Menopause Vocabulary for Mental Health Therapists: The Menopause Transition and The Menstrual Cycle
- 5 days ago
- 7 min read
The Menopause Words we have not been taught.
As psychotherapists, we are aware of how much words matter. Yet there is almost no menopause vocabulary for mental health therapists — few of us have been taught the words, the names, or the ability to call by name what is happening during the menopause transition.
That means that during some of the most important years for a woman's health and longevity — approximately one-third to one-half of her lifespan, after all — we simply do not know the words.
And therefore, we must also ask: how do we make meaning?
Without words, how do we make meaning of our journey in the menopause transition?
When it comes to menopause vocabulary, I learned this language on purpose and mostly on my own accord — reading books, reading research articles, using various AI platforms, and years of piecing together what has been my own experience.
Seven years of it, post induced-menopause — ironically, a stretch in which word finding has all sorts of meaning. Reading, coursework, certification, consultation. None of it arrived with my degree, nor with my primary care doctor, nor with my ob-gyn. That is not a complaint about my training. It is a description of my field, and of the level of stigma this experience can be cloaked within.
Our graduate work in marriage and family therapy covered development across the lifespan and the psychological stages. Most of it was presented without inclusion of the body — much less a body born female. So somewhere in the middle of that lifespan a whole endocrine transition went unnamed. No words for one of the longest stages of the female lifespan.
And as of this writing in late summer 2026, there remains a whole host of discrepancies in the words around this experience. Do we call it perimenopause, or menopause, or postmenopause, or the menopause transition? It is unclear in the medical field, in social media, and in our own sacred spaces as therapists as well. This leads to systemic barriers and cracks in care we are only now identifying. The shared vocabulary is limited at best.
So in this blog I am handing over — free — the menopause vocabulary I am building, slowly. I am hoping we can all help bring the words into being, into meaning, on personal, professional and communal levels.
Menopause vocabulary for mental health therapists: who this is about
This vocabulary applies to those born female — because the events it describes follow from ovarian tissue, not from identity. Trans men and nonbinary clients assigned female at birth move through this same transition, sometimes alongside gender-affirming hormone therapy that alters the picture in ways worth asking about rather than assuming. Women who never menstruated regularly still have it. Women who have had their uterus removed still have it.
Say those born female when you mean the biology and women when you mean the population you are mostly seeing. Being able to hold both is part of the competence.
The perimenopause stages in plain language
The perimenopause stages come down to four words — with subtle substages even between them. The distinctions carry almost everything else in this article.
Premenopause — the reproductive years. Cycles are regular and predictable enough that a person can plan around them.
Late reproductive stage — subtle shifts occur, often with sleep, before any change in cycle length, flow or frequency.
Perimenopause — the transition. This is when more noticeable shifts occur. It is the long stretch, often several years, and it is where the majority of symptoms live. It is also where most of your clients are when they come in.
Early perimenopause — greater presence of variance symptoms. Hot flashes and cycle changes often begin here.
Late perimenopause — the stage carrying the greatest symptom burden and the widest cycle variance, typically including intervals of sixty days or more. This is the stretch most often described as a window of vulnerability. See the distinction drawn below.
Menopause — a single day, and retroactive. Not a phase, not a decade. It is the date of the final menstrual period, and it can only be identified retrospectively, twelve consecutive months later, once no period has come and nothing else explains the absence.
Postmenopause — everything after that day.
Early postmenopause — the first years past the menopause date, a window in which hormonal, mood and other adjustments can continue.
This is the distinction that does the most work in any intake. When a client says she is "in menopause," she almost always means she is somewhere in perimenopause — and once you can hear the difference, you have a question available: are your cycles still coming, and how have they changed? That question locates her. Very little else will.
The formal system behind these words is STRAW+10 — the Stages of Reproductive Aging Workshop +10, published in 2012 as an update to the 2001 criteria [1]. It stages reproductive aging by menstrual bleeding patterns rather than by age, and two of its criteria are worth carrying in your head because clients describe them without knowing they are describing anything: the early menopausal transition is marked by a persistent difference of seven days or more between consecutive cycle lengths, with persistence meaning recurrence within ten cycles of the first variable cycle; the late menopausal transition is marked by an interval of amenorrhea of sixty days or more [1]. STRAW+10 was deliberately designed to apply regardless of age, ethnicity, body size or lifestyle [1] — useful to be able to say out loud, given how readily midlife symptoms get attributed to weight or stress.
One note for reading across literatures. In the perimenopausal depression research, perimenopause is defined to include the early and late transition stages and the early postmenopause [2], so the psychiatric window is wider than the reproductive one.
The menstrual cycle phases and why they matter
You need the menstrual cycle phases because perimenopausal symptoms are often cycle-phased, and a client who tracks nothing cannot tell you that.
Menstruation — the bleed itself, and the start of the next cycle.
Follicular phase — from the first day of bleeding to ovulation. Estradiol climbs. Many people feel most capable here.
Ovulation — mid-cycle release of the egg. Estradiol peaks.
Luteal phase — from ovulation to the next bleed. Progesterone rises, then falls sharply just before menstruation. This is where premenstrual mood symptoms cluster.
What this gives you is a timing question. When in your cycle does this happen? If the answer is a reliable window, you are looking at a hormonally-phased symptom rather than a continuous mood state — and in perimenopause the phases themselves become unreliable, which is why previously predictable premenstrual patterns turn chaotic.
Clients often describe this as the PMS I always had, but now I never know when it's coming. That sentence is diagnostic information.
The window of vulnerability and the critical window
Two terms sit close together in this literature and mean different things. Both are worth having precisely.
The window of vulnerability describes psychiatric risk. The 2018 guidelines for the evaluation and treatment of perimenopausal depression — the first of their kind, from a panel convened by the Menopause Society and the Women and Mood Disorders Task Force of the National Network of Depression Centers — frame perimenopause as a window of vulnerability for both depressive symptoms and major depressive episodes, with risk elevated even in those with no history of major depressive disorder [2].
The critical window hypothesis describes treatment timing. It holds that hormone therapy initiated earlier in the transition has a different benefit-risk profile than therapy initiated years after the final menstrual period. The Menopause Society's position is that for healthy people under sixty or within roughly ten years of menopause onset, without contraindications, the balance is generally favorable for symptoms and bone loss [3].
You will see the two collapsed into "critical window of vulnerability." They are adjacent — a period of heightened neurobiological sensitivity in which both risk and responsiveness to intervention are elevated — but when you write or teach, separate them. One tells you when to watch. The other belongs to a prescriber.
Next in this series
The perimenopause stages and the menstrual cycle phases are where this vocabulary starts. Coming next: the parts, and the hormones as neuroactive compounds — what estradiol, progesterone, testosterone, FSH and AMH actually do for mood, cognition, sleep and relational life.
If you have words you use with clients that work, send them. This vocabulary gets built together or it does not get built.
Continuing education
If you'd like to explore this further, I teach two CAMFT-approved CE courses on the intersection of trauma and hormonal transition:
Both are self-paced and CAMFT CE–approved (Provider #61115).
To learn more or enroll, visit Courses Page
About the Author
Julie Cardoza, MS, LMFT is a licensed marriage and family therapist, EMDRIA Approved Consultant, and Certified EMDR therapist specializing in Somatic EMDR, based in California. She is a CAMFT-Approved Continuing Education Provider (#61115) and an IWHI Certified Perimenopause/Menopause Health Coach, and the founder of Heartscapes, LLC.
Julie specializes in the intersection of trauma, neurobiology, and hormonal transition, integrating Somatic EMDR, polyvagal-informed practice, and menopause-informed care. She provides consultation and continuing education for clinicians working where trauma and the menopause transition meet.
Disclaimer
This article is for educational and informational purposes only and does not constitute therapy, medical advice, or a therapeutic relationship. The content reflects the author's clinical perspective as a Licensed Marriage and Family Therapist in California and is not a substitute for individualized medical or mental health care.
Julie Cardoza provides therapy through her licensed private practice (juliecardoza.com) and coaching and education through Heartscapes, LLC (heartscapesllc.com). These services are distinct and offered under separate legal and ethical guidelines.
If you or a client is experiencing a mental health crisis, contact 988 (Suicide and Crisis Lifeline) or go to the nearest emergency room.
Land Acknowledgment
I acknowledge that I live and work on the traditional and ancestral lands of the Yokut and Mono peoples.
AI Acknowledgment
I use AI platforms as research and drafting assistants in developing this material, alongside books, peer-reviewed literature, coursework and consultation. Every source cited here was located and verified by me. The clinical judgment, the framing and the final language are my own.
References
Harlow SD, Gass M, Hall JE, et al.; STRAW+10 Collaborative Group. Executive summary of the Stages of Reproductive Aging Workshop +10: addressing the unfinished agenda of staging reproductive aging. Fertility and Sterility. 2012;97(4):843–851. https://www.fertstert.org/article/S0015-0282(12)00187-2/fulltext
Maki PM, Kornstein SG, Joffe H, et al. Guidelines for the evaluation and treatment of perimenopausal depression: summary and recommendations. Menopause. 2018;25(10):1069–1085. https://pubmed.ncbi.nlm.nih.gov/30182804/
The North American Menopause Society. The 2022 hormone therapy position statement of The North American Menopause Society. Menopause. 2022;29(7):767–794. https://journals.lww.com/menopausejournal/abstract/2022/07000/the_2022_hormone_therapy_position_statement_of_the.4.aspx
