October 18 is World Menopause Day(opens in new tab), a time to bring visibility to a life transition that affects millions yet remains underrecognized in both medical and mental health care. More than a reproductive milestone, menopause is a neuroendocrine transition that can influence physical health, emotional well-being, cognition, identity, and trauma responses. In this blog post, EMDRIA™ member Julie Cardoza explores how a menopause-informed approach to EMDR therapy can foster attunement, resilience, and reclamation during midlife and beyond.

Reclaiming Midlife and Menopause: An AIP Perspective

Guest Blog Post by Julie Cardoza, LMFT(opens in new tab)

Reclamation is the vital act of a person taking back authority of their own story, history, and identity from outside forces who have misrepresented, suppressed, or dictated it. The adaptive shift is from a place of being constricted and passive by a storied narrative into expansive authority, active inhabitants of their own sovereign body-land.

Eye Movement Desensitization and Reprocessing (EMDR) therapy, developed by Dr. Francine Shapiro, is based on the Adaptive Information Processing (AIP) model, utilizing an eight-phased approach (Shapiro, 2018). It has been broadly researched in multiple applications within mental health and is an evidence-based treatment of post-traumatic stress.  

A menopause-informed EMDR approach is emerging (Fort & Irvine-Kindle, May 2026). It’s the sound of silence breaking—these are the moments of the power shift of reclamation. This reclamation is the territory where beyond story is meaning, and the core of understanding is living attunement. And it’s precisely where EMDR therapy excels.  

Midlife as mid-journey emergence  

We, as humans, are a collective of roles, histories, adversities, achievements and biopsychosocial identities within a life journey. In the midway points of this journey, there is a falling away, a shedding of outer-life-driven values orientation toward inner-life meaning, and later-life legacy beyond physical form. A mid-journey is a second chapter of life’s character development, and it’s a reclaimed narrative away from midlife crisis into emergence.  

The menopause transition is a neuroendocrine transition occurring within a larger ecology of biological, psychological, relational, social, developmental, and existential change, most often within midlife. “Menopause” is not a moment. It is an arc of transition whose entry is premenopausal, opening into perimenopause and continuing through the postmenopausal years.  

The invisible critical gaps in care: The menopause transition, early adverse childhood experiences and racial trauma  

The arc of the menopause transition equates to a 40 to 50 percent span of the life expectancy of those born female. It is more a half-circle than an arc. Early intervention matters, meaning we should dispel the media stereotype of a late postmenopausal, White, cisgender, gray-haired female. A menopause-informed approach to EMDR therapy brings the neuroendocrine transition into therapeutic spaces: 

• the late-thirties mother, already in perimenopause, of the recently diagnosed ADHD student, who is just realizing her ADHD symptoms and diagnosis; 
• the twenty-something woman recently diagnosed with premature ovarian insufficiency (POI), grieving infertility and somehow trying to comprehend herself as “menopausal” within her social context; 
• the cancer survivor who has never been informed about the hormonal impacts of menopause because she needed to survive the cancer; 
• the Black woman who is experiencing severe perimenopausal symptoms while another peer has seemingly none (Harlow et al., 2022)(opens in new tab); 
• the transgender man who is now in induced menopause. 

And there are so many other examples seeking support in our uninformed spaces, concomitant with a medical system with a critical care gap.  

The medical and mental health care gaps

Among the identifiable populations in the U.S., there are an estimated 1.3 million women transitioning into menopause this year and approximately 55 million currently “postmenopausal” (Carlson & Vadakekut, 2026(opens in new tab); Manson et al., 2024(opens in new tab); Society for Women’s Health Research, 2025(opens in new tab)). A 2023 research study reported a thirty-one percent presence of menopause curricula in obstetrics and gynecology residency programs (Allen et al., 2023(opens in new tab)). 

Research also reports that among family medicine, internal medicine, and obstetrics and gynecology residents, twenty percent received no menopause lectures at all, and less than seven percent felt adequately prepared to manage menopause (Kling et al., 2019(opens in new tab)).  

As for mental health, currently midlife women are frequent users of mental health services, and menopause has long been treated as belonging to medicine, leaving mental health providers with little training in menopause care (Thurston et al., 2025(opens in new tab)). Mental health, including psychiatry, has no mandated training requirements in the menopause transition, and formal training remains nearly non-existent (Thurston et al., 2025(opens in new tab)).  

Studies identify a relationship between ACE score and level of symptoms (Kapoor et al., 2021(opens in new tab); Thurston et al., 2025(opens in new tab)), including greater vulnerability to depression during the transition (Thurston et al., 2025(opens in new tab)). We also know that racial and cultural stress is associated with earlier onset and a higher degree of symptom experience (Harlow et al., 2022(opens in new tab)).  

For those of us in the field of trauma, it is the invisibility factor that stands out. It is the stunned silence that, in and of itself, is cause for despair—often this represents a re-opening of old wounds. EMDR therapy provides a model to work with both the overt trauma acts and, perhaps even more importantly, re-shape the covert neglect in the time of a person’s life that now demands attunement for survival and sovereignty.  

This is the neurobiological perspective of trauma applied in the arc of the menopause transition: a whole brain-body view, a neuroendocrine transition, not just a reproductive one (Avila-Varela et al., 2024(opens in new tab); Crockett et al., 2026(opens in new tab); Thurston et al., 2025(opens in new tab)), expanding how we can see the person in transition.  

The neuroendocrine transition of menopause: An emerging definition

Menopause is medicalized in the United States, with the average age occurring around fifty-one years of age. Chronological age varies, so the medical classification system called the Stages of Reproductive Aging Workshop +10 (STRAW +10; Harlow et al., 2012(opens in new tab)) is the gold standard tool for identifying stages of the hormonal transitions. It is largely based on cycle frequency, duration, and flow. It is formulated around the final menstrual period, or FMP. The FMP is the single-day event of menopause, identified 12 months retrospectively. The transition begins 4–8 years prior to the FMP (Society for Women’s Health Research, 2025(opens in new tab)).

The Stages of Reproductive Aging Workshop +10 (STRAW +10) stages are:

1. Early Perimenopause;
2. Late Perimenopause;
3. Menopause (the final menstrual period, or FMP);
4. Early Postmenopause; and
5. Late Postmenopause.  

A strictly cycle-based classification system is problematic, just as a chronological age model is. Estrogen and progesterone are whole brain-body messengers, meaning they cross the blood-brain barrier and have many systemic roles. These hormones have influence on neurotransmission, neuroplasticity, cognition, mood, stress responsivity, and many other central nervous system (CNS) functions (Crockett et al., 2026(opens in new tab); Thurston et al., 2025(opens in new tab)), and their shifts and declines have long-term effects on brain, cardiovascular, bone, metabolic, genitourinary, musculoskeletal, sexual, psychological and overall health. 

Research suggests that estradiol, a form of estrogen, may influence how the brain remembers that something is no longer dangerous. Studies in healthy reproductive-age women have found little difference in the initial learning itself, but better retention of that learning the following day when estradiol levels are higher. This may be particularly relevant to trauma therapy, where new learning around cues of safety can include helping the brain and body recognize and retain: “this is no longer a threat” (Milad et al., 2010(opens in new tab); Graham & Milad, 2013(opens in new tab)). The implications of these findings for the menopause transition and trauma-focused psychotherapy remain an important area for further research. 

It is the late perimenopause window that is identified as a key window of vulnerability for both mental and physical health impacts (Thurston et al., 2025(opens in new tab)). This is when the hormonal shifts are most unsteady and unpredictable. This has its own intense abandonment effect with negligently informed care models.  

A global 2024 study identifies joint and muscular pain as the most prevalent symptom (Fang et al., 2024(opens in new tab)), and chronic pain at midlife is the focus of World Menopause Day, occurring on October 18, 2026. The other common symptoms include vasomotor symptoms (hot flashes and night sweats), sleep disruption, brain fog, irritability and mood changes, anxiety and depression, with urogenital changes that include sexual problems (Thurston et al., 2025(opens in new tab)).  

In the most vulnerable women, the psychological load extends to suicidal ideation, as this can be a peak window of suicide risk (Crockett et al., 2026(opens in new tab)) and a window of vulnerability for eating disorders and substance use (Thurston et al., 2025(opens in new tab)) and calls for more menopause-informed care.  

The post menopausal threshold: A new beginning

While menopause, the FMP, is a biological ending, it is also a psychological beginning. This is the reclamation and arrival into postmenopausal lands. From within a menopause-informed approach, research notes that midlife is also a time of generativity, growth and well-being for many women (Thurston et al., 2025(opens in new tab))—what I have come to call an unexpected discovery of a deeper tending of our being.  

The tending is based in the ability to learn how to attend, something that might be challenging if this was not shaped earlier in life. A new bio-rhythm and lifestyle are to be learned, one within a 24-hour and 52-week structure, no longer driven by a cycling of 28–30 days. Seasons of life are here to celebrate—with possibilities for new interests, relationships, values, and mature discernment around the dualities of life. 

A menopause-informed (MI) approach to EMDR therapy

“I’m falling apart, I just don’t feel like myself” are the typical whispered words I hear that cue my own menopause-informed approach to therapy. And I ask, “May I ask you where you might be in the menopause transition?” There is a knowing look, a confirmation, a sigh, a relief.  

From an AIP perspective, a menopause-informed approach does not require a new EMDR therapy model. Rather, it is an invitation for clinicians to be more intentional and attuned to the ways menopause may influence a client’s presentation and treatment needs. Menopause itself is a natural transition and does not need to be pathologized. And yes, the many pathways through which menopause can occur, the length of the transition and life beyond it, and the frequent lack of recognition, support, and informed care are part of the context of menopause-informed therapy. Hormonal shifts, sleep disruption, chronic pain, changes in body shape and size, identity, sexual health and intimacy, relationships, medical experiences, and earlier adverse experiences may shape how a client presents, what becomes activated, and what resources are available during treatment. Attending to the menopause transition can therefore strengthen EMDR case conceptualization, history-taking, preparation, reprocessing, pacing, and target selection. The goal is not a pathology or fear-based approach, but more attuned care that helps ensure this significant neuroendocrine and psychosocial transition is not overlooked when clinicians seek to understand a client through the menopause transition and into postmenopause. 

Self-attunement is a highly necessary skill due to the external stigma that misrepresents, suppresses, and devalues this phase of life. Therapeutic attunement is therefore multi-functional: modeling and teaching new skills of self-attending; reinforcing agency; somatically, creating space for tracking menopausal stress functioning; and reshaping when there has been a history of emotional neglect, including in medical care settings.  

Introduction to MI in EMDR therapy—some areas to consider within the 8 phases:  

1. Phase 1 History-Taking: While gathering historical information about the client and planning treatment, pay careful attention to midlife stressors; supports and resources; relational shifts, including friendships; menopause-specific and medical history, medical trauma, and perceived support; sleep assessment; chronic pain and illness; body image, identity, eating disorders; substance use; and trauma, either recent or complex, including neglect.
2. Phase 2 Preparation: Scaffolding for regulation may be reduced both physiologically and psychosocially. Less predictable neuroendocrine rhythms can coincide with disrupted sleep, pain, shifting roles, and relational supports that may themselves be in transition. Like a construction zone, familiar internal and external roadmaps may temporarily be less reliable. Preparation can include orientation that this unpredictability is transitional, with greater neuroendocrine stability generally emerging in post menopause. Consider pacing, parasympathetic intermissions, somatic tools, and resourcing allies, future self, and future traits. In my experience, nature themes and changing biorhythms can also be helpful.
3. Phases 4-6 Reprocessing Phases: Based on history-taking, reprocessing may include relational and attachment themes, grief, identity and schemas, medical and other traumas, and future anxieties. Reinforcing emerging safety learning – “this is no longer a threat” – may also be important.

An MI approach considers pacing and capacity through titration, constricted processing, extended closure, and specific check-ins within and between sessions. This invites agency, or sovereignty, into every contact, supporting the process of change.

How a menopause-informed perspective can assist clinicians and clients

Reclaiming the narrative of midlife as emergence and menopause as a neuroendocrine transition is a new frontier. A menopause-informed perspective can help clinicians recognize biological, psychological, relational, and historical factors that may otherwise remain invisible in case conceptualization. My entry point was a surgically induced menopause experience. Now, as an EMDRIA Approved Consultant™ with more than seven years of study in the neuroendocrine lens of menopause, I’m excited to be an advocate on this topic. Resources for self-education on the menopause transition are referenced below. For clinicians working with people in midlife and beyond, becoming menopause-informed is one more way of practicing with attunement and curiosity that sets the conditions for effective EMDR therapy. 

 

Julie Cardoza, LMFT, is an EMDRIA Approved Consultant™ and Somatic EMDR practitioner specializing in midlife and menopause and owns a solo practice in California. She holds an Integrative Women’s Health Institute (IWHI) perimenopause/menopause coaching certificate and is a California CAMFT-approved continuing education provider (CEPA Provider #61115), focused on menopause and mental health. 

 

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References 

Allen, J. T., Laks, S., Zahler-Miller, C., Rungruang, B. J., Braun, K., Goldstein, S. R., & Schnatz, P. F. (2023). Needs assessment of menopause education in United States obstetrics and gynecology residency training programs. Menopause, 30(10), 1002–1005. https://doi.org/10.1097/GME.0000000000002234(opens in new tab)   

Avila-Varela, D. S., Hidalgo-Lopez, E., Dagnino, P. C., Acero-Pousa, I., del Agua, E., Deco, G., Pletzer, B., & Escrichs, A. (2024). Whole-brain dynamics across the menstrual cycle: The role of hormonal fluctuations and age in healthy women. npj Women’s Health, 2, 8. https://doi.org/10.1038/s44294-024-00012-4(opens in new tab)   

Carlson, K., & Vadakekut, E. S. (2026). Menopause. In StatPearls. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK507826/(opens in new tab)   

Crockett, C., Lichtveld, G., Macdonald, R., Newson, L., & Rampling, K. J. (2026). Menopause and mental health. Advances in Therapy, 43, 98–108. https://doi.org/10.1007/s12325-025-03427-w(opens in new tab)  

Fang, Y., Liu, F., Zhang, X., Chen, L., Liu, Y., Yang, L., Zheng, X., Liu, J., Li, K., & Li, Z. (2024). Mapping global prevalence of menopausal symptoms among middle-aged women: A systematic review and meta-analysis. BMC Public Health, 24, Article 1767. https://doi.org/10.1186/s12889-024-19280-5(opens in new tab)   

Fort, K., & Irvine-Kindle, H. (2026, May 2). EMDR-centred intervention enhanced with lifestyle and cognitive strategies to support the complex mental health needs of peri and menopausal women [Conference presentation]. EMDR Australia 2026 Conference, Sydney, Australia   

Harlow, S. D., Burnett-Bowie, S.-A. M., Greendale, G. A., Avis, N. E., Reeves, A. N., Richards, T. R., & Lewis, T. T. (2022). Disparities in reproductive aging and midlife health between Black and White women: The Study of Women’s Health Across the Nation (SWAN). Women’s Midlife Health, 8, 3. https://doi.org/10.1186/s40695-022-00073-y   

Harlow, S. D., Gass, M., Hall, J. E., Lobo, R., Maki, P., Rebar, R. W., Sherman, S., Sluss, P. M., & de Villiers, T. J. (2012). Executive summary of the Stages of Reproductive Aging Workshop + 10: Addressing the unfinished agenda of staging reproductive aging. Menopause, 19(4), 387– 395. https://doi.org/10.1097/GME.0b013e31824d8f40 

Kapoor, E., Okuno, M., Miller, V. M., Rocca, L. G., Rocca, W. A., Kling, J. M., Kuhle, C. L., Mara, K. C., Enders, F. T., & Faubion, S. S. (2021). Association of adverse childhood experiences with menopausal symptoms: Results from the Data Registry on Experiences of Aging, Menopause and Sexuality (DREAMS). Maturitas, 143, 209–215. https://doi.org/10.1016/j.maturitas.2020.10.006(opens in new tab)   

Kling, J. M., MacLaughlin, K. L., Schnatz, P. F., Crandall, C. J., Skinner, L. J., Stuenkel, C. A., Kaunitz, A. M., Bitner, D. L., Mara, K., Fohmader Hilsaca, K. S., & Faubion, S. S. (2019). Menopause management knowledge in postgraduate family medicine, internal medicine, and obstetrics and gynecology residents: A cross-sectional survey. Mayo Clinic Proceedings, 94(2), 242–253. https://doi.org/10.1016/j.mayocp.2018.08.033(opens in new tab)   

Manson, J. E., Crandall, C. J., Rossouw, J. E., Chlebowski, R. T., Anderson, G. L., Stefanick, M. L., Aragaki, A. K., Cauley, J. A., Wells, G. L., LaCroix, A. Z., Thomson, C. A., Neuhouser, M. L., Van Horn, L., Kooperberg, C., Howard, B. V., Tinker, L. F., Wactawski-Wende, J., Shumaker, S. A., & Prentice, R. L. (2024). The Women’s Health Initiative randomized trials and clinical practice: A review. JAMA, 331(20), 1748–1760. https://doi.org/10.1001/jama.2024.6542(opens in new tab)    

Milad, M. R., Zeidan, M. A., Contero, A., Pitman, R. K., Klibanski, A., Rauch, S. L., & Goldstein, J. M. (2010). The influence of gonadal hormones on conditioned fear extinction in healthy humans. Neuroscience, 168(3), 652–658. https://doi.org/10.1016/j.neuroscience.2010.04.030(opens in new tab)   

Shapiro, F. (2018). Eye movement desensitization and reprocessing (EMDR) therapy: Basic principles, protocols, and procedures (3rd ed.). Guilford Press.

Society for Women’s Health Research. (2025). Women’s health disparities: Menopause [Fact sheet]. https://swhr.org/wp-content/uploads/2025/02/SWHR-WHEI-Menopause-Factsheet-2025Feb.pdf(opens in new tab) 

Thurston, R. C., Thomas, H. N., Castle, A. J., & Gibson, C. J. (2025). Menopause as a biological and psychological transition. Nature Reviews Psychology, 4, 530–543. https://doi.org/10.1038/s44159-025-00463-9(opens in new tab)      

Free Resources 

American Psychological Association. (2026). Women’s health and well-being during midlife and menopause: Recommendations to improve access to and quality of medical and mental health care. https://www.apa.org/pubs/reports/midlife-menopause-health(opens in new tab)

Cardoza, J. (n.d.). Trauma-informed menopause care for therapists. Julie Cardoza, LMFT. https://www.juliecardoza.com/trauma-informed-menopause-for-therapists(opens in new tab)  

Dutchen, S. (2021, Spring). The mental health aspects of menopause: The mental health issues that can accompany menopause often go unaddressed. Harvard Medicine Magazine. https://magazine.hms.harvard.edu/articles/mental-health-aspects-menopause(opens in new tab)

 

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