However, should there be increasing family or financial stress, if there has been problems with their husband or children or they find themselves with looming bankruptcies, the likelihood of depression increases tremendously (Robinson, et.al., 2001) and the maladaptations of overextension and rejectivity (Erickson & Erickson, 1997) can lead to increased depression and difficulty in coping with menopausal changes. Other factors that can influence mood states include gender differences in the approaches to middle age / midlife. For instance it has been noted that the empty nest syndrome can be different for both men and women. Furthermore, the deeper effect of this syndrome on women depended on a large degree on their level of activity. Whether this included involvement with work or simply volunteer or community service outside the home, the impact of empty nest was lessened substantially when other activities were present. However, if there were not outside interests and motherhood was the women's primary concern, than the effect was certainly more devastating. (Ostrove, J., & Stewart, 1998) Counselors should be considering many factors when assisting women through this stage of life.

Another significant interruption to midlife or any of the other stages of development are nonnormative changes. Nonnormative or unexpected changes are usually specific to individuals, which mark an unforeseen event of circumstance that has occurred. Such as a mentioned previously, a wife loosing her husband, or the after effects of an accident or a devastating illness for either spouse are just a few examples of nonnormative changes. An event of this type often requires one to reassess and restructure their life, careers and ways of thinking and possibly coping with life in general come under reevaluation.

By using the lifespan models of development, like Erickson's, a clinician can have a general guideline to the course of the development of an individual at certain points or stages in their lives. However, lifespan theories are often rather generic and give one little perception into the events of unexpected agencies and their total effect. The loss of a spouse, the onset of a debilitating or deadly disease, is not directly dealt with in the lifespan models. By Indirectly showing where an individual should be and how they should cope, lifespan models certainly have some relevance, but there are no direct mechanisms or guidelines for individual idiosyncratic changes or behaviors. By focussing on nonnormative changes the clinician is able to view the unexpected event on several levels, allowing the lifespan model to guide the general affect of the patient, and using a normative crisis model to adjust for variances in the time frame and development.

Also for consideration is the effect that the macrocosmic world of history has on the culture and on the individual who has grown up through them:

It makes sense that generations raised with different expectations and in different historical circumstances may age differently. In fact, some psychologists have pointed to the often profound implications of historical experience for individuals' development such that small differences in people's ages may make big differences in their lives...the social historical events that occur in a person's childhood shape the individual's background assumptions about life and the world, while those that occur in late adolescence shape the individual's conscious identity. (Ostrove & Stewart, 1998, p 1185).

These authors see major difference throughout the century such as history, improvements in health care and generational differences have a snowballing effect and affect both women at midlife as well as men. Furthermore, even the precise age where midlife starts is beginning to be adjusted. Typically forty was the traditional start of midlife, but executives in their second careers at sixty might have something to say about that. When one views old movies one is always stricken by the fact that someone on the screen saying they are thirty appears to our modern perspective to be forty or more years of age (Ostrove & Stewart, 1998). The catchphrases such as, "fifty is the new thirty" and so on ring throughout the culture as a reflection of not only the new trend in health and longevity but in attitudes as well.

As the age norms for life events begin to blur, women who are making now-traditional, but once non-traditional choices may be confronted with opposition from family members or others who feel their choices are inappropriate. Understanding that midlife can be a time of new developments, rather than a time of closing down, may enable mental health counselors to normalize the experience and reactions of significant others. Mental health counselors may...

(Degges-White & Myers, 2006)
Additionally there are other gender differences:

Forty may feel like midlife at work to a man, but not necessarily to a woman. Women balance multiple roles and follow idiosyncratic paths. Unique patterns emerge, depending on the personal configuration of age at marriage, age at childbearing, having or not having children, stage of family life cycle, age entering the workforce, career, and method of balancing multiple responsibilities. Biology alone is insufficient to explain our lives. Chronological age focuses too heavily on biology, such as menopause and ending the reproductive years. 14 Chronological age alone does not reflect the patterns of women's lives. (Edelstein, 1999, p. 107)

On a more positive note, Sharon Mcquaide designed a questionnaire that seeks out factors for overall well being at midlife:

Women who reported doing well at midlife also reported that they had a sense of their own relevance. They did not feel marginal or useless (r =.61). There was a less strong although significant correlation between well-being and positive feelings about one's own appearance (r =.54) or having positive images of midlife women (r =.44). Satisfaction with one's sex life was also moderately associated with well-being (r =.47). Confidence in one's ability to manage finances was not, however (r =.22, p =.0269). Surprisingly, a sense of spirituality was completely irrelevant to feelings of well-being (r = -.06, p =.6623). (Mcquaide)

While these seemingly contradictory indications about spiritually may at first seem confusing, it is more than likely a reflection of personal biases for or against religion and spirituality in general. For those who believe it, spirituality and religion are a comfort, for those who do not it may feel either neutral about it or vehemently rejected it.

Other studies noted that there were often some women who found the change of life easier handle than others but some were overcome by this transition:

It was common for the women in these samples to make changes in early middle age, and to engage in a process of life review and midcourse correction. Most of the women weathered this process very well indeed, whereas a few seemed unable to transform their lives and experienced a kind of paralyzed depression in middle age (Ostrove & Stewart, 1998, p 1192).

Further studies seem to contradict these common sense ideas about the psycho-social environment of midlife for women:

Ravenna Helson and Paul Wink's study found increased confidence and decisiveness as well as decreased feelings of dependence in women aged fifty-two. These women were mostly menopausal or postmenopausal, no longer had children living at home, rated their health fine and life satisfaction very favorably. Helson and Wink did not find that these changes were associated with menopause, empty nest, or involvement in caring for parents, so it was not a change in biology or caretaking that enabled the positive shifts to comfort, self-confidence, decision-making ability, flexible thinking, and tolerance of complex feelings and ideas. (Edelstein, 1999, p. 67)

As mentioned previously the predominant cause of menopause is the declining level of estrogen in the female hormonal system. There is also a resultant loss of ovarian follicles during this stage. While for the most part this appears to be part of the natural process of aging, declining levels of estrogen can also be exacerbated by a variety of other factors. Women who are smokers have been found to have much lower levels of estrogen much earlier in their lives and they consequently enter into menopause at earlier ages than the norm. Additionally, the surgical removal of the ovaries or a complete hysterectomy will result in the total disruption of the menstrual cycle and put a woman into immediate menopause. At such time a sudden shock to the system can occur and can certainly be cause for concern. This abrupt change is usually treated immediately by Hormone Replacement Therapy (HRT) in order to cope with the sudden biological changes (Short pause, 1998).

Hormone Replacement Therapy has gone through decades of highs and lows as the treatment of choice for women going through menopause. Beginning in the 1960's millions of women have been using hormone replacement therapy to treat both the physical and psychological symptoms of menopause. Going into the 1990's the hormone estrogen was turning into a miracle drug for women that could not only help with women's midlife changes and menopause, but could also help…