Menopause-Informed Psychological Care

A Working Definition and Defining Criteria

A position paper from Menopause CBT Clinic® 

Simona Stokes | 2026 

Working definition · Version 1.5

DOI: 10.5281/zenodo.20830153

View and download the full position paper:
https://zenodo.org/records/20830153

Purpose of this paper

The term Menopause-Informed Psychological Care has been used in clinical and professional contexts to describe psychological practice tailored to women in perimenopause and menopause. Until now, it has functioned more as an orientation than as a defined concept, a way of signalling that menopause is taken seriously within psychological work, rather than a clearly bounded set of practices.

This paper offers a working definition and proposes seven defining criteria that, taken together, distinguish Menopause-Informed Psychological Care from psychological work that is menopause-aware, menopause-literate, or simply happens to involve menopausal clients.

The definition is offered as a contribution to professional dialogue. It is intended as a starting point for engagement with colleagues, professional bodies, training providers, and academic partners and not as a fixed standard. The expectation is that the working definition will be refined through field engagement over time, in the same way that adjacent concepts such as trauma-informed care have developed through proposed definitions, peer engagement, and gradual institutional adoption.

Why a working definition is needed

Psychological services for women in midlife are increasingly described as menopause-aware, menopause-friendly, or menopause-informed, but these terms are used inconsistently. Without shared defining criteria, it is difficult for women to identify appropriately trained clinicians, for commissioners to evaluate services, for training providers to demonstrate competence, and for researchers to investigate outcomes.

A working definition with defining criteria addresses this by offering a shared reference point. Care that meets the seven criteria below can reasonably be described as Menopause-Informed Psychological Care. Care that meets some, but not all can be described as menopause-aware or menopause-literate, but the term Menopause-Informed is reserved for practice that meets the full set of criteria.

The defining spine: Aware, Literate, Informed 

The distinction at the centre of this paper can be understood as a progression through three levels of practice. Setting them out explicitly clarifies what Menopause-Informed Psychological Care requires, and what it does not.

• Menopause-aware practice is the level of recognition. The clinician knows the menopause transition exists and may affect a woman's mood, cognition and wellbeing, and is willing to acknowledge it and signpost onward. Awareness is a necessary starting point, but on its own it does not change how care is delivered.
• Menopause-literate practice is the level of knowledge. The clinician understands the mechanisms involved: the hormonal and neurobiological changes of the transition, their impact on mood, cognition, sleep and the stress response, and the social and identity dimensions that accompany them. A literate clinician can hold an accurate picture of what a woman is experiencing and why, but knowledge held in the background is not yet the same as care shaped by it.
• Menopause-informed practice is the level of integration. Here the clinician's understanding actively shapes their clinical work: how they screen, how they formulate, how they intervene and how they hold the therapeutic relationship. Understanding has become embedded competence. This is the level the working definition below describes, and which the seven defining criteria operationalise.

The three levels are cumulative. Informed practice contains awareness and literacy and goes beyond them. Most current provision sits at the level of awareness; some reaches literacy. The purpose of this paper is to define the level beyond, and to reserve the term Menopause-Informed for practice that meets it in full.

Working definition

Menopause-Informed Psychological Care is psychological practice in which the biological, neurobiological, cognitive, emotional, behavioural, relational, and identity dimensions of the perimenopausal and menopausal transition are routinely recognised, formulated, and addressed as part of integrated clinical work, delivered by clinicians with current competence in menopause science and within established collaborative care pathways.

Seven defining criteria operationalise this definition and are set out below.

Defining criteria

Care is Menopause-Informed when it meets all seven of the following criteria.

1. Routine screening for menopausal status. Women aged approximately 40–60 presenting with mood, anxiety, sleep, cognitive, or stress-related symptoms are routinely asked about menstrual changes, vasomotor symptoms, and other indicators of perimenopausal or menopausal transition, regardless of the presenting complaint.
2. Biopsychosocial formulation that includes hormonal and physiological contributions. Clinical formulation explicitly incorporates the potential contribution of hormonal fluctuation, vasomotor symptoms, sleep disruption, autonomic dysregulation, and inflammatory processes to the woman's presentation, alongside cognitive, emotional, behavioural, relational, and contextual factors.
3. Psychoeducation grounded in menopause neuroscience and physiology. Women receive accurate, accessible psychoeducation about the neurobiological and physiological changes of perimenopause and menopause, including their impact on mood, cognition, sleep, and the stress response. Psychoeducation is delivered as an active therapeutic intervention, not as background information.
4. Adaptation of psychological approach where symptoms interact. Where menopausal symptoms (hot flushes, night sweats, sleep fragmentation, brain fog, joint pain, fatigue, etc.) interact with the cognitive, emotional, behavioural, or relational targets of psychological work, the clinician's approach is adapted to remain clinically appropriate to the woman's current physiological and cognitive capacity.
5. Integration of lifestyle factors within scope of practice. The clinician recognises, discusses, and signposts the role of lifestyle factors (nutrition, movement, sleep hygiene, stress regulation, social connection) in menopausal wellbeing, working within their professional scope of practice and collaborating with or referring to specialist colleagues where appropriate.
6. Collaborative care pathways. The service or clinician maintains established pathways for collaboration with menopause specialists, GPs, gynaecologists, and other relevant health professionals, and works within a shared-care model rather than in isolation.
7. Current clinician competence in menopause science. The clinician maintains current continuing professional development in menopause-related research and practice, including hormonal physiology, the neuroscience of the menopausal transition, the evidence on lifestyle factors influencing menopausal symptoms and wellbeing, and the cultural and identity dimensions of midlife transition.

What does not, on its own, constitute Menopause-Informed Psychological Care

To support the integrity of the term and prevent its dilution into general marketing language, the following are explicitly identified as falling outside the scope of Menopause-Informed Psychological Care as defined above:

• Clinicians offering generic CBT or other psychological therapies to women who happen to be menopausal, without the adaptations described in the defining criteria
• Services that reference menopause in marketing or intake materials but do not embed the seven criteria into clinical practice
• Wellness programmes that address lifestyle factors without psychological formulation or clinical competence
• Practitioners working outside their professional scope (for example, offering nutritional prescribing without appropriate qualification)

These distinctions are not intended as criticism of practitioners working in adjacent ways. They are intended to keep the term Menopause-Informed Psychological Care meaningful for the women, commissioners, and professionals who rely on it.

Relationship to the EMBERS® framework

EMBERS® is the structured clinical framework through which the Menopause CBT Clinic® delivers Menopause-Informed Psychological Care and trains clinicians to do so. EMBERS® comprises six domains of clinical exploration and intervention, each playing a defined role within a single mechanism of change: reducing physiological dysregulation to enable psychological capacity.

The six EMBERS® domains, and the role each plays within the overall mechanism of change, are:

• E - Essentials: the domain of physiological foundations. Role: reducing physiological load.
• M - Mind & Mindset: the domain of cognition, perception, and meaning-making. Role: reducing perceived threat.
• B - Becoming: the domain of identity, self-concept, and life-stage adaptation. Role: resolving identity conflict.
• E - Emotional Fitness: the domain of emotional processing and regulation. Role: increasing regulation capacity.
• R - Relationships & Resilience: the domain of relational and social resources. Role: buffering stress and enhancing recovery.
• S - Shape-Up: the domain of sustained behavioural change. Role: stabilising and maintaining change.

The six domains are not delivered in fixed sequence. The clinician explores and addresses them with flexible entry points based on the woman's presentation, level of dysregulation, and dominant driver of difficulty. The coordination of the domains around the underlying mechanism of change is what distinguishes EMBERS® from a checklist of areas to cover.

It’s important to note, Menopause-Informed Psychological Care as defined in this paper is the concept; EMBERS® is one route to delivering it. Other clinicians, training providers, and research groups may develop alternative routes to meeting the same defining criteria, and this paper is intended to support that development across the field, not restrict it to a single framework.

Toward field consensus: a collective task

This working definition is offered as a starting point for professional dialogue, not as a finished or authoritative statement. Field consensus on a concept of this kind develops through engagement between practitioners, professional bodies, training providers, academic researchers, and the women whose experience the concept is intended to serve.

The development of Menopause-Informed Psychological Care as a recognised field of practice is a collective task. Colleagues, training providers, professional bodies, and academic partners are encouraged to engage with this working definition, to test it against clinical experience and research, to propose refinements, to identify gaps, and to contribute to the development of shared defining criteria.

The definition and its criteria will be revised as the concept develops through this engagement, and revisions will be published openly so that the working definition continues to reflect the considered judgement of the field rather than the views of any individual practitioner or organisation.

Correspondence and contributions can be directed via the Menopause CBT Clinic®.

A note on the development of this work

The approach described here as Menopause-Informed Psychological Care, and the EMBERS® framework through which it is delivered, were developed and taught from 2020, with the first EMBERS® Professional Training Programme delivered in April 2022.

Licence

This working definition is shared under a Creative Commons Attribution 4.0 International licence (CC BY 4.0). It may be freely shared, cited and built upon with attribution. The EMBERS® framework and its associated training materials are separate and are not covered by this licence.

Citation

This working definition may be cited as:

Stokes, S. (2026). Menopause-Informed Psychological Care: A working definition and defining criteria (Version 1.5). Menopause CBT Clinic®. Zenodo. https://doi.org/10.5281/zenodo.20830153

^{_{Version history}}

Version 1.5 – 2026. Added a defining spine (aware, literate, informed) articulating the three-level progression that the working definition and criteria operationalise; harmonised the middle-level term to 'literate' for consistency; added a licence statement and a note on the development of the work.

^{_{Version 1.4 - 2026. Refined Criterion 7 to remove disciplinary naming and describe the relevant body of knowledge directly, consistent with the other items in the criterion.}}

^{_{Version 1.3 - 2026. Refined Criterion 6 to broaden the range of collaborating professionals beyond a specific qualification and revised the closing section to a peer-to-peer framing of collective field development.}}

^{_{Version 1.2 - 2026. Refined language: 'role' adopted as secondary descriptor for the contribution each EMBERS® domain makes within the mechanism of change.}}

^{_{Version 1.1 - 2026. Refined language: 'domains' adopted as primary descriptor for the six EMBERS® areas of clinical exploration. Criterion 4 revised to modality-neutral wording.}}

^{_{Version 1.0 - 2026. Initial working definition and seven defining criteria published for field engagement.}}

^{_{Subsequent versions will be published as the working definition is refined through professional dialogue.}}