Mirror Shock: Why menopause changes the way you look and how it affects your mental health

Menopause can make us feel like strangers in our own skin, and that disconnect can quietly shrink our lives. We talk with psychotherapist Dr. Stacy Kratz about the biology and culture behind the identity shift and how self-compassion helps us rebuild. 

• the mirror shock of not recognizing your face or body 
• how hormone shifts affect mood, energy, sleep, and motivation 
• why anxiety, irritability, low mood, and brain fog can feel sudden 
• the midlife pile-on of empty nest changes, career shifts, and grief 
• how youth-as-currency culture fuels shame around aging 
• the difference between healthy guilt and unhealthy guilt 
• self-compassion as a daily practice using kinder self-talk 
• reframing menopause as a remodel and an adaptation, not a betrayal 
• letting go of toxic positivity while still moving forward 

If this episode spoke to you, please share it with a friend who might need to hear it too, because I know there are so many women who are suffering in silence. And if you're looking for a supportive community where we keep these conversations going, I'd love for you to join us inside the pause diaries on Facebook. And don't forget to download this episode so that you can come back to it whenever you need a reminder, whenever you need to hear Dr. Stacy tell you, be kind to yourself. 

Loved this conversation? Let’s keep it going.
Join our private Facebook group, The Pause Diaries, where we dive deeper into all things perimenopause and menopause—without judgment, just real talk.

If this episode inspired you, share it with a friend or colleague. And don’t forget to subscribe, rate, and review The Pause Podcast—your support helps us bring more expert voices to the table.

 Got a story, symptom, or question? Send it my way at by posting it our Facebook Group The Pause Diaries that supports the podcast. 

I just might feature it in an upcoming episode!

Until next time, stay curious, stay empowered, and never hit pause on your wellbeing.

Transcript

Welcome To The Pause

Val 0:00

Welcome to The Pause, the Menopause podcast with unfiltered conversations about the symptoms you hate, the changes you didn't see coming, and the hilarious moments midlife can bring. I'm your host, Val Lego, and I've been a dedicated health reporter for 25 years, and I wanted to normalize something that every woman goes through: menopause. Hey friends, welcome back to The Pause. I'm your host, Val Lego. And if this is your first time here, I am so glad that you have found us. This is a space where we talk honestly about midlife, menopause, and everything that comes with it. Today's topic feels especially personal to me because I hear about it constantly in conversations and messages. And you know, honestly, I've really felt it myself over the last two or three years. Um, it's that moment when you look in the mirror and you think, who is looking back at me? I don't even recognize myself. Who is that woman? Maybe your face looks different. I know mine did. Mine was so, it's such a full face. I never had one like that before, except for maybe when I was a baby. You know, maybe your body doesn't feel familiar anymore. Your confidence has shifted, and suddenly you're just like, ugh, my whole being feels unfamiliar. So I've been dealing this for, as I said, about three years, and it's really gotten me to the point where I hate having my picture taken. And maybe you can relate to this. It's really starting to take a toll on my personal life. The other day, somebody asked me to see a picture of my husband, and I scrolled back through an entire year's worth of photos, and I had only taken four pictures of us, and they were from far away. So you couldn't tell that I'd gained a little weight or my face was a little fatter or any of that. And how sad is that? That I missed that entire year of documenting all the fun, amazing things that we did. And I've got to the point where I just don't know how to emotionally deal with that. And I know that I'm not alone. So for you, for so many women, menopause isn't just physical, it is also psychological. And it can really feel like you are losing pieces of yourself while you're trying to figure out who you are becoming, you know, getting into that second stage of life. That is a true phrase that you need to live out. So here's the part we don't want to talk about. It's the dis that the disconnection can feel lonely. You can feel really lonely in this process. So I say, enough. Today we are going to unpack that experience with someone who understands this journey, psychotherapist and mental health expert, Dr. Stacy Kratz. We'll talk about why this identity shift happens during menopause, what's normal, and most importantly, how to reconnect with yourself when you feel like a stranger in your own skin. So if you've ever wondered whether what you're feeling is normal, this episode is for you. Dr. Stacy, welcome to the pause. I'm so happy that you're here and you're going to spend some time talking with us about this.

Dr. Katz 2:58

Thanks so much, Val. I'm so, so happy to be here.

Hormones Mood And Unpredictability

Speaker 3:01

I love hearing you talk about this. I truly feel like it's something so many women are going through, but they just don't talk about it. You know, they don't want to talk about the fact that they look in the mirror and they're like, who is this woman? So, from a mental health perspective, like what is happening during menopause psychologically?

Speaker 1 3:19

Oh gosh, we're just so we just live in a context, don't we, Val? Like obviously there's uh a loss of predictability about our emotions and also our and also our energy. And um, it's a profound loss of predictability in this hallmark time. So biologically, you know, it's driven by that erratic fluctuation, right? And really the eventual decline of our hormones specifically. Like I know that uh we've heard so much about estrogen and progesterone. So, and we know that they're closely linked to those the production of serotonin and dopamine. And dopamine feel good, right? Like dope, dopamine. And what what helps with mood stabilization and motivation? Those those serotonin and dopamine are the big players there. And of course, they are this, there's other aspects of our mental health, but when our levels bounce around unpredictably, so do our mood regulating chemicals, right? And this this does mean unpredictability, which can make it so, oh my God, I don't even recognize myself. And how this the unpredictability piece, right? Up and down, up and down. It can be. And how it manifests emotionally is that we it's we can experience really sudden anxiety or irritability. Um, that's a big one, or even a depressive mood. And sometimes it comes out of nowhere. And our energy levels take a massive hit, and it's not just from the the hormonal shifts themselves, but also the cascading effects of this transition. And things like night sweats and insomnia, they fracture our sleep, and that can lead to really chronic fatigue, a deep chronic fatigue. And sometimes we can wake up feeling ready to tackle the world one day, and then the next day, why am I so entirely depleted? And there doesn't seem to be any real clean, like a real clear reason why. And that's part of the reason why we just have this um almost kind of a disbelief, right? Like what's going on here?

Val 5:44

Yeah, and I think there's a lot of other things that are happening that are compounding this too. Like you might be sending your kids off to college, and all of a sudden you have an empty nest, or you might be switching careers, or you might be, you know, grieving for that younger self. And I think that is a true thing that you have to allow yourself to do.

Dr. Katz 6:06

Oh my heavens, yes. Without a doubt. So, yes, there's this identity disruption, isn't there? And it's incredibly common and it's entirely valid. And just like you said, Val, it's it's a jarring feeling looking in the mirror and not recognizing that person that's staring back and feeling disconnected, even from my personality or from my capabilities, or even the body that I've lived in for decades. And um, of course, this happens as a result of those several factors that are occurring simultaneously simultaneously. It's kind of a hard word to say. Um, so like my context, right? There are physical changes and there's shifts in metabolism, shifts in fat distribution. There's oh, one that seriously jarred me was elasticity of my skin.

Val 7:03

Yes, and sometimes we feel like you it happens overnight, like you wake up and say, I swear my jowls were not there yesterday.

Dr. Katz 7:10

And the like and the goal, the hashtag is, oh my gosh, look at my jowls. How are they serving me today? Right? I love it, I love it. Yeah. Um, but even things like hair thinning, that's a major thing. And there's cognitive changes, like obviously brain fog, like the very real phenomena of brain fog that can make us feel like we're just losing our sharpness, like or like being quick, or um in our in our work context, like that professional edge. Um and then the shift of like that deeply, what you're getting at too, Val, I think is like that deeply internal re-evaluation of who I am outside, yes, outside of my reproductive capabilities, too, that are so culturally driven, right? Right. And realizing that you still have value, even though that part of your life is ended. That's what I think women are starting to finally rediscover. And it's a beautiful thing, but it doesn't mean that it's still not hard to go through on a personal level. Absolutely. Um uh is so, so deeply personal and so deeply unique, each one of our experiences, because each one of us is different. So we just, you know, to be able to talk like this and uh talk about collective experiences and knowing that I'm gonna have my own experience too, and that shift for that midlife reflection kind of and our the changing social roles, like like you said, kids leaving, um, perhaps, perhaps career shifts, even aging parents and the grief that we can go through of that younger version of ourselves. So it is a profound psychological shift, and it can involve grief, yeah. Outdated theories, like we solely blamed empty nest. Like that was it, you know, like it's just this change. But now we look at it from a bio biopsychosocial need, so biological, psychological, social model that includes spirituality too. And when I talk about spirituality, I'm not talking about um necessarily a involvement in a formal faith community, but who we are as people in this big universe kind of thing, meaning of life. So, so it is a modern view, recognizing that we can process grief that's related to this loss of fertility, a loss of our youth, a loss and a closing of our reproductive years. And that that does require an emotional adjustment to this new phase. And it's something we don't recognize yet because we haven't been there.

Val 9:55

You know, for so many women who are listening right now and feel that disconnection and and feel that loss and are mourning, you know, their younger selves or the woman that they're seeing in the mirror that they don't recognize, how do they begin to feel themselves again? I think it's important that we talk about that self-compassion practice and all of those things that help you redefine your identity.

Youth As Currency And Cultural Pressure

Dr. Katz 10:18

You know, I a hundred percent agree with you, and I love the focus because the emotional load of the physical changes is compounded by the culture that we live in, right? And the messaging women receive about aging and menopause, and um, it continues, and we have seen some progress. I'm very hopeful, but it still is oftentimes toxic and it's deeply ingrained. Yeah. And it's it is um, you know, nobody has a magic bullet to ignore it. I can ignore it all. It's very hard to ignore that.

Val 10:56

And you know what's become hard, um, Dr. Stacey, is like when you see the women in Hollywood who are 60 plus, or you see Chris Jenner who's 75 and looks like she's 30, and you look and you say, What am I doing wrong that I can't have this um same outcome when I go through menopause? Yeah, and then have to realize it's all it's different journeys, and um sometimes, you know, embracing your own journey is where you find your peace.

Healthy Guilt Versus Unhealthy Guilt

Self Compassion And Daily Reframing

Dr. Katz 11:26

Yeah, yeah. There is this um such a it's a double-edged sword because we want to feel our best for ourselves, and yet we do live in a concern uh uh context that youth is currency. And in in many societies, including our American context, much of our worth is implicitly and sometimes really explicitly tied to youth. Yes, and physical beauty, and you know, Val, that even goes to our worth tied to our fertility. Um you know, menopause biologically marks the end of fertility, but the cultural message messaging, it also often falsely equates it with the end of vitality, uh, maybe relevance, desirability. And so we do live in that culture of youth as currency, and we live in an anti-aging industry. We're bombarded with the messages that aging is a disease and we have to fight it rather than rather than a natural life stage that we experience. I mean, embracing all the wisdom that you have. I I don't know that I would want to go back and live in my 20s, honestly, with now the wisdom that I have, you know. So we have to build this new self that we love and embrace as much as we did in our younger selves. So, what is your advice for reclaiming that power? You know, I think that uh first thing, you know, sometimes we feel guilty. Um like there's there's a deep emotional guilt. But I think the first thing we have to realize because we live in this society, like, am I a bad feminist if I wear red lipstick kind of thing? Right, right. Rock staying game, saying this line, right? Yeah. Um so the first thing is I want to point out that there's a difference between healthy guilt and unhealthy guilt. And healthy guilt, like I make I'm making choices to do something that I know healthy guilt is. I've made choices to do something that I know that was not in line with my values, and I'm feeling it. And you know what? I'm not doing that again. That's really healthy guilt, very healthy, and it keeps us like in the straight and narrow on being ourselves and being authentically true to our own values. Unhealthy guilt is maladaptive, it's irrational. It is irrational because it's the persistent feeling that somehow we're responsible. This feeling of responsibility, shame, the slippery slope between guilt and shame, or like even remorse for things that are largely entirely sometimes outside of my control. So that's unhealthy guilt. Healthy guilt keeps us with a moral compass. So when we're talking about these images and everything we see out in society, and it's um it keeps us in that on that compass for us. Unhealthy guilt makes it so we act like in heavy, paralyzing weight, a feeling of paralyzing weight. And it doesn't lead to positive change or repair, like changing those ways that we do things, including the way we think about things. And it traps us in a cycle of self-punishment. And I think that self-punishment is a key to embracing this new, to avoiding self-punishment is a key to embracing this new stage that we're in. So, in the most healthiest of ways, emotionally, we can definitely what you're getting at Val is practicing self-compassion. And at its core, that's a practice of treating ourselves with the very same kindness and the patience and the understanding that we would give to even our best friend that's struggling. That's self-compassion. And we're going through this massive life transition. Anytime we're going through these transitions, because there's there's several market transitions, right? But we're facing identity shifts and wrestling with unhealthy guilt and that inner voice that can easily become our harshest critic looking in the mirror. So self-camp self-compassion is an intentional shift away from that harshness. What do you feel about that kind of a thought?

Val 15:53

I love that kind of a thought. Do you have practical tips, even practical first tips on how to start that?

A Remodel Not A Betrayal

Dr. Katz 16:00

Well, we'll we we're gonna do well to stay near self-kindness versus self-judgment, right? So instead of harshly criticizing ourselves for these perceived flaws or these mistakes I'm making, like I'm I gotta get to the vitamin store, or let me just be a mass consumer because I'm gonna fight this aging kind of thing, right? So, um, or the physical changes. Um understanding to ourselves. So it's a conscious choice, intentional choice to stop the internal beating that we all do at different levels and at different times of vulnerabilities. But we can say to ourselves, this is really difficult right now, and it makes sense that I'm struggling, which is a replacement rather than I should be handling this better. What's wrong with me? So that when when we say that it's this, it makes sense that I'm struggling, this can help us really redo redefine our identity. And it's beyond our identity, it is beyond productivity and appearance. I like the way that you're looking at it and reframing it because if you can, and it's hard work, it's not like you can say it one time and it's gonna stick. You might have to do that every day in the mirror, reframing the sentence so that it's positive, it has self-compassion, it's loving towards yourself and it's accepting. And then eventually you will get to that moment where you like the person in the mirror and that you are moving on into a direction that is very fulfilling, even more so than maybe it was in your younger years. I mean, there's a lot left to give. You know what? Dr. Stacey, I just love this idea of going forward, not backwards.

Val 17:52

Um, before we wrap up, I'd love to leave listeners with just a few gentle reminders. So, what is one thing that you would love every woman to know when she looks in that mirror and she sees someone she doesn't know?

Dr. Katz 18:05

We're we are we're not alone, right? So we can we're helping to build this new self rather than trying to reclaim an old one, right? So that's the shift. So you we're you we're not disappearing, we're not failing. Our brain and our body are undergoing this massive biologically necessary remodel. Let's just call it a remodel.

unknown 18:34

Yeah.

Dr. Katz 18:34

When you when you like that. I do too. I just thought of that. Yeah, let's remodel. Um, so when you feel when you feel that shock of unfamiliarity, it's easy, it's so natural and easy to internalize it as a personal loss or a betrayal of our own body. But we're grounding that emotion in biological reality that can help strip away that unhealthy guilt and that unhealthy shame. And then actually actually find out what's actually happening behind that reflection. It's an adaptation, it's not a betrayal, it's an adaptation. So my body's not giving up on me, it's actually actively adapting to this completely new baseline, and it's doing exactly what it was programmed to do at this stage in my life. So the cultural narrative that we live in is lying to us. It's lying. It's and it does a great job because society equates the end of our these years, the re these reproductive years, with the end of our relevance, which makes that really unfamiliar reflection feel like this comes, they want to tell us it's a tragic ending, but that is not true. So I don't have to love everything immediately either. Like, oh, you know, you know, like toxic positivity that I instantly embrace the new me. Now, real realistically, that is really an unfair expectation.

Val 20:08

It is, it is something out right with practice, yeah, you can get to. It's it is a hard thing to do, um, but you can get there and have that different reflection where you wake up and you're like, I'm happy to see that person in the mirror and I'm happy at who I'm becoming. It's kind of almost the you've got to start looking at it like it's a blessing that I have a second chance in life to do something new and different with this new person I'm getting to know. Dr. Stacey's, thank you so much for this uh conversation today. It's been wonderful talking to you. I truly appreciate you joining us.

Dr. Katz 20:41

It's my my absolute privilege and pleasure, and I'm so inspired. Thanks, Al.

Reminders Community And Closing

Val 20:45

You're welcome. So if today's conversation resonated with you, I want you to know something very important. You're not broken, and you are definitely not alone. I hope that that those are your takeaways. Metapause can change the way we look and feel, but it can also be an invitation to reconnect with ourselves on that deeper level that we've been talking about during this episode. So if this episode spoke to you, please share it with a friend who might need to hear it too, because I know there are so many women who are suffering in silence. And if you're looking for a supportive community where we keep these conversations going, I'd love for you to join us inside the pause diaries on Facebook. It's a safe place for real talk and encouragement and connection with other women. There's over 700 women in this space that are connecting and navigating the season together and giving each other advice and encouragement, and it's a lovely place to be. And don't forget to download this episode so that you can come back to it whenever you need a reminder, whenever you need to hear Dr. Stacy tell you, be kind to yourself. Because you're not walking this journey alone. Thanks so much for spending this time with me today. Until next time, remember, menopause isn't an ending, it's a beginning. I'm Belle Lego, and this is The Pause. The Pause Podcast. This is for informational purposes only and not intended as medical advice. Always talk to your healthcare provider about any questions or concerns. Views shared by hosts and guests are their own and don't replace personalized care from a qualified professional.