We might think of three thresholds that mark the unfolding of a woman’s life in her body: the arrival of menstruation, the possibility of motherhood, and the transition of menopause. Each is a moment of rupture, where the body changes course and asks the woman to redefine herself. Menarche opens a new horizon of fertility, and society celebrates it as the entrance into womanhood. Motherhood, if experienced, expands the body into the possibility of giving life and is surrounded by cultural scripts of nurture and devotion. Both of these thresholds, though marked by endings, are followed by roles that society praises and affirms.
Menopause is different. Here, the body closes fertility, but no new culturally celebrated identity waits on the other side. Instead, menopause is often met with silence, stigma, or dismissal. If the earlier thresholds are linked to the beginning and flourishing of life, menopause is imagined as decline, as loss, even as a kind of death. Yet to reduce it to biology or pathology misses its essence: menopause is a profoundly existential threshold, where a woman must face questions of finitude, freedom, responsibility, identity, and meaning.
Menopause is different. Here, the body closes fertility, but no new culturally celebrated identity waits on the other side. Instead, menopause is often met with silence, stigma, or dismissal. If the earlier thresholds are linked to the beginning and flourishing of life, menopause is imagined as decline, as loss, even as a kind of death. Yet to reduce it to biology or pathology misses its essence: menopause is a profoundly existential threshold, where a woman must face questions of finitude, freedom, responsibility, identity, and meaning.
A Transitioning Body and Inner World
The body is at the centre of this passage. Menopause, literally “menstrual pause,” refers to the cessation of ovulation and the fall of estrogen and progesterone, which usually occurs around the age of fifty-one or fifty-two. The transition is often turbulent, with potential hot flashes, night sweats, disrupted sleep, irritability, mood swings, anxiety, forgetfulness, cognitive fog, and changes in sexual desire and pleasure. There might also be visible signs of aging such as thinning skin, hair loss, weight gain, or joint pain. The body that once carried fertility, praised for its capacity to give life, now becomes unpredictable, sometimes unrecognizable. A woman may feel betrayed: where once her body followed a rhythm, now it erupts in heat, robs her of sleep, or blurs her concentration. Recent research highlights that menopause is far more than a hormonal event. Vasomotor symptoms such as hot flashes, night sweats, and insomnia are strongly linked with depression and anxiety, especially in women who have previously experienced depressive episodes. Yet, as studies show, the causes of emotional distress during menopause are not purely hormonal. Biological sensitivities — like fluctuating estrogen levels and disrupted sleep — interact with psychological factors such as low self-esteem or high anxiety and with social pressures including financial strain, caregiving demands, and lack of support. Together, these shape each woman’s experience of this transition. Yet other forces can be protective. Women who stay physically active, maintain satisfying relationships, and feel informed and supported often navigate this phase with greater ease. Compassionate medical care, open conversations, and social environments that normalize rather than stigmatize menopause can make an enormous difference. Practices such as mindfulness, regular exercise, enhanced sleep routines, and nourishing eating habits can all support emotional steadiness and wellbeing. Qualitative studies with women going through this transition reveal just how complex this experience can be. Some describe menopause as a time when the body feels out of control, unfamiliar, even alien — disturbing not only physical comfort but also their sense of self. Others experience it as natural, inevitable, even freeing, like a shedding of expectations and a clearer sense of who they are. This tension between loss and possibility is what gives menopause its genuinely human character. It is a transition written both in the body and in the inner world. Let’s look more closely at what these tensions involve.
Existential Conflicts at Midlife
Menopause often brings women face to face with existential conflicts, those fundamental tensions between what is lost and what remains possible, between the limits of the body and the longings of the self. It is not only a biological transition but also a confrontation with life’s basic realities. The body reminds women of their finitude, while questions of freedom and responsibility emerge alongside shifts in identity and meaning. These conflicts can feel unsettling, but they also offer the possibility of reorientation — of choosing anew how to live the years ahead.
Finitude
Menopause brings finitude into view. The end of fertility marks a boundary: some possibilities are now closed forever. Aging becomes undeniable. Time feels more limited, more precious, and questions of life moving toward an end emerge in new ways. For some, this awareness is frightening. For others, it sharpens life. Finitude is not only loss but also an urging invitation to ask, How do I wish to live the years ahead?
Freedom
From the recognition of limits arises the question of freedom. Menopause removes the possibility of reproduction, yet it can also bring a sense of relief or lightness. In some cultural contexts, it comes with increased social participation and authority. Yet freedom at this stage is complex. Symptoms such as fatigue or cognitive fog can restrict autonomy, and workplace pressures or stigma may narrow options further. Freedom in menopause expands in certain ways yet contracts in others.
Responsibility
Menopause often arrives at a time of heavy responsibility: caring for aging parents, supporting children on the edge of independence, managing professional or community roles. Many women find themselves giving more than they receive. The existential challenge becomes one of balance: How can I meet the needs of others around me without losing myself? Responsibility becomes the meeting point of freedom and limitation, a place where choice, care, and self-preservation must coexist.
Identity
The convergence of finitude, freedom, and responsibility naturally leads to questions of identity. A woman may no longer recognize herself physically or emotionally. Cultural stereotypes — the “old,” “sexless,” or “invisible” woman — can amplify this confusion. Yet for many, menopause opens a period of reinvention: a time to shed roles, redefine priorities, and reclaim parts of the self long set aside. Identity may weaken but can also be re-formed on more authentic ground.
Meaning
At its core, menopause raises questions of meaning. The end of fertility or the fading of certain roles can leave women wondering about purpose in life. However, meaning can shift and expand. Many women describe this transition as a second life — a time to explore, create, and live more deliberately. Menopause becomes both an ending and a beginning: a space where old meanings are mourned and new ones slowly take shape. Together, these conflicts create a landscape that is both challenging and full of possibility. Menopause is not just a physical transition but a profound reorientation, where a woman may feel herself shifting on many levels at once. The body changes, roles evolve, relationships adapt, and long-held assumptions about who she is and what her life is for may begin to loosen. Many women find themselves needing space, reflection, and a compassionate companion in the process. This is where psychotherapy may help. It offers a place to explore how these physical, emotional, relational, and existential fluctuations come together, and to understand what this transition is opening or asking in a woman’s life.
How Existential Psychotherapy Can Help
Existential psychotherapy offers a distinctive kind of support during menopause. Rather than treating this stage as a set of symptoms to manage, it understands it as a threshold where essential questions come into focus.
Therapy provides room to explore how bodily changes influence identity, self-esteem, relationships, and daily life. Women can grieve the loss of roles tied to youth, fertility, or desirability, while also discovering new forms of freedom. Therapy invites reflection on finitude not only as decline but as a reminder of life’s urgency and preciousness. It helps women reorient toward what truly matters to them.
Meaning becomes a central element. Therapy allows women to voice the emptiness left by lost meanings while also cultivating new sources of significance. In this way, therapy does not aim to erase the discomfort of menopause but to reframe it. The transition becomes less a story of decline and more a passage of self-discovery, depth, and renewal.
Summary
Menopause is often treated as a medical problem to solve, a stage of decline to endure. But it is more than biology; it is an existential threshold that invites the woman to answer questions around finitude, freedom, responsibility, identity, and meaning. While menarche and motherhood are celebrated as affirmations of femininity, menopause remains largely unacknowledged, even stigmatized.
In truth, menopause is not the death of femininity but its redefinition. It is a profoundly human threshold, where the body and the self call for attention, care, and renewal. Existential psychotherapy can serve as a companion on this journey, supporting the movement from loss toward becoming.
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