One in four women find it difficult to cope during the menopause, with almost half (43%) feeling depressed, and about a third (36%) experiencing anxiety, according to recent research as reported in The Scotsman. As the article states, the menopause is commonly accepted to be just ‘a fact of life’ meaning that distressing symptoms experienced around this time are often dismissed as ‘to be expected’. A staggering amount of women (70%) feel that they are not being adequately supported at this difficult time of their lives. This is a subject I feel passionately about, so I was pleased to read this article and learn about the study, as I feel it is a hugely overlooked issue that affects every woman to some degree.
The menopause, in biological terms, is the end of menstruation, signalling the natural end of a woman’s ability to reproduce. It usually occurs during the 40s or 50s though it can strike earlier or later – the average age is 51. In medical terms it is a straightforward process of gradual change in a woman’s menstrual cycle before it ends altogether. Menopause is triggered by hormonal changes – principally a reduction in progesterone and estradiol, ultimately causing the ovaries to pack up and retire. So in textbook terms the menopause is quite simple really. However the degree of variation in women’s experience of the menopause is seemingly immense. From working with and talking to many menopausal and post-menopausal women, I have concluded that no two women appear to experience the menopause in the same way.
For some women the menopause seems to come and go fairly quickly or without much trouble; indeed some seem to be completely unaware of the changes their bodies are undergoing until they realise they haven’t had a period for over 12 months – which officially puts them into the post-menopausal category. They are the lucky ones. For other women the process can drag on for years and cause considerable physical and psychological difficulties.
Let’s look firstly at the physical symptoms. As well as the commonly known symptoms such as menstrual changes, night sweats and hot flushes, the menopause can be associated with a whole range of other physical symptoms. These include joint or muscle pain, migraine or headaches, rapid heartbeat, dizziness, urinary incontinence or urgency, the list goes on. And on. Many women find themselves repeatedly attending their GP surgery but not getting answers to what is causing their pain or problems. Medical tests are often undergone but repeatedly show up nothing. Some women have been referred for tests for serious conditions such as Multiple Sclerosis, diabetes, rheumatoid arthritis, even cancer, when in fact their symptoms have later been found to be menopause related. And the fittest of women can suddenly be struck down with debilitating physical pain or dysfunction. Some of the physical effects may be temporary and recede post-menopause, but other physical effects can be permanent, such as changes to the skin condition or body weight, arthritic damage and reduction in bone mass.
However I am more interested in the effect that the menopause can have on the mood and emotions, indeed the mental health of women. The often dramatic fluctuations in hormone levels as well as coping with the physical effects can have an enormous impact on a woman’s life – often at a time when she is still busy and active, and in most cases working. And then there’s the psychological impact of the menopause and of what it represents – an end to fertility, the start of a new phase leading inexorably to old age, made all the more real with accompanying physical effects that can – simply put – make one feel one has suddenly aged by years. For some women this can dramatically affect the way that they think and feel about themselves. In addition, it can put an enormous strain on relationships and on family, work or social life.
Although medical textbooks, and even health professionals may play down – or simply ignore – the psychological effects of the menopause, I can testify from my own client work and from talking to friends and family that women often find it difficult to cope during the menopause. Many feel completely overwhelmed by what they are experiencing. Some of the psychological effects include dramatic mood swings, increased anxiety – sometimes the onset of panic attacks, which can be very frightening, onset or increase in depression or depressive episodes, confusion, memory problems, extreme fatigue and loss of libido. While undergoing all of this, many women feel they have little support. Many family doctors seem to downplay the role of the menopause – and if a hormone test comes back within the ‘non-menopausal’ ranges then the possibility of it can be quickly discounted, even though specialists confirm that blood tests can be poor indicators of menopause due to hormone level fluctuations. As a result women can find themselves in pain or discomfort, concerned about what may be wrong with them, not getting any answers, and extremely anxious, depressed or confused. In extreme cases women are sometimes prescribed psychiatric medications or labelled with mental health diagnoses.
Many women do seek talking therapy for help and support at this time, and indeed it can help them to cope with what they’re going through. I strongly recommend anyone who feels that they may be experiencing psychological symptoms linked to the menopause to seek support in the form of counselling or similar. Also speak up and ask your GP or other medical practitioner if your problems could be menopause related. It’s surprising how many don’t even consider it.