NASW Social Work Talks - EP 131 - Menopause and Mental Health

Episode Date: October 17, 2025

NASW Social Work Talks podcast episode 131 - Menopause and Mental Health with Lauren Tetenbaum LICSW, Author of the book, Millennial Menopause: Preparing for Perimenopause, Menopause, and Life's Next Period

This episode of Social Work Talks is sponsored by HPCC, the Hospice and Palliative Credentialing Center. From the National Association of Social Workers, this is Social Work Talks, and I'm your host, Elizabeth Lamott. Really glad to be welcoming Lauren Teddenbaum to our conversation today. She's a social worker, she's an attorney, she's in private practice, and we are here to talk about her new book, Millennial Menopause. I'm holding it up for our viewers. I really enjoyed reading it and she's going to tell us all about it and its important messages. So Lauren, welcome to Social Work Talks. Thanks for joining us. Thank you for having me.

So could we start, most of our listeners are social workers or other helping professionals. can you tell us a bit about your educational background and why you chose social work in addition to the law? I love social work. I love being a social worker. My mom got her master's in social work from NYU when I was in high school. So I initially knew that the social work program was a really amazing opportunity for people who are whatever, in whatever phase of life they're in. And she always worked with the elderly. And when I finished college, I went straight to law school, didn't love it and thought the missing piece is a social work education. So I also pursued my master's in social work. I went to NYU and I've been a licensed social worker since 2011.

And you are in private practice. And in your book, you tell an interesting story near the beginning of how you came to have this area of focus, both menopause and millennials. So tell us about how you came to this and the message of the book. So I am 40. I am a millennial born in 1985. And I primarily do work in my private practice with women who are in their twenties and thirties, but we are all aging. That sort of tends to work. I mean, when I started out in my twenties, I was mostly with women in their twenties, men in their twenties, couples in their twenties. Actually, the longer I practice, the wider my range, which I love. Yes. It's such a privilege to be able to connect on so many levels with all kinds of

populations and reproductive mental health was always very important to me, but I had been focusing on it during the perinatal period and my kids are young and I was very passionate about supporting new moms, working moms, etc. But as I was approaching my 40s, I thought, what's next and why do I know nothing about the next phase of my health? And I started asking questions about menopause. I wrote an article and then I got the opportunity to write my book. And you also mentioned, if I remember correctly, that you attended a conference where you decided to go into a workshop and there was some surprise at how few people were in attendance and how few people under a certain age in attendance, because it seems like part of the message of the book is

how much off our radar this topic is, even though every woman who's fortunate enough to make it to a certain age goes through it and we don't talk about it. Exactly. That is the message of the book. It's not to scare people off, but rather to empower them with knowledge and information and resources because this phase of life is happening. And every older woman that I've spoken with has said things like, I wish I had known, I wish I had been warned. And that's why I wrote it because I wanted my generation to be proactive instead of reactive. And I would say your generation is more proactive generally. I wasn't surprised that this book would exist and would be sharing that the approach can and should and likely will be different. And of course,

it's changing. I think part of it, zooming back a bit, is that we are living longer and therefore addressing this stage of life looks a bit different than it used to. We are more active, we work longer. And I do think that's a part of the big picture. But also, as you explain, another part of the picture is that women have for a very long time been socialized to be quiet about pain, suffer in silence, and not talk about certain things. What do you want social workers to know in this lane with respect to this piece of it? I love this question. I love talking to other mental health professionals and advocates about menopause because much like me, we are so rarely offered information on this. And we're not the only ones. Other helping

professionals don't get information or training in this area either, unfortunately. Doctors, nurse practitioners, etc. And we are increasingly calling for more training. And I think all social workers should be aware of what menopause is, what perimenopause is, the impact that the symptoms can have on a woman's mental health and interpersonal dynamics, and then the resources available so that social workers can point that woman in the right direction. I view being a social worker in part as being a connector. And we do have, I believe, the responsibility to connect people in need with the resources available to help them. Connector and advocate. And you mentioned perimenopause, which of course for millennials is very relevant right now. I really liked the

part of the book where you draw a parallel between adolescence and perimenopause. I thought that was very interesting and psychologically makes a lot of sense. And also that you point out that menopause is a retroactive diagnosis, which means we don't know we're in it until we're already in it, which is all the more reason, as you say, for self-advocacy and education. Absolutely. And you don't have to have a diagnosis of perimenopause or of major depressive disorder or whatever it is to get help and support for whatever is bothering you. And so if you're having trouble sleeping all of a sudden, or your mood swings are out of control, it could be hormonal fluctuations, it could be something else, but you certainly deserve support. And social workers are often on the front lines

of providing that support. For sure. Social workers are on the front lines. And I think that's where we should be. You're talking about getting mental health support. And in your book, you mentioned that cognitive behavioral therapy is a real focus for you. Talk to us about why that is. Why CBT? And what do you observe taking that approach? So up to 70% of women in perimenopause experienced some sort of mental health struggle, the mood swings, the irritability and rage are common themes that we see, some teariness, sadness. So that doesn't mean that 70% of women are suffering from depression, but they're having a hard time. And as a psychotherapist who primarily uses CBT, I feel very privileged that I'm able to support them by modifying their thoughts,

their interpretations of situations, their triggering events by helping them come up with more effective behaviors and communication strategies. And CBT has been proven not only to help with the mental health struggles, but also with the physical symptoms that are common like hot flashes. A lot of the work around that draws on ACT, on acceptance and commitment therapy, because you can say to yourself, okay, I'm having a hot flash and accept it instead of try to push it away, which often doesn't make us feel any better. It usually makes us feel worse. Just lean into what's happening. Remind ourselves that it's going to pass. It makes me think of wearing layers, which is a nice tip. But I will share that as I was reading

your book, which again, really glad you wrote it, really enjoyed it. It reminded me of a text chain that I had with a group of friends where someone was looking for a new gynecologist. And we all started sharing what our gynecologists, mostly male, were saying to us about menopause. And it was not what you're saying in this book. And that is why many of us changed to work with somebody who had a bit more experience with this stage of life. And I wish that I had known to advocate on this topic sooner. I really do. Another one that's a particular topic since the book is millennial menopause is pelvic floor. You have that in there and it is something that young people can be thinking about that nobody talks about. Let's just like dive into that for a moment

and go from there. So I feel that my cultural rhetoric around pelvic floor therapy has been more open to it than in prior generations, beginning in the perinatal phase. And there are even some countries that pelvic floor therapy is very much part of the OB process when one is pregnant, postpartum, et cetera. And frankly, in the US, you know, that should be part of our treatment plan. I never heard anything about that. Exactly. I know. I started to hear, I had my first kid in 2016. And I feel like it was not by my wonderful doctor, but it was mentioned to me as a postpartum care factor that we should be looking out for and that we should be considering. And in the book, I quote Dr. Sarah Reardon, who's an amazing advocate and pelvic floor therapist.

And she taught me a lot about the pelvic floor during perimenopause. And it's very much often a forgotten body part. And it really shouldn't be. There are so many ways that it plays a role in our health. And it's important that we keep that in mind as we age and always. And as social workers, simply for us to know to put words to that and to put that out there, I think is so important. And what about sex? What do you want to share with our listeners and viewers on the topic of sex and sexual activity, sexual life. So I will say that during perimenopause, the sex-related symptoms that we tend to see are more mental in a way. They're related to low libido, to perhaps body image concerns, a mental load factor in which

women feel like they're exhausted from carrying the weight of the family, plus their career, plus their aging parents, et cetera, et cetera. So they're not in the mood for sex. So that is not just due to hormonal fluctuations, but also life. And then the hormonal fluctuations can make it all feel worse. And then as we continue to lose our estrogen, women may and often do suffer from vaginal dryness. They might get recurrent UTIs and they experience what has been called vaginal atrophy in which the tissue weakens around the vagina. And so sex or any sort of insertion, whether it's a tampon or a finger, whatever it is, can be really, really painful. And I want, I know I just said a bunch of things that are negative, but the good news very much

is that health is available. So I'm not a doctor, but the first line treatment for these issues, especially the physical ones, is usually vaginal estrogen. And that is safe and effective for all women, even those with active breast cancer. It's not systemic and it can make a world of difference for women who've been suffering. And unfortunately, women still don't have access and information around vaginal estrogen and the myriad of other resources. And that's why I have a whole chapter on it in the book and also talk about it all the time. Right. I mean, women are 51% of the global population and less than 5% of research and development goes to specifically women's health issues. Again, why this topic is important and

why this message is important. And it is such good news that there's a range of help that's available. What would you say are the risks or the limitations now that we do have these options? But of course, they're not a cure-all. They're not for everyone. Different ones work better for different people. What do you observe as the limitations through your research and writing? I would start with the lack of information. And that's why I wrote the book and why I wrote it in a conversational tone. I wanted to make it accessible to everyone. And it's not accessible to everyone because it's written in English and it does assume certain economic privileges or access to health care providers. And I can only hope and advocate

for more access by all women, no matter the color of your skin or if you live in a rural area or your immigration status, because all women deserve access to care and information. Doctors and other healthcare providers are still living under the shadow of the study that was done in 2002 that was subsequently misinterpreted. And all that means is that doctors are reluctant still to provide hormone therapy. They are perhaps not accessible financially, the ones that do have the additional training. So we are seeing growth in terms of accessibility when it comes to telehealth platforms and providers who do seek out additional training, but we have a ways to go. And that's where I, again, put on my social work hat because social workers can advocate for macro

level change, whether it's in politics or workplace policies or just conversation in our communities. Yes. I mean, I thought it was very interesting the way you point out that in the UK and other places, there are workplace initiatives and supports for women who are going through menopause. Yes. And Rhode Island actually just passed a law. New York, California, New Jersey are considering other laws that do help with discrimination against women in menopause, that do help promote education on menopause in the workplace. There are also bills being considered that require training for medical providers. These are all sort of basic things that one would think are already part of our policies, but they're not. And that's why we do need to be advocates for

the women in our lives and in our countries and families and homes. Yes. And I think one strain of the advocacy that I found myself thinking about, because not everybody has access. And I do think then there's a risk of imagining that certain parts of HRT could heal more than is possible. For example, I noticed that when I started doing certain research and had certain prescriptions, my algorithm changed. And suddenly it's like a million vitamins and youth things

and HRT adjacent information that I think is also important for us to be aware of in advocating that not everything is a fountain of youth and not everything is foolproof in this area and that exercise, diet. Social connections. Social connections, yes, exactly,

is all so, so important. This episode of Social Work Talks is sponsored by HPCC, the Hospice and Palliative Credentialing Center. Take the next step in your professional journey with the Advanced Palliative Hospice Social Worker Certified, APHSWC, credential. Tailored for experienced hospice and palliative social workers. This unique certification involves a process that validates and evaluates your expertise in this specialty. While licensure assures minimal competency to practice in a field, certification indicates mastery of a defined body of knowledge. Showcase your expertise in social work. Take the first step today and learn more by visiting www.advancingexpertcare.org forward slash HPCC.

another thing that that is in your book um just going back to the study for a moment because i think some doctors who read that study understood the limitations of it from the beginning but the social hype around it was so great that people got frightened and of course the the women who were studied were much older right and the hormones now are different than what they were prescribed but also for women to be educated that heart disease is the number one, do I have this right, the number one cause of death for women in the U.S., not breast cancer. Absolutely, yeah. And HRT, can you explain this part because you know better than I.

Sure, although again, I'm not a doctor, but yes, HRT or menopausal hormone therapy, by which we typically mean estrogen and a form of progesterone, has not been found to be a cause of cardiovascular health overall. There are still contraindications, such as if you have a certain kind of heart health issue, you are probably not a candidate for HRT or hormone therapy. But it's an incredibly nuanced consideration that one should be making collaboratively with her healthcare provider. I know many women, for example, who 10 years ago, they would not have been candidates for hormone therapy because they did have active breast cancer. And 10 years later, after they've treated the cancer, they're in remission, they're

doing well, but now they're suddenly really suffering from menopause symptoms like hot flashes or whatever it is. And the non-hormonal options are not working for them. And they are deciding with their providers to go on hormone therapy. So whether it's a heart issue, a breast cancer issue, or any other issue that might make you not a candidate, it doesn't mean you have zero options and you should always get information at the very least. Right. That's why this book is so important because you're putting information out there and also encouraging all of us in the social work field and in the helping professions to access more information. What would you say you've learned from different cultural groups

and different backgrounds just in the journey of researching, writing, and now speaking out on this topic? I've learned the power of community and peer support. What I have found and seen, especially for women of color who are unfortunately still discriminated against in our healthcare system and not listened to the way that they deserve to be, that they really do rely on their peers and the women in their community. And I think that is so beautiful. To your point a little bit earlier about trusting the source, we always should be critical thinkers, especially on the internet, but in real life too, because every woman is different. What your aunt went through may not be what you went through. So nothing is exactly what you should be doing. You know,

you shouldn't necessarily take everyone's advice as gospel or truth or a prescription for you. But having the support is incredibly powerful. And I think something that we should all be building on. So community and social connection are so important. We're hardwired to seek that out. We do much better generally psychologically when we have it. And you mentioned in the beginning that your mother is a social worker. I'm a social worker. My mother's a social worker. and I'm curious how has this book impacted your relationship with your mother who went through this at such a different cultural time? My mother did not talk about it with me and she was of the generation that really did not have access to hormone therapy and even when I asked her about

it. She had a feeling of fear around it because that's what she had been messaged to. And I think my generation is more open-minded when it comes to medications in some ways. But we are also still under the shadow. So it was really cool to be able to teach her about it and to celebrate with her. we were just at a party for my book and all of her friends came. And it's really been special to feel the support of the women who have known me forever, who are in their 60s and 70s and cheering me on, even though they're well past menopause. And I imagine that that is similar to a lot of the feedback you get, not just from your mother, but from other people who you come in contact with, what do you want social workers to read in addition to your book or listen to

in addition to your book in terms of how we best educate ourselves on this topic? There are so many amazing health care providers who have adequate licensure and training in this area who do a lot of free resources and provide a lot of free information on social media. There are also books, Mary Claire Haver, Kelly Kasperson, Heather Hirsch. These are all incredibly brilliant physicians and advocates for women who talk a lot about these. They have podcasts, they have new books coming out. You don't need to be a medical provider to be able to support a woman going through this. We all will know women going through this, no matter how old you are or what your gender identity is. So I do think getting a basic understanding of what the menopause

transition is, knowing how to point a woman in the right direction for whatever her symptoms are, and also just being able to provide basic psychoeducation to her can make all the difference. What would you say are the symptoms you were most surprised to learn about? Speaking of symptoms that our listeners or viewers might not have on their radar, anything you want to point to with that? Yes. So we tend to think of hot flashes and those are certainly common, but it's so much more the mood symptoms and the rage that kept popping up as a common theme really struck me. I spoke with quite a few women who had been to multiple therapists, psychiatrists, they had gone into inpatient treatment programs. No one mentioned menopause, even though they were in midlife.

And they finally, once they were able to access hormone therapy, in addition to SSRIs and psychotop therapy, they felt better. So that was just very profound for me because what if someone had taught them earlier, right? How might their suffering have been alleviated? Or asked a question that indicated being informed about how menopause is a part of life where symptoms arise and things change. Yes. And there are also the funny symptoms of, and I say funny because they're not expected, but we're not on our radar, right? Uh, tonight is ringing in one's ears, frozen shoulder syndrome, itchiness, metallic taste. So I would say as a rule of thumb, if anything is different for you and bothering you, speak up.

Exactly. Speak up. There was this one example, as you're talking about, if anyone would just ask, if anyone would just notice, there's an example in your book about a married couple who the woman is having trouble sleeping. Do you remember that one near the end? Yeah. Would you share that with everyone? I just, I just loved it. Yes, that was from one of my mother's friends. And she told the story of she had been suffering tremendously from night sweats from the inability to fall back asleep, really struggling with sleep, which of course, exacerbates every other symptom mentally and physically that one might have. And one night she got a really restful night of sleep. And when she woke up, she looked over at her husband and he was in his ski gear because the room was so

freezing, but he was happy to wear his winter clothes and accessories in bed so that his wife could sleep. And that speaks to the importance of communication with our partners and the men and our loved ones in our life being able to support us however we might need. It's a really lovely example of a partner noticing and the flexibility that can make such a difference during this time. Anything else that you want to make sure social workers and helping professionals who are listening and watching today should know as we're getting ready to conclude. Social workers and all helping professionals should know that women who go through what they call natural or spontaneous menopause at the average age of 51, women

experience symptoms in their late 30s, early 40s. So if you have someone in front of you who is describing any of the above or is simply saying, I don't recognize myself, that should be a little clue that perhaps this is perimenopause and there are resources. And if you're looking for referrals to medical providers or for more information, of course, read my book and you can feel free to reach out to me. I'm happy to point you in the right direction and also visit the menopause society at menopause.org for their list of providers who have advanced training in area. We will put that along with, of course, a link to your book in the show notes for our listeners and viewers. Lauren, thank you so much for writing this book. Thank you for joining

Social Work Talks. We really appreciate the message that you're putting out there and the work that you're doing. Thank you so much.