Peri-Menopause, Post-Menopause and Mental Health
By Kathryn Spence, Accredited BACP Psychotherapeutic Counsellor, Accredited BABCP CBT Therapist, EMDR Therapist | InnerFocus Therapy | 1 February 2024
Why is this topic so taboo? No-one tells you about this time of life to prepare you! And no-one tells men what to expect with their partners either! And no-one explains to kids what their mums are going through!
In Urdu the word for menopause is “banjh”, which means "barren" - literally you are barren! As far as I understand it, in Punjabi there isn’t even a word for menopause!
Wow! So here goes, I’m going to talk about it and this is my story…
I had my only child when I was 39 years old after IVF (also by the way, not a fun time for hormones and mood swings). I thought it was just a lot of hard work to raise a child, a very energetic child, at this age, and therefore put my mood and fatigue down to stress, which in turn I assumed was the cause of all the arguments in my marriage. We’d only got married when I was pregnant (though this was planned beforehand); so the start to married life – during lockdown with a newborn – was far from simple. But it wasn’t until my son was about 3 – at least 2 years later than symptoms were really evident – that I realised it wasn’t just stress! It wasn’t until I had a recurrence of spots on my face that I worked out what was going on. Spots in my 40s was weird and it was the only symptom I ended up Googling. I was shocked that this might be linked with peri-menopause. I knew NOTHING about the menopause with my only knowledge being “Isn’t the menopause something that happens when you’re 50?” “Isn’t it all about hot flushes, but I don’t get these?”. Then I read more and found I was having tonnes of symptoms I didn’t know were connected, and weren’t just stress related; I was peri-menopausal!
Trouble breathing, the BRAIN FOG (especially fun as a talking therapist… argh!), being clumsy, headaches every evening which no painkiller helped alleviate (FYI I had been to the GP about and was told "They’re tension headaches, just drink more water by 12pm" – nope they were hormone headaches and disappeared as soon as HRT started), sore breasts, no libido, fatigue, mood swings and anger (lots of anger), feeling overwhelmed, and even the worsening of Trichotillomania (eye lash pulling – which ironically started when I hit puberty and said hello to these damn hormones in the first place!).
What a relief! I had answers, I understood (kind of at this point) what was happening, and I could get some treatment. Treatment took a while, a bit of trial and error, a few problems with my GP, blood tests etc. and a painful coil fitting - but wow the relief of HRT taking away Mr Hyde (almost at least!).
And this led me to write this blog so I may be able to help other people find out what could be peri-menopause earlier…
Let’s start off with some information…
Peri-Menopause
Peri-menopause is where hormonal levels start to fluctuate causing numerous symptoms.
Peri-menopause symptoms on average can start between 40-44 years old.
Peri-Menopause can last between 2-10 years.
Menopause
Menopause is 12 consecutive months with no period.
The average age of menopause is 51 (ranging from 45 to 55).
Post-Menopause
Post-menopause is after this 12 month mark known as menopause.
Premature Ovarian Insufficiency (POI)
POI happens when a woman's ovaries stop functioning as they should before she is 40.
1 in 100 biological females will experience the menopause before age 40
1 in 1,000 biological females will experience the menopause before age 30
1 in 20,000 biological females will experience the menopause before age 20
The earliest known age was recorded as 14 years old.
13 million people in the UK are CURRENTLY experiencing menopausal symptoms:
25% report the symptoms as ‘severe’
10% will leave the workplace due to symptoms
25% will experience little or no symptoms
People are potentially more vulnerable to symptoms if they have had difficulties with PMS or hormonal fluctuations in the past.
Those who were born biologically female but now identify as Trans Men and Non-Binary are often a forgotten group who suffer equally with menopause, therefore this information is just as pertinent to these groups too. However, throughout this blog I will refer to 'women'.
Which Hormones are Involved?
Oestrogen
Oestrogen is one of the main female sex hormones and declines during peri-menopause. This particularly contributes to the symptoms of vaginal dryness and pain, as well as other urinary/bladder symptoms, heavy bleeding, hot flushes, night sweats and emotional instability.
Progesterone
Progesterone is another one of the main female sex hormones and declines during peri-menopause. Due to the decline in progesterone, this contributes to symptoms including night sweats, hot flushes, anxiety and insomnia.
Testosterone
We normally think of testosterone as a male sex hormone, but women actually produce testosterone too, just at a much lower amount. But if this hormone decreases during peri-menopause and menopause it can lead to a reduced libido, increased tiredness and difficulty concentrating.
Follicle Stimulating Hormone (FSH)
Follicle Stimulating Hormone (FSH) actually increases towards menopause. If a woman is under 45, doctors may test levels of FSH to identify whether they are peri-menopausal. However, there are some issues with this; oestrogen and FSH vary greatly day to day during peri-menopause. One elevated FSH level is not enough to confirm menopause, and a low level of FSH, where the woman is experiencing symptoms such as hot flushes and changing menstrual cycles does not eliminate the likelihood she is peri-menopausal.
Luteinising hormone (LH)
Luteinising hormone (LH) is a hormone secreted by the Pituitary Gland in the brain, which interacts with other sex hormones to regulate menstrual cycles. LH also increases in women after menopause.
What are the Symptoms (there are LOADS of them!)?
Click on the different types of symptoms below to learn more.
Vasomotor Symptoms
Night sweats
Hot flashes / flushes
Feeling cold
Heart palpitations – when your heartbeats suddenly become more noticeable
Physical Symptoms
Digestive problems and/or feeling nauseated
Clumsiness
Headaches and migraines
Sore breasts
Acne
Poor sleep – problems falling asleep and/or waking frequently
Low libido
Frequent urination
Joint and muscle aches
Changed body shape and weight gain
Skin changes, such as dry and itchy skin
Vaginal dryness and pain, itching or discomfort during sex
Recurrent urinary tract infections (UTIs)
Reduced or changes in menstrual cycles
Bloating/Water retention – swollen tummies
Burning mouth (if this is the case for you, try and avoid hot and spicy foods)
Loss of bone and teeth density / strength
Gum problems
Dizziness
Thinning hair
Sagging breasts or changes in breast size
Dry eyes
Dry mouth
Breathing difficulties or shortness of breath
Changes in smell and taste due to reduced saliva production
Brittle nails
Tinnitus – ringing/buzzing/humming in the ears
Electric shock sensation
Body odour
Psychological Symptoms
Lack of energy / fatigue
Irritability / anger
Mood swings
Lack of interest / motivation
Loss of self-esteem
Feeling overwhelmed
Feeling depressed
OCD
Reduced empathy and tolerance
Feeling like you’re going “crazy”
Anxiety and stress
Feeling suicidal
Brain / Cognitive Symptoms
Brain fog – loss of words, losing train of thought
Forgetfulness
Loss of concentration
Behavioural Symptoms
Trichotillomania – hair pulling
Withdrawal from activities you would normally enjoy
Withdrawal from social situations
How Does this Phase of My (or my loved one’s) Life Affect Me?
Workplace
10% of women experiencing peri-menopause or menopause leave the workplace. We need our employers to understand more about what we’re going though. That may have to start with us sharing our experiences and asking for what we need to support us.
Divorce / Relationship Problems
In a survey completed by Family Law Menopause Project and Newson Health Research and Education, found eight out of 10 women experiencing marriage difficulties said the symptoms of the perimenopause or menopause put a strain on their family life. The survey also found 73% (1,000 women surveyed) blamed the menopause for their divorce or marriage problems, with some saying it increased arguments or domestic abuse. There could be several reasons for this: such as the loss of libido affecting sex life; increased arguments due to mood swings, reduced empathy and tolerance; lack of confidence affecting mental health and the strain this causes in relationships.
Infertility
During peri-menopause your fertility starts to decline, meaning it will become harder to get pregnant. Once you’re menopausal, you become infertile. This can be a particularly hard adjustment if you’ve always longed for a family, struggle to get pregnant the older you get, or go through POI (Premature Ovarian Insufficiency). It can therefore lead to feelings of despair, failure and depression.
Loss of self-confidence and self-worth
Due to the symptomology of peri-menopause and menopause, women can lose confidence, become anxious and/or depressed, and therefore start to withdraw and avoid, leading to an endless vicious cycle, making our emotional wellbeing worse and worse. If this is the case, seek professional help, such as a therapist or your GP.
How do I get a Diagnosis?
Information below is taken from NICE on 26/01/2024 about how medical practitioners will diagnose menopause and peri-menopause and what tests they may want to do. You can find out more information directly from NICE.
Usually a GP can make a diagnosis for an otherwise healthy woman over 45 years old with menopausal symptoms if:
They are experiencing vasomotor symptoms and irregular periods;
They have not had a period for at least 12 months (and are not using hormonal contraception); or
In women without a uterus, the symptoms they're experiencing are consistent with menopause.
In women aged 40-45, a GP may consider an FSH test to diagnose menopause if they are experiencing menopausal symptoms, including a change in their menstrual cycle.
In women aged under 40, a GP may consider an FSH test if Premature Ovarian Insufficiency (POI) is suspected.
GPs will often use symptom profiles to aid diagnosis - see the list of symptoms above. You may wish to keep a diary of your symptoms or a list, which may support your consultation with a GP.
What Can I Do to Help Myself (or someone I love who’s going through this)?
These are just initial suggestions but I am not an expert in the following areas:
Medical Treatment - HRT
Visit your GP and consider HRT (Hormone Replacement Therapy) – oestrogen, progesterone, testosterone. There are various different methods to administer these hormones depending on your needs. HRT is not suitable for everyone, but a GP should be your first port of call. If you don’t feel supported by your GP consider seeing an alternative GP at your practice, a GP with a special interest in female health at your practice, or even changing your GP surgery.
Anti-depressants are often prescribed for menopause symptoms but there is no evidence to support this as being beneficial (NICE Guidance).
Exercise
Due to reduced hormone production, women are at higher risk of health problems, such as osteoporosis and cardiovascular disease. Women are also more likely to put weight on around the tummy area (I certainly have! Shame I'd just bought a new pair of Levis and not I can't get into them!).
Exercise is also very good for our mood, which is often all over the place due to these hormone fluctuations. Exercise releases our 'happy chemicals'; Serotonin, Dopamine and Endorphins. We should make sure we exercise in a healthy way and find ways that are right for us. Speak to a doctor if you're worried about your physical health and exercise.
Alternative & Complementary Therapies
There is some evidence for yoga, aromatherapy, reflexology and acupuncture may help some women with menopausal symptoms.
Johnson, Roberts and Elkins researched different forms of complementary and alternative therapies for menopause and found the following.
Biofeedback, Mindfulness-Based Stress Reduction and relaxation techniques may reduce stress and improve quality of life for women transitioning through menopause, but have not shown efficacy for specific menopausal symptoms.
I am not an expert in this area and you should do your own research.
Psychological Therapies
The role of psychological therapies or counselling for menopause can be varied - exploring someone's life transition towards the menopause, ways to reframe any negative thinking about this transition, psychological education to aid healthy coping strategies for some of the symptoms of menopause, improve self-esteem and confidence, ways to reduce anxiety and improve communication, or just somewhere to reflect and be offered support through this time in your life.
Diet and Nutrition
Eating a healthy diet can support women through the menopause, this includes having calcium-rich food like milk, yoghurt and kale to keep bones healthy.
Eat plenty of fruits, vegetables, high-fibre foods (such as wholegrains), dairy or dairy alternatives, a range of protein sources (especially beans, peas and lentils) and small amounts of unsaturated fats (such as olive or rapeseed oil) [British Nutrition Foundation, 2022].
Lifestyle Changes
It could be useful to keep a diary and see if there are any triggers which make your individual symptoms worse (e.g. alcohol or caffeine).
Rest is important to manage stress and symptoms of menopause, as well as having a good sleep regime. Ensure work-life balance and engaging in life doing things you enjoy and that gives you a sense of closeness to others and a sense of achievement.
Are There Any Benefits from Going Through All This and Reaching Menopause?
And there is hope post-menopause...
No More Periods (and no need to spend money on tampons and sanitary pads!!)
Relief from PMS - the cramps, headaches, mood swings, lethargy, bloating, the list continues!
Being able to have sex without the worry of falling pregnant
Disappearing body hair - decreased progesterone and oestrogen can make your body hair grow slower or not at all - less need to wax, shave or tweeze!
If you have ever suffered from Uterine Fibroids, these shrink following menopause
Post-menopause shows an increase in memory function again
Post-menopausal women also report improved sleep and feeling calmer
Increased Confidence and Inner Strength - many post-menopausal women report that life is more balanced and they can focus their energy better
A renewed zest for life - one study showed that optimism rises in your 50s :-)
“There are women who have gone through menopause who say, ‘I feel like I know myself more, and I’m more confident in who I am as a woman and a person. I don’t put up with nonsense the way I used to’.” says Millheiser.
Some More Sources of Information (and references for this blog)
Davina McCall documentary (Channel 4) “Sex, Myths & Menopause”
Davina McCall with Dr Naomi Potter book “Menopausing”
Louann Brizendine, MD book “The Female Brain”
Louann Brizendine, MD book “The Upgrade: How the Female Brain Gets Stronger and Better in Midlife and Beyond”
https://www.everydayhealth.com/menopause-pictures/positives-of-menopause.aspx
https://www.nhs.uk/conditions/menopause/
British Nutrition Foundation, 2022 | nutrition.org.uk
Johnson A, Roberts L, Elkins G. Complementary and Alternative Medicine for Menopause. J Evid Based Integr Med. 2019 Jan-De
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