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Clinical Psychology and Psychotherapy

A Roller Coaster Ride

With hormonal swings and changes in our social situation, life after forty presents distinct challenges. Psychologists Hannah Süss and Jasmine Willi examine the best ways of managing this phase of our life.
Interview: Roger Nickl / Thomas Gull
Roller Coaster
Hormonal roller coaster ride: life after forty presents distinct challenges.


Hannah Süss, Jasmine Willi, for many men and women, life around forty is a period characterized by change. Why is this?

HANNAH SÜSS: Around middle age, we experience a number of physical and social changes. For one, our hormone levels change. And then there are the changes within the family: Children grow older and parents find that their relationship takes center stage again. This calls for a refocus. Many people look back over the first half of their life and take stock. They ask themselves whether they want to continue living in the same way, or whether they want to change something. This can lead to life crises.

This sounds like the notorious mid-life crisis – does it really exist?

JASMINE WILLI: This can't be confirmed so easily. However, we know that the number of challenging life situations increases with age – relationships break up, divorce rates rise, people close to us die. All in all, middle-aged people have to deal with many more stressful situations.

What are the hormonal changes that occur?

WILLI: Strong hormonal changes occur in both men and women, especially in the sex hormones – which can lead to physical as well as psychological symptoms. Women have long been thought to suffer from menopausal symptoms when their estrogen levels fall. Today, however, we believe that it's the strong fluctuation which is more likely to be responsible.

How should we picture this hormonal roller coaster ride?

SÜSS: Although we know today that these hormone fluctuations exist – and that they're strongest in women during perimenopause – we don't yet know exactly how much each individual hormone fluctuates. This is what we want to take a closer look at in our new study (see box). Certain hormones have the advantage of being easily identified through saliva, which means that study participants can collect the samples in the comfort of their own home.

What are the symptoms that hormonal changes can trigger?

WILLI: Some women experience mood swings, irritability, anxiety, depressive moods or depression itself. But there are also many physical changes that can be related to hormone fluctuations, such as sleep disorders, hot flushes or night sweats. It's important to note that not all women react equally to hormonal changes. While for some women the symptoms are severe, others barely develop any symptoms at all. The aim of our study is not to focus on how bad the menopause is and what is negative, but rather to explore the subject and show how people can maintain their health and manage the challenges they face during this sensitive phase of their life.

You also provide therapy – what can be done to help?

WILLI: The key thing is to see the whole picture. Psychotherapeutic treatment needs to consider all the factors involved – hormonal, medical and psychosocial. It's therefore vital that gynecologists work closely together with psychiatrists and psychologists. If introduced at the right moment – at the first sign of strong hormone fluctuations, for example – hormonal therapy can be effective in combination with psychotherapy. However, it's imperative to act at the right moment and to get early support once symptoms are clearly apparent.

How do hormonal changes affect men over 40?

SÜSS: Much less research has been done on this. However, men don't experience such major hormone fluctuations as women. The level of sex hormones in a man's body decreases at a steady rate, which means that they react less strongly to hormonal changes during this phase of life. It's psychosocial factors that play a more central role for men.

This means that the challenges during this time are gender-specific and very different, with women seeming to face greater risks than men?

WILLI: Yes, the differences are there. Women, for example, run a much greater risk of developing depression – generally over the course of their lives, but especially during the phases in their life in which major hormonal changes occur.

How can women manage these risks?

SÜSS: Information and education is important – not only for the women concerned, but also for their relatives. They should be aware of what it means to go through the menopause, what challenges the menopause raises, and how to deal with them. This is an issue that has yet to be fully addressed. We all have an idea about the menopause, but often know only half the picture – and also many fears that could easily be put to rest. Frankly, we need more information on the subject.

What's only "half the picture"?

WILLI: Few women, for example, know to what extent menopausal symptoms vary from one woman to the next – both in terms of type and duration. This means that individual experiences of the menopause differ widely – the bandwidth is huge. Many people are also unaware that depression or anxiety disorders can be related to hormonal changes.

Showing people how to maintain their health during the menopause: Psychologists Jasmine Willi (left) and Hannah Süss.

How can you help women who suffer from the effects of the menopause?

SÜSS: For one, we explain what menopause is and talk about related changes and challenges. We also develop a treatment plan tailored to the woman's individual symptoms. This could be a standard depression therapy, for example. Low self-esteem resulting from the menopause is often an issue in therapy.

Do you treat depression with medication?

SÜSS: Not necessarily. We often use cognitive behavioral therapy techniques. The idea is to develop specific thoughts and behaviors that help the menopausal woman to solve problems like: What can I do when I wake up at night with a hot flush and can't get back to sleep? However, for certain symptoms, psychotropic medication can indeed be helpful.

People tackle the challenges of the menopause very differently. What can women, but also men, specifically do to stay healthy?

SÜSS: Being optimistic, for example, helps people to cope better with the challenges of middle age. This has been proven by our research at the Chair of Clinical Psychology and Psychotherapy.

Can optimism be learned?

SÜSS: Optimism, as a character trait, is quite solid. However, for those not born with it, a more optimistic attitude to life can – to a certain degree – be learned. The first thing to do is identify which pessimistic attitudes and thoughts stand in your way. You can then try to reformulate them into something more appropriate. In psychotherapy we also call this cognitive restructuring.

What else can we do?

SÜSS: Work on body awareness. When we see how the body changes at this time of life, we should not only continue to be physically active but also find a way to reduce stress – through yoga, for example.

WILLI: Another important factor is sexuality, which changes over the course of a lifetime. Here, too, we try to provide more information about the natural processes and changes. Many sexual problems such as sexual dysfunctions can also be treated. Common examples include sexual desire or erectile disorders. Depending on the problem, we can offer medical and/or sexual therapeutic interventions.

Are sexual desire and erectile disorders physical problems, or do they also have psychological roots?

WILLI: As with many conditions, both the body and the psyche play an important role. In the case of sexual desire disorders, we know that psychological factors such as self-esteem or our own body image are critical.

Does our sexuality inevitably diminish as we get older?

WILLI: Although certain biological changes can't be halted, this doesn't mean that your sexuality automatically declines or even disappears. It can even continue to evolve. The important thing is not to make too many comparisons with "before", but to focus on the positive and the present.

So it depends on the right attitude?

SÜSS: Yes, the right attitude is very important across the board. We should set ourselves realistic goals that are appropriate to our age. This also goes for sport. When jogging, for example, we shouldn't only watch to see how fast we can run a certain distance, but also consider our endurance levels and how we're feeling.

We're quick to see aging as a process of decay. At the same time, people are getting older and older. Is it time for society to find a new way of dealing with old age?

WILLI: Yes, definitely. It's sometimes said that 50 is the new 30. And with life expectancy on the rise, new perspectives are indeed emerging. Changes in society that endorse this are therefore highly important.