When we think about the effects of menopause (the ending of ovulation and periods) and perimenopause (the transition which comes before), on women and people who menstruate, we tend to focus on better-known symptoms like hot flushes and night sweats.
Just as common as these physical issues are the less spoken about side effects related to mental health, from anxiety and low mood to the lack of mental clarity and inability to focus known as brain fog – all of which are caused by a fluctuation of the hormones released by the ovaries (primarily in perimenopause) and consistently low hormone levels (in menopause).
“In my experience, I would say more than 70% experience - to a degree - experience the cognitive and emotional symptoms. These symptoms overtake the presence of the flushes and the sweats in terms of how much they impact on life,” said Dr Theodora Kalentzi, a GP and menopause specialist at Medical Prime.
“For so many women, the first symptoms are not hot flushes or periods changing - they are anxiety, low mood, mood swings, irritability and loss of joy. When you don’t understand why that is happening to you and nobody has ever told you that these can be symptoms of perimenopause, it can leave you feeling scared and alone,” said Diane Danzebrink, a menopause counsellor and the founder of Menopause Support.
Menopause awareness campaigner Elizabeth Ellis set up Pausitivity after struggling with mental health issues like paranoia and anxiety on her own menopause journey.
“It was only when I got hot flushes that I learnt menopause can affect your mental health, too. I went through the NHS website playing Menopause Bingo, ticking off each symptom I’d gone through without realising it. When I went to my GP, he then gave me information, but it was too late. I’d started having symptoms years previously. I needed the information then,” she said.
According to Dr Kalentzi, there are a range of reasons why people aren’t able to access the right support as quickly as they need from their GP. These include time constraints (the average appointment is eight minutes long); the generalist nature of GPs’ knowledge and the fact that perimenopause and menopause symptoms present in similar ways to anxiety and depression.
“Being a GP myself, I know how difficult it is to be up to date with every area of medicine. We are generalists. I went down this specific route exactly because of the lack of training I had in medical school, in my undergraduate and postgraduate career. There was very little that we had to learn about [this area], particularly the perimenopause,” she said.
But what does this mean for the lives of those navigating perimenopause and menopause?
Menopause, mental health and me: 5 stories
For Sandra Jorden, 44, a student mental health nurse from Weston-super-Mare, the shock of extreme tiredness, lethargy and joint pain due to menopause has taken its mental toll.
“It’s the complete opposite of who I was, or who I am, so it’s hit me hard. You can go through this life under the illusion that you’re okay, feeling quite positive, then this happens,” she said.
In summer 2020, Sandra’s GP told her she was too young to be going through menopause. She reminded the doctor to check her notes in order to see that she’d had a hysterectomy (a factor which brings on menopause), at which point she was offered a blood test.
“It’s like harnessing a wild horse in order to function and explain yourself. You’re working extra hard to ask questions and speak to your GP because it takes so much energy. You feel despondent,” Sandra said.
For some people from Black, Asian and Minority Ethnic backgrounds, there can be cultural taboos preventing them from even speaking about what they’re going through. Sandra is originally from Zimbabwe and knows that all too well.
“I’d never heard of menopause or HRT until I came to the UK. The majority of women in Africa get on with it, because you still have to raise your kids and cook and clean. You are supposed to be tough,” she said.
“Explaining [about symptoms] to women in Africa, it’s like: ‘What are you talking about? Get a grip, sort yourself out and get on with it.’ You’re fighting that as well, as an African woman.”
Lifestyle changes like regular rest time and natural remedies are helping Sandra to continue with her studies as a mental health nurse, although she’s taking everything day by day and has considered the option of taking a break from her course.
“You think: ‘Menopause means I’m getting old and decrepit. This is the end, this is how I die. I’m not a woman enough anymore, who would want me?’ But it’s not, it’s just a pause. You take a pause, you recalibrate, you pick yourself up and you adjust accordingly,” she said.
Maria Rooney, a 49-year-old social worker from Nottingham also noticed a shift in her emotions when she began experiencing menopause symptoms in 2017 including brain fog, chronic fatigue, anxiety and low mood.
“I've never suffered with any mental health problems before. I was always a very happy, positive, sociable and confident person. It’s the low mood and anxiety that made me think: ‘Something's not right here,’” Maria said.
A combination of a huge and growing workload and her symptoms meant Maria was signed off work in 2018. When she did return, it wasn’t long before she handed in her notice after 12 years of being a social worker. In 2020, her 15-year relationship broke down, too. Supportive friends are helping Maria through the challenging time.
“We're all going through the menopause together so we've got a WhatsApp group where we try to cheer each other up and emotionally support each other, so that's quite good, especially during lockdown when you can't go to anybody's house,” she said.
“Women in their 40s and 50s don’t like to admit they’re going through certain things but I think we need to be more open in discussing this and get things out in the open.”
Jaspal Sidhu, 51, from Berkshire, works in communications and like Maria, menopause impacted her mental health and consequently, her career. Jaspal opened up to her boss about how much she was struggling and she began to work from home increasingly, feeling anxious about going into the office.
“My symptoms were to do with memory and brain fog and basically the inability to function. I’m a very creative person but I lost that. I couldn’t write anything that sounded witty. I couldn’t find the words. I felt a bit stupid,” Jaspal said.
“The crux came when I’d been in my pyjamas for three days, I hadn’t showered, I wanted to call my boss and resign. I’d been in the company 14 years then, I’d worked my way up, I’m very good at what I do and I just thought: ‘I want this to go away.’ I didn’t feel suicidal, but I’d lost the joy in my life.”
Jaspal sought help, started taking HRT and soon she was back to feeling calm and collected; she calls her experience with HRT “life-changing.”
Her Indian background means that talking about menopause symptoms isn’t the done thing, but she feels strongly that everyone needs to be supported in speaking about what they’re going through.
“In my culture we don’t really talk about it but I’d rather do that openly, it’s just something all women go through and we need to educate,” she said, referencing the importance of resources being available in languages like Punjabi and Urdu.
“If you’ve got somebody who’s not been brought up here and doesn’t really know about any of this stuff it can be a bit of a shock, so those resources are very important.”
For some, menopause symptoms are experienced in conjunction with other health issues, making for an extremely difficult situation. Sunita Thind is a 38-year-old writer and homemaker from Derbyshire whose first menopausal symptoms came at the same time as chemotherapy treatment following operations to remove cancerous cysts and then Sunita’s ovaries. Sunita has felt the loss of her periods keenly, and it’s had a big impact on her mental health.
“I miss my periods, I want them back, that whole identity of being a woman,” she said.
“I saw some pads and I burst into tears. I looked in the mirror and saw my hair has gone and I burst into tears. I know I’m emotional because of menopause but it’s not just that. It’s traumatic. Seeing blood on TV in certain instances triggers me and gets me really upset. The only way I’ve been able to get through it is by talking to my husband, crying on his shoulder and asking: ‘Why me?’ I just don’t understand.”
Sunita has been able to access mental health support, though she feels it’s not as robust as it could be.
“The hospital has been amazing but on the menopause side I’ve only had one phone conversation with the menopausal clinic doctor. There isn’t that much support out there for women, especially younger women,” she said.
Sunita finds creative writing to be an important release; she’s penned poetry books and is thinking about a memoir.
“I've been able to use it as a platform to raise awareness because I don't think there are enough women of colour who are talking about it, maybe because it's not something that they want to talk about and they don't find it comfortable,” she explained.
Sunita is still going through cancer treatment whilst experiencing menopause symptoms, and at times, she feels a sense of anger towards her body.
“You feel like it’s failed you in some way. It’s given me an inner strength and resilience that I didn't think I had, though, so it hasn't all been bad,” she said.
Perimenopause and menopause symptoms can be brutal, but they’re not permanent.
Jo Mosley, 56 from North Yorkshire, works in the engineering industry and was at her lowest ebb with menopause symptoms when she was 48, experiencing extreme anxiety and dread.
After bursting into tears in the supermarket and telling her sons she couldn’t cope, Jo sought advice from a friend who gave her an indoor rowing machine to use. Although at that time, she didn’t know what perimenopause was.
“Neither of us talked about the fact it could be perimenopause, she just said it might help me to sleep if I exercised. I put the rowing machine in the kitchen and within a couple of weeks of using it, I was sleeping and then starting to feel better,” Jo said.
“I pieced together that I was going through perimenopause in hindsight - I’d read things on Twitter and then I’d put two and two together. I spent two or three years in the worst-case scenario and once I started exercising and looking after myself it definitely eased my symptoms.”
Jo is now post-menopausal and has noticed her clarity of thought is back and she’s feeling more confident. In 2019, she became the first woman to stand up paddle board coast to coast across the UK and she credits exercise as being an entry point to self-care and joy, something she’d lost.
“I wish I’d found all the lessons the menopause has taught me when I was in my 20s and had learned to look after myself then. It’s forced me to really understand what brings me joy. I know now that joy and sunshine is within,” she said.
What needs to change?
While Dr Kalentzi feels that progress has been made in the last few years, she says more awareness of perimenopause and menopause symptoms needs to be raised among healthcare providers and the wider public.
“Awareness is half of the battle in this mission to understand more about the perimenopause and menopause. The willingness is there,” she said.
“What I admire is how women nowadays want to learn about their bodies and how they function and the level of knowledge that women who come to my clinic demonstrate is amazing. It’s great to see the shift. There is more and more discussion going on and more and more women are prepared to take control of their bodies and their lives.”
The #MakeMenopauseMatter campaign is calling for better menopause education, care and support. Find out more HERE.
The KnowYourMenopause poster has been created to be displayed in GP waiting rooms. Find out more HERE.
Pause, created by mental health charity Mind, is a self-care subscription service that brings creativity, relaxation, and calm to your door each month. Subscribe HERE.
Find ideas and support related to getting active with This Girl Can HERE.
Find out about menopause services at Dr Kalentzi’s clinic Medical Prime HERE.
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