TL;DR
By Fabiola Balmori and Karina Benitez Lin
Insights from six months in the Theory of Change Makers incubation program at -the Laboratory of Social Entrepreneurship
Over the next decade, tens of millions of women in Latin America will go through the menopause transition. Many will experience anxiety, depression, and severe sleep disruption, yet very few receive psychological support tailored to this stage of life.
During the last six months, through the Theory of Change Makers incubation program at the Laboratory of Social Entrepreneurship, we explored whether an evidence-based intervention could help close this gap.
The result is Lunava, a guided virtual -based cognitive behavioral therapy (iCBT) program designed to support women experiencing depression and anxiety during the menopause transition.
This post shares how the project emerged, what we learned during the incubation process, and why we believe this intervention could improve the quality of life of millions of women.
A large but rarely discussed mental health gap
The menopause transition is a universal biological stage, but its psychological impact is often underestimated.
Hormonal fluctuations during perimenopause and menopause can affect neurotransmitters involved in mood regulation, including serotonin and Gamma-aminobutyric acid (GABA). As a result, many women experience symptoms such as anxiety, depressive episodes, sleep disturbances, and emotional dysregulation.
These changes often occur during one of the most demanding phases of adult life. Many women in their forties and fifties are simultaneously navigating professional responsibilities, caregiving roles, and family transitions.
Despite this, mental health support specifically designed for menopause remains extremely limited.
In Mexico alone, there are more than 18 million women between the ages of 40 and 59. Across Latin America, tens of millions of women pass through the menopause transition each decade. Yet the psychological dimensions of menopause are rarely addressed within health systems.
This combination of large scale and limited attention is what initially drew our interest during the program.
From problem mapping to intervention selection
One of the first steps in the Theory of Change Makers program was to map different social problems and evaluate them using criteria such as scale, severity, neglectedness, and tractability.
Mental health repeatedly emerged as a major area of need. Within that field, the menopause transition stood out as a moment where biological changes and social pressures intersect in ways that significantly affect wellbeing.
Once the problem became clearer, the next step was to identify interventions with strong evidence of effectiveness.
Cognitive behavioral therapy (CBT) adapted for menopause symptoms appears consistently in clinical research. Studies suggest that CBT can help reduce depressive symptoms, anxiety, sleep problems, and the psychological impact of vasomotor symptoms.
Importantly, these interventions have also been tested in digital formats, which significantly increases their scalability.
This evidence base led us to explore a digital adaptation of CBT designed specifically for women navigating menopause.
The intervention we are developing
Lunava is a guided internet-based cognitive behavioral therapy program for women experiencing depression and anxiety during the menopause transition.
The program combines structured CBT modules with facilitated online sessions in small groups. The intervention typically runs for eight to twelve weeks and includes:
- psychoeducation about menopause and mental health
- cognitive restructuring techniques
- emotional regulation strategies
- tools to address sleep disruption
- guided group discussions that reduce isolation
Participants complete standardized assessments such as PHQ-9 and GAD-7 to monitor changes in depressive and anxiety symptoms throughout the program.
A safety protocol is integrated into the intervention to identify participants who may require additional clinical support.
Our goal is to adapt existing evidence-based CBT protocols into a format that is culturally relevant, accessible, and scalable for Spanish-speaking contexts.
Early prototyping and initial signals
During the incubation process, we ran early prototype sessions with small groups of participants.
The purpose of this stage was not yet to measure clinical impact, but to explore feasibility questions such as whether women felt comfortable discussing menopause and mental health in a group setting and whether the content resonated with their experiences.
The early signals were encouraging.
Participants frequently described feeling relief when they understood that many of their emotional and cognitive changes were connected to the menopause transition. Several also reported that simply having a space where these experiences could be discussed openly reduced feelings of confusion or isolation.
While these observations are preliminary, they reinforced the idea that there is a real unmet need for this kind of support.
Why scalability matters
Mental health care is often limited by the availability of trained professionals and the cost of traditional therapy.
Guided internet-based CBT offers a potential way to expand access while maintaining evidence-based treatment methods. Digital delivery reduces barriers such as transportation, scheduling constraints, and geographic access to specialized clinicians.
Group formats can also increase reach by allowing one facilitator to support multiple participants simultaneously.
If our replication of the model proves effective, the intervention could potentially be implemented across multiple Spanish-speaking countries with relatively low marginal costs.
Even modest improvements in mental health outcomes during the menopause transition could translate into substantial gains in wellbeing for individuals, families, and communities.
What comes next
Our next step is to run a larger pilot of the Lunava program in Mexico. This phase will focus on evaluating:
- early changes in depressive and anxiety symptoms
- participant retention and adherence
- feasibility of replicating the intervention in different contexts as early signs of the potential for scalability.
In the long term, we hope to build an organization capable of delivering evidence-based psychological support for menopause across Spanish-speaking countries.
The Theory of Change Makers program provided the structure to move from an initial question to a concrete intervention design, encouraging an approach grounded in evidence, experimentation, and iteration.
For us, that process ultimately led to Lunava.
Questions we are still thinking about
As we move toward a larger pilot, a few questions remain particularly important:
1. Engagement and retention
What design elements most improve adherence in guided iCBT programs over 8 to 12 weeks?
2. Cultural adaptation
How much adaptation is typically needed when implementing CBT protocols developed in high-income contexts forLatin American populations?
3. Scaling pathways
If the pilot proves effective, what delivery channels might allow the intervention to reach large numbers of women?
Invitation for feedback
We are sharing this project early because many people in the Effective Altruism community have experience with evidence-based mental health interventions, digital health programs, and scaling nonprofit initiatives.
If you have experience with digital mental health programs, CBT adaptations, or scaling interventions in low to middle-income countries, we would greatly appreciate your feedback.
We would also welcome suggestions of aligned funders, relevant research or organizations working in this space.
For those interested in learning more, we invite you to visit our website, read our research report and explore the first version of our cost-effectiveness model.
You can write to us directly at: karina@lunava.ngo or fabiola@lunava.ngo
We greatly appreciate any comments, suggestions, or relevant connections at this stage.