received some negative student feedback and one of them said… the lecturer sat throughout the lecture. And I was just mortified by that because it wasn’t me, it wasn’t how I wanted to represent myself, you know. And then I’d also, so I was a consultant, like a chief psychologist in a health tech company. And then we’d be doing like, pitching meetings and things. And then I’d be presenting to clients and suddenly couldn’t retrieve some, you know, psychological terminology, something I would think was basic, you know, our bread and butter. And as the psychology expert in the room, which is why I was brought in, you know, that really knocked my confidence a bit because I’d kind of quickly have to think of something simpler to say and then carry on. I mean, obviously they, nobody probably knew that something was missing because they didn’t know what I was going to say. But that’s not the point, I noticed. So I felt it, you know, as well. So I think the other thing is as well as psychologists, we kind of carry a sense of responsibility around fitness to practice, you know, and I think that probably somewhere in the back of my mind was there when I was going through the worst of it. And I never reached that point actually, thank goodness, where I felt I wasn’t fit to practice and nobody ever questioned my competence. But I did kind of have that sense of wondering if I was giving the best best to my clients at the time, you know, when your memory and concentration feels different, it’s easy to start questioning that. So all those things kind of, you know, affected my professional identity because I’d always thought of myself as confident, fairly confident, competent, you know, and I suddenly felt very vulnerable. And I was trying hard not to let everyone see that as well, because you don’t want, you know, your colleagues to see that you’re struggling. But then that effort in itself becomes quite exhausting. And so in terms of support and things, I mean, at the time there was very little conversation about menopause in the workplace. There were no menopause policies, no adjustments being made. And, you know, there was no culture where you could say, you know, actually, I’m having brain fog. So like many women, kind of, instead of asking for support, I think I just kind of thought I’ll have to deal with it in some other way. So then I started reducing my hours. I stepped down from my trustee role just to give myself a bit of space. Because again, I’m a problem solver, you know, by nature. So I thought this is a problem, how do I solve it? So that’s why I thought, just give myself some space. But of course, I recognized that I was fortunate enough to be able to do that because a lot of women can’t just reduce their hours or give up a role because, you know, they can’t afford to. So again, being able to recognize that is important. And then eventually I actually left the NHS, not just because of this, I suppose, it was kind of on my mind a little bit because of ongoing organisational changes. But I think the idea of working independently and giving myself that autonomy was appealing, you know, because if I’d had a sleepless night, I could start my day later, ease into the day a bit and work around my symptoms. So again, that’s another privilege again, to be able to do that, which a lot of women can’t.
Paula Redmond (17:52)
Can I ask Momotaj, like, so there was this phase where all this stuff was happening and it was very difficult but you didn’t know that it was menopause related? And then like that penny dropped and you know, then you had that framework to understand the symptoms. Did that impact how you were with work?
Momotaj Islam (18:17)
I think that made it, it helped me to understand, so eased the anxiety, I suppose, because, you know, to realise actually it’s not dementia, it’s brain fog, it’s what a lot of women are going through. That fear of, because obviously as soon as you think dementia, you start doom and gloom. So I think that made things a lot easier. And then being able to name it, having a name for it, working out what it is, means you can do your research. As psychologists, we do our research on things. So then I could start looking into what helps with brain fog, what helps with hot flushes, what helps with… Because apart from hot flushes, which we all kind of relate to menopause, a lot of the time we don’t know about any of the other symptoms. We don’t even think about it. So my idea before I started looking into this was you have some hot flushes and then your periods stop. That’s it. Menopause is over. I think that’s what a lot of us think actually. And then some women, for the very lucky ones, will say, I didn’t even notice it happening. Now, statistically about, apparently about 25 % of women have an easy time of it. But the rest of us have some symptoms. And then there are about 25 % who have very severe symptoms. So I think I was in that middle 50%. So yeah, I think it just helped to know what was happening. And then I think, like I said, kind of drawing on your skills, your psychological skills. So, you know, one thing I found that really helped me was to learn to name it as well. So instead of panicking when I forgot a word, you know, what I do now, like in a lecture, I’ll actually name it and say, that’s my menopause brain, give me a second, it’ll come back to me. Usually comes back to you. If it doesn’t, you just move on, you know. So I think by naming it, you’re kind of creating that space for yourself where people are not judging, they’re not wondering what’s going on and then you’re also able to kind of normalise it as well. I think naming it normalises it and I think that’s really important that we do normalise these things because half the population is going to be going through at some point anyway.
Paula Redmond (20:33)
Yeah. And it it was interesting to hear what you describe how, you know, and there were other reasons as well, but it didn’t feel possible to stay in the NHS, stay in an employed role, and that you were able to, you know, explore other avenues for yourself, which as you say is not is kind of an individual solution, isn’t it, that isn’t available, you know, more broadly?
Momotaj Islam (21:01)
Yeah, actually, that’s, I mean, that’s the thing. I’m talking about my own experience. But when you think more widely, I started to become aware that it’s not just a health issue, it’s a workplace kind of issue, really, isn’t it as well, because most of us are working as well. And also, by the time you get to menopause age, you could actually be at the peak of your career, you can have a lot of responsibilities. So many women are kind of trying to juggle all that, maybe leading teams, maybe supervising others, you know, carrying significant responsibility. And then you’ve got this whole host of symptoms that you’re trying to manage. And if you’re trying to do that silently because you’re worried about how it would be perceived, that adds another kind of pressure on you, which is why I think there are statistics to show that about one in one in 10 women do leave their jobs or change their roles in some way, like I did, because of their menopausal symptoms, and a lot more women also try to reduce their hours. So that’s kind of like a huge loss to them. But also, I think it’s a loss to employers and industry, isn’t it? Because you’re losing people who are at the top of their game, if you like, with a lot of skills that they’ve built up, because you’re not managing, helping them manage the difficulties. I mean, the good news, the encouraging thing is that there are a lot of changes happening. So there are… organisations are beginning to recognise it, try to support women. Employers are kind of developing menopause policies. So there’s actually the legislation that came in, I think came in this year, the Employment Rights Act, which kind of states that any UK employer who has more than 250 employees needs to publish a menopause action plan by next year. So hopefully that means not just publish it, hopefully implement it, you know, what they publish. So that’s really helpful. And then it’s also helpful that there’s recognition about how it affects our mental health as well. And so I think the Royal College of Psychiatrists recently published a position statement on menopause and mental health and also like a women’s mental health strategy link it, you know, to help us think more about these issues and how we bring it into the workplace and support women everywhere.
Paula Redmond (23:26)
That is really encouraging. One of the things that I was thinking about, and partly based on my own kind of experience of being in that perimenopausal zone, is the kind of fluctuation of things and the uncertainty and the like I don’t know, like just unpredictability basically feels like a key theme. And how hard that is when you’re wanting to make plans for work or think about reasonable adjustments, like, you know, for me, I, you know, I am self-employed, so I can be like, right, you know, I need to like get this, you know, do this differently. But by the next week, it’s something else. Like that thing is gone. And it’s something else. So that’s so, so challenging. And I guess particularly when you might be working within you know, these like really clunky systems that like, you know, everything has to be approved and agreed and, you know, a process, by the time that happens, you might be experiencing something completely different.
Momotaj Islam (24:37)
Yeah, I think that’s it. It’s like a roller coaster. You don’t know when the ups and downs are gonna be happening. And yeah, like you say, I would have months of these hot flushes and night sweats and then that will go away and then I’ll just, I’d get joint pains for a while and then that would go away and then I’d get the brain fog and you it’s just, you never know what’s, so it’s really, it is hard to prepare for. And I think that’s where that kind of having more of that general attitude of acceptance and gratitude and self-compassion I think is so important as well. Because I think if we’re used to being capable and then suddenly we can’t do the things we used to do, it’s very easy to kind of judge yourself and blame yourself, what’s the matter with me? Why can’t I do this? It was so easy, you know, last year even, and suddenly I can’t. But kind of acknowledging what you’re going through, yeah, that is an upheaval, things are up in the air a lot of the time then, so having that self-compassion that we teach to our clients, we need to do that for ourselves. Because I think as psychologists, we tend to feel like, you know, we tend to feel like we’re the helper and we only help others, we don’t need help, you know, kind of thing. And so then we don’t ask for help. I think maybe that’s women in general, we kind of tend to be the carers, don’t we? And I think that was my instinct as well, you know, don’t ask for any help, any support at work, just keep going and don’t tell anyone because you don’t want to look like you can’t cope. And so that whole judging yourself makes it harder to manage as well. So I think self-compassion is really important. And as psychologists, as therapists, it’s important to recognise that we’re not immune to it. We’re just as human as everybody else, you know, because we tend to intellectualise things as well, don’t we? So I think just allow yourself to go through the process, give yourself the space that you need, where you can. I mean, I think, like you say, when you’re self-employed, it is easier to make those adjustments for yourself. But if you’re not, then it’s about talking to people and asking for those adjustments. And I think most reasonable managers these days would understand if you, I don’t know, if you have hot flashes, you need to sit near a window or if you’re needing a bathroom a lot, being able to sit somewhere or have access, you know, that kind of thing, being able to excuse yourself from meetings without making a big fuss, you know, those kind of things. I think most people would cater for that. And actually they have to these days because there are cases where women are taking employers who don’t accommodate those things to court these days as well. So even if they don’t do it through just an understanding perspective, they’ll have to do it from a legal perspective anyway. So yeah, so I think that’s important.
Paula Redmond (27:32)
I’m wondering how being a clinical psychologist impacted your journey. And I guess you’re kind of touching on some of the wisdom there that you’ve learned and developed through your profession that has been able to support you personally through this. But yeah, say more about that.
Momotaj Islam (27:50)
I think, yeah, first, like I said, we have to recognise that we are just as vulnerable as everybody else. You know, just because we’re aware of what’s going on doesn’t mean we can prevent ourselves feeling those things. So we do need to acknowledge it, feel it and ask ourselves, you know, what is it I need right now? You know, that simple question rather than intellectualising it. And then I think being psychologists gives us tools that, you know, maybe other people aren’t as fortunate enough to be aware of. It gives us tools of, for example, I talk about acceptance and commitment therapy in my book. So that talks a lot about distinguishing, you know, the unavoidable pain and suffering and so on, and not trying to work against it, not trying to work against the reality of the situation, but accepting it, acknowledging it, and then try, you know, question, how do I respond to this, you know? Not trying to change it, you know, allow it that space it needs. And then with CBT, you know, we talk about not catastrophizing things. So you can imagine when you’re having the brain fog and then thinking, my God, have I got dementia? You know, if you’ve got somebody in the family who has dementia, and you can see that some of the symptoms might look very similar, you know, and then you think, my God, am I going down that road? So CBT teaches you not to catastrophize but look at things in a more rational way, put things into perspective. So again, that’s another tool that we’ve got about stepping back and looking at the evidence and weighing things up. And then like I’ve said about self-compassion as well, which you know, we teach in CFT in general, ecological work. So I think that’s it. It’s about acknowledging things, looking at yourself with the same kindness that you would with other people. So those are the things that I kind of learned. So I think the experience of menopause kind of taught me to apply the same principles to myself that I would do work with with a client. So hopefully I think maybe it makes me a better psychologist because you’re able to empathize with maybe not menopause but other similar situations where people feel out of control. It kind of maybe deepened my empathy when people feel out of control because I think as psychologists we’re used to feeling in control a lot of the time. We’re the experts. We know how it works to be put in that position of not having all the answers and that sense of uncertainty. So as we know, all anxiety is based on the intolerance of uncertainty, isn’t it? And like you were saying about all the symptoms, it is that uncertainty. What am I going to have next week? Am I going to have hot flushes all this week or am I going to have, you know, brain fog moments and so on? So again, learning to tolerate that, you know, and accept that these things are not in our control is something that even as psychologists, we kind of have to learn, you know, and embrace those human experiences.
Paula Redmond (30:58)
As you’re talking, it’s making me think about a tendency I’m aware of as a psychologist is to spend a lot of time in my head and with my feelings. Like I’m really drawn to that. I’m aware of definitely a kind of mind-body dichotomy in terms of my relationship to things. I was noticing you said about how when you were first were aware of things, that you thought it was stress related, which is kind of a very psychological interpretation, isn’t it? And that being able to kind of join the dots with your biology took a bit longer.
Momotaj Islam (31:34)
I think that’s where we have a role actually as health professionals, you know, because like I was saying earlier, there’s, you know, there’s excellent medical information out there. You know, people can talk about their own experiences, but we have that skill in between, haven’t we, to connect those dots. And I think that’s where I would say to health psychologists, therapists, people as health professionals is to kind of make menopause a part of your clinical thinking. Especially as most of us will be working with midlife women at some stage, because often, also in midlife is also when you do have a lot of stresses, we do manage a lot and balance a lot. So, you know, you hear that term sandwich generation. So, you know, often women in their late 40s, 50s might still have young children or even older children, they will have, they might have elderly parents that they also care for. They’re sandwiched between those caring roles. But like we’ve said, they’re also often at the peak of their careers. So there are all those stresses. So when we see women, because of maybe other issues that they come for, to have that awareness of menopause as well, as part of your clinical thinking, I think is really helpful, will be really helpful for yourself and the client. And I think when I look back at it now and I think about how I was going through perimenopause and I was seeing other women also probably going through it, but they didn’t know that, like I said, we didn’t know this word perimenopause. So they wouldn’t have known to say to me, I think it’s menopause. I wouldn’t have known to say, it looks like perimenopause, you know. And so we had this kind of shared ignorance about it, which meant I didn’t even think to bring it up because I didn’t know. And I was probably struggling the same as everybody else. And I talk about my, in my book about the irony of, you know, talking about sleep hygiene and so on with someone when I’m kind of struggling with it myself. You know, I think a lot of us probably do that because you know what needs to be done, your advice, but actually it doesn’t stop you experiencing it. So similarly with the menopause, I would have been going through all those symptoms and not known. So I think that was one of my motivations for writing the book, actually, kind of primarily as a self-help book for women, but also I wanted it as a resource for health professionals to kind of build their confidence in recognizing menopause, you know, and bringing it into the conversation. And I think that’s what we need to do. And I think formulation around the biopsychosocial transition is something that we are really well placed to do because like I say, we are good at kind of thinking about people in context. Relationships is another thing I have mentioned. So I think menopause impacts a lot of relationships. And sometimes we’ll be seeing people because they’re having problems in their relationship. And if we’re aware of how the, how what they’re going through as women might be impacting on the relationship, that’s something that can be brought into the conversation as well. I’m not saying that it’s relevant for everybody, but I think it’s more that if we can bring it into our awareness, it’s something that we can think of as part of our formulation as a possible factor as well.
Paula Redmond (34:57)
And it’s fascinating because I guess as clinical psychologists we would pride ourselves on taking a biopsychosocial approach and a developmental perspective. But I never had any training about menopause.
Momotaj Islam (35:10)
You’re right, we didn’t, I don’t think any of us got training on menopause at all. And even in the medical world, I think even medics got very minimal training. I think now people are starting to specialise in women’s health and so on. But, and I think maybe social media and the internet obviously plays a big part because we often now look things up before we go to our doctor. So we go informed and then maybe GPs feel like, I need to become more informed myself, which is a good thing, of course, but there’s a lot of misinformation as well that we have to be careful about. So because we recognise that there is no training, after I wrote the book, actually, I started collaborating with Professor Amy Spector at the Menopause Mind Lab at UCL. And she and I and another psychologist, Helen Donovan, we developed the Introduction to Menopause Awareness course for psychological therapies. So we’ve started kind of doing that for people who want to enrol and do that. And then we realised actually why not start bottom up and train clinical psychology trainees and then get that interest in the, so we’ve actually started, I think, I’m pleased to say we did the inaugural, I think was the inaugural, clinical psychology doctorate course training on introduction to menopause at UCL. And then I’ve done several others since then as well. And it’s really nice to get that interest early on. It’s not, you don’t I mean, obviously, at that stage, you don’t have to give a lot of data. It’s just the introduction of the awareness that’s there. And then if people are interested, and I do sometimes have trainees coming up who are interested and then say, well, how do I get more into this kind of work? So it’s just to kind of spark that interest. And then make them aware that this is an area that you could look more into as psychologists because I think in the past it was always thought of as a medical issue but what we’re trying to say like I said with the Royal College of Psychiatrists as well is to kind of look more at the psychological impact and the wider context of it as well. So I think that’s I think I would say is to kind of remember that it’s not just a hormonal event it’s a biopsychosocial event and then to think about how psychological support can be really helpful, along with medical, like you’re saying, it is in your body, it is a physiological thing. So we’re not ignoring that. So it’s kind of how to, how those things work alongside each other. So as you probably know from the NICE guidelines, HRT is the first course of treatment that’s offered, but CBT is also in the NICE guidelines because CBT has been shown to be effective, especially for hot flushes, sleep problems, or menopause related problems. So I think kind of trying to remember that we have a lot to offer. And then I would say the next thing is to kind of not be afraid to ask. Again, that’s what I’m saying. If we become knowledgeable ourselves, if we become aware, we can then ask, you know, like we do tentatively about other issues, you know. Could menopause be a part of what’s going on here? So building that confidence. And I want to kind of make sure that it’s not just women, but also male therapists and also feel confident to ask, which is where we need the training. Because obviously if we don’t have the training, we don’t feel confident to ask about that. And then I think just to, you could just ask just a simple question like, you know, I wonder if menopause might be playing a part in what you’re experiencing, what do you think? Like we do with other things really and try to be validating, help them. Sometimes when I do that, sometimes we may actually suddenly say, now it all makes sense. It’s like you’ve connected the dots for them. You know, I hadn’t thought about it. So like I was saying, if back in the day someone had said to me, all these things you’re going through, it kind of fits under the umbrella of perimenopause, it would have been a light bulb moment. It would have made sense to me like it did later on.
Paula Redmond (39:22)
Great to hear about these developments that things are moving and changing, both in the sort of policy level but also training. And you’ve mentioned a lot of really helpful, kind of key things for health professionals to keep in mind there. Is there anything else that you would really like listeners to take away or…
Momotaj Islam (39:42)
I yeah, if I was going to give four kind of practical reminders, I would just say what I’ve just been saying is kind of firstly, kind of listen without assuming because every woman’s experience is different. That’s I think, that’s something I haven’t said that although there are so many symptoms of menopause, you see all these lists that are available, 36 symptoms, 65 symptoms, whatever. And you can have a lot of those symptoms, but not everybody goes through all those symptoms. So it becomes your own menopause, in terms of which symptoms you go through or don’t go through. So we can’t assume, just because we read about it, that every woman is going through the same thing. So I think it’s about asking, really, not assuming. Again, I would kind of talk about not pathologising it, but at the same time not dismissing things as, it’s just hormones. So avoid either extreme really, I would say. And then think about the wider context. So menopause isn’t just in isolation, but it’s about their careers, their caring responsibilities, you know, that they might have relationship changes, other significant life events that might be going on. And as psychologists, we do that anyway, don’t we? So that’s really useful. And then equipping yourself with the knowledge of just basic knowledge like about HRT, about the NICE guidelines, about what’s available psychologically, so that even if you’re not the one that’s going to be treating them, you can signpost where it’s relevant as well. So like we’ve kind of been talking about personal and professional with regard to menopause, aren’t we? And I think one of the reflections, I think we talked about it earlier, that I kind of feel for myself is how it’s kind of made me more aware about things like uncertainty. And so again, acknowledging that, that you know, and I think that’s where we can have more empathy for our clients, acknowledging how all these changes, not knowing when things are going to happen, not knowing where things are going, how long it’s going on for. Because again, we have said perimenopause can go on from like a few months to two years to up to 10 years for some people. For me, it was like eight years, I think I worked out. So that’s a long time to be dealing with things. so that actually learning to manage uncertainty is really important for ourselves first, but also helping our clients to manage that I think is really important. And I think the other thing is also also that as psychologists, we can teach people all these skills that we’ve talked about, but kind of still to remember that it’s not just a responsibility for that woman on her own to look in the wider context and think, you know, that although we’re teaching them how to have coping strategies, how we’re teaching them psychological flexibility and self-compassion, the wider context of workplaces, healthcare services and society also has to adapt. So I think it’s unfair to just put all that responsibility on the woman like you need to, you just need to deal with it. Which is probably what has always been in the past, just get on with it, it’s what everyone goes through. But actually now we’re starting to recognise that everybody needs to deal with it, it’s not just us. So I think that’s good that that’s happening and so that we’re kind of thinking of menopause as something that we transition through, we don’t have to just endure it and survive it somehow. I think as psychologists again, we’re well placed to help people to kind of use it as an opportunity to kind of rethink their priorities. I think menopause is that opportunity to kind of redefine who you are, maybe gain some clarity on what’s important to you. So talking about values comes up a lot, know, which is I use act skills to talk about values. And I think it can be a really positive thing in that sense, because suddenly you’re kind of, these are things we don’t think about. We just go through life, usually, doing all the stuff we do. And in some ways, I think that’s probably one of the benefits of menopause. It kind of just like, pushes you into having to think, having to reflect. And I think a lot of women talk about how it gives them the opportunity to kind of redefine themselves. So in some cultures, they call it a period of rejuvenation or a second spring. And I like those kinds of phrases because it’s like you can work things out and start again, have a fresh start. And I think that’s a really nice way of viewing it. So it’s not all doom and gloom. I think we’ve got a lot we can do to help ourselves, but also we need help as well from the wider context as well.
Paula Redmond (44:42)
And Momotaj, what has your experience been like of this process in terms of you know discussing some very personal things in your book? You know, you talk about, you know, like experiences of having very heavy periods and having to kind of hide away in the loo while you’re waiting for someone to rescue you. What’s that been like for you in terms of as a psychologist writing and then I guess you know talking about it in this kind of form?
Momotaj Islam (45:08)
Yeah, I think, so we’re talking about self-disclosure as therapists. I think that was like one of the difficult parts, I suppose, in deciding to write. So we kind of don’t think we kind of think we should keep, we kind of make good relationships with our clients, we’re taught to do that. But we’re also taught to keep a distance, a kind of professional distance, if you like, so we can have warm, engaging relationships, but it’s a professional distance. I mean, I think maybe things have changed a little bit now, but I think that’s how it was, wasn’t it, in the past. And I think that’s something I was very aware of. And also culturally as well, for me, it’s not something that, you know, talking about personal matters, especially, you know, menstruation, reproduction, all that, are not things we talk about, you know, and we’re still writing a book and describing it. So I think it was a hurdle to get over. I think, luckily, it wasn’t just me that was going through that hurdle because of the ‘coping with’ series. So there were a group of writers, so we kind of got together, when we talked about it, we kind of discussed what the issues were that could come up for us. So we’d be thinking about, you know, what will our clients think of us when they read this? How will it impact? Will they see us differently? Will it undermine our credibility? All those kind of thoughts came up. so when I reflected on those, I realized those questions were really about vulnerability. And I suppose, again, we try not to be vulnerable, even though that’s what we teach. We try not to show vulnerability because we want to be seen as the coping that, you know, so on. So I think, again, it was something that to reflect on and think, well, you know, how do I model how vulnerability can actually be a useful thing? Yeah. So I kind of thought people need to know that the person writing this understands the lived experience as well as, you know, the theory behind it all. So if I’m going to write it, I’m going to have to open up. So I kind of had to get over that hurdle, but I just wanted to be authentic at the end of the day and I feel I have been and I like that people report that they found it validating and so on and it’s rewarding to get that kind of feedback actually, that people found they could relate and that’s what you want at the end of the day. And culturally again, again I wanted to change that narrative a little bit so that it’s okay to talk about these things you know because if we don’t how are people supposed to learn? Like you know, if people had been talking about perimenopause and menopause for years, I wouldn’t have not known what was going on and struggled all that time so I kind of felt it like a responsibility once I realized it to kind of share as well.
Paula Redmond (48:15)
And that makes me think of it as like in ACT terms, kind of making room for that discomfort of vulnerability in the service of those values around authenticity and you know connection with the reader and validation. So the book was published in 2024 and you obviously started writing it before then. So I wonder if there are kind of any updates in terms of your own experience with the menopause?
Momotaj Islam (48:42)
Yeah, so I chose to write the book, like I said, I wrote it whilst I was in the depth of perimenopause and I did question whether that was a good idea at the time. So like even just writing sentences a lot of the time, I couldn’t think of the right words, you know. So I was going through all that and even at the end of it, so I think in my last chapter I talk about how I’m still not at the end of the journey. But since then, I have gone into menopause, which is when you haven’t had a period for 12 months. And I think a lot of us think it’ll be over then. Unfortunately, I mean, fortunately, a lot of things have kind of dissipated, if you like, but some things carry on for a bit longer. I think the brain fog is a lot better. I still get bouts of it, but like the hot flushes have gone down quite a bit and you still get different symptoms at different times. The other thing to be aware of is aging, natural aging. And I think a lot of the time it’s like I question myself, is this menopause, post menopause or is this aging? And I think we have to be aware. And I also always like to point out to not just assume symptoms are menopause, always get it checked out because you don’t know that there might be something else going on. That’s natural aging kind of. Even dementia, if you feel like it’s not going away, it’s still worth checking out. Is there something else going on? So I’ve gone into postmenopause, but some symptoms are still carrying on. But I’m just a lot more aware now. And I feel that, you know, I feel I manage it a lot better. Even by the end of the book, I was managing a lot better than the beginning of the book. So, you know, as it takes over a year to write a book and I was managing, but I was writing it as I was going along. And I’m quite pleased I did that, because I think we tend to forget how hard things are once we’ve got through it. So if you think about childbirth, for example, you know, at the time, it’s just like, you kind of think, how did I get through that? But afterwards, you forget, you forget the pain, you forget, and you do it again sometimes. I wouldn’t want to do menopause again. But I think I’m glad I wrote it as I was going along because as I say, going back to being authentic and real, I could describe things as they were happening, how bad they were. I think if I wrote it now, I might gloss over it a little bit because I might, I think when we get through things, we just assume, and I have a tendency to think I just coped with it, didn’t I? It was fine. But to be able to write it at the time meant I could, you know, give that full narrative rather than just, you know, glossing over it and forgetting really how difficult some of things are.
Paula Redmond (51:35)
Yeah, and I think that’s also the other thing that’s great about the book is just so lots of practical application in terms of, you know, drawing on those psychological skills and you’ve got lots of like workbook, you know, forms to fill in and things. So I wonder if there was also that for you in terms of, you know, making some of that explicit to yourself as you’re going along, you know, the ability to draw on those skills?
Momotaj Islam (51:58)
Yeah, I’ve always been someone who mind maps, I mind map about everything, work, home stuff. I just I think that’s one of, I don’t know, I learned it a long time ago. It was like with my kids, actually, it’s Tony Busan, isn’t it, who teaches kids to mind map to learn new topics. And then I think there was someone called Mark Williams, who did it for formulation, psychological formulation. And then so that’s when I realized I could use it for work. But I use mind maps for, like I’ve got a mind map about house decorating stuff I’ve got to get done. I’ve a mind map about all my work stuff. So I think that’s a really good tool and I do put that in there. I’ve done it for menopause for myself because again with menopause there are so many, because there are so many symptoms. I think, I don’t know about you but I’m quite a visual thinker and a visual memory. So to see it there and the other thing I describe about it, like I was saying, you were saying as well, how you go through all these different symptoms. And what I found was once I was going through some symptoms and I’d done my research and worked out how I might cope with it, if I record that and then I get a different symptoms, so maybe I got hot flushes and I learned how to cope with them, manage them, and then I brain fog, I might forget about, what did I do about the hot flushes again? So if I’ve kind of done this mind map and written down what I did, I don’t have to start that process all over again. And I think that’s how I use mind maps. And then recording sleep and mood and eating and all those things. That’s the other thing, when you go to your doctor with symptoms, I think one of the best things you can do for yourself is to have a record of all the things that are going on, how they’re going, because it will save you time, but it also will help you collaborate with the doctor in terms of your menopause care. If you know what your flow of your periods are like, or if you know what your sleep patterns are like, you can show how it’s impacting you in terms of your quality of life. I think you’ll get a better kind of collaboration in terms of developing care for menopause for yourself as well. I think my main positive message I would give is that it feels like a state of flux, but I think that in itself is a good opportunity to reflect about what’s important to me and maybe think about how life could be different going forward, taking away stresses. I talk about in my book, about shedding your load. And I know it’s not just a case of saying, right, I’m no longer going to do the washing up or I’m no longer going to do that, but it’s more about reflecting, thinking, do I really need to be doing that all the time? Do I really need to be giving here? What’s more important? So evaluating your load and not assuming everything is your responsibility, and then thinking about how you want to go forward. I’m very much into looking at positive aging and longevity is something that’s talked about a lot at the moment, isn’t there? And, you know, health span, I think is another popular phrase. So because we are an aging population and there’s a long life hopefully ahead of you post menopause. So I think it’s a good time to maybe redefine, you know, yourself as well.
