The midlife mental health crisis around menopause: Part two

Hormonal changes in a woman's body during menopause can affect their mental health as well as physical health making them feel anxious, stressed, and even depressed. The hormones that control their menstrual cycle also influence serotonin, a brain chemical that promotes feelings of well-being and happiness. The drop in these levels can trigger mood swings that make you less able to cope with things. For some, these hormonal dips can result in them feeling depressed, especially if they've faced depression before.

Part two of this article sees three women take us on their journey.

ALEX DARBY 53, coach and founder of emotional health platform Body Belief, based in Cardiff

I put the hot flushes, sluggish weight gain, and body aches to the back of my mind. Even my uncharacteristic bouts of rage—like the time when my husband bought the wrong type of sun cream—paled in significance next to my recovery. Still, I felt able to take control of my life: swapping my senior corporate job to coach women on their relationships with themselves, so I could spend more time with my five-year-old daughter. But I wasn’t prepared for what was to come.

In 2017, I tested positive for the BRCA genes, which increase your risk of breast and ovarian cancer, and doctors recommended surgery to remove my ovaries. I recovered relatively quickly, crossing the finish line of the New York City Marathon a year later and making the final preparations to marry my husband. But, by the time we returned from our honeymoon, the emotional tsunami felt insurmountable.

What began as creeping self-doubt evolved into full-on social anxiety. My confidence plummeted. I was running a coaching business, but during one debilitating episode, I became so panicked that I couldn’t bring myself to make a business call. I felt like a fraud—I gave my clients notice and put my business on hold. I no longer knew myself. I was an intelligent woman who’d overcome a deadly disease, whose mental strength had carried her through losing both parents, gruelling IVF and divorce. Now, I couldn’t even pick up the phone.

When my daughter told me she never heard me laugh any more, I knew I needed help—but my health history presented another hurdle. HRT is hard to access at the best of times, thanks to a postcode lottery and hesitancy among some GPs to prescribe it—a hesitancy that’s rooted in a 2002 study linking HRT with a raised risk of breast cancer, that’s since been shown to have been flawed.

Scroll through the NHS guidelines online today and you’re told HRT’s benefits outweigh its risks for most women—with the caveat that anyone with a history of breast cancer is still advised against taking it. (Along with ovarian and endometrial cancers, breast cancer relies on oestrogen to grow.) But my symptoms had stolen life’s enjoyment and were affecting my ability to function—so I decided HRT would be worth the risk and sought out a prescription privately. 

It’s been four years since my rock bottom and, thankfully, I’ve regained my strength. I built my business back slowly, enlisting a coach’s help and taking small, meaningful daily steps. The biggest change has come from having the energy to look after myself again. I’m eating a diet based on whole foods and currently training for a marathon—I’m running to mark 10 years of being cancer-free. 

I’m still horrified that the psychological impact of menopause felt so unknown to me. It’s one reason I’ve returned to my work with a renewed sense of purpose: I want to help others navigate the emotional toll of this life stage. My daughter, now 15, hears me laughing again; I’m determined that her generation will feel better prepared when their time comes.

KATE PLEACE 43, specialist women’s health nurse, based in Essex

In some ways, it had been helpful going through three rounds of IVF at the same NHS fertility clinic where I worked as a nurse. The stress of struggling to conceive was debilitating and I valued the familiar environment as my husband and I navigated the uncharted territory of preparing for parenthood.

My menopausal symptoms were subtle and, even with years of experience and training in fertility behind me, I failed to detect them. On reflection, menopause lay behind my soaring anxiety and mood swings; emotions I’d attributed to the strain of balancing a busy job with trying to conceive—and the irregular periods that followed my coming off the Mirena coil.

When blood tests revealed low levels of anti-mullerian hormone, indicating shrinking egg supply, I started to put the puzzle pieces together; when I didn’t respond to stimulation treatment during my second round of IVF, the cycle had to be cancelled. Shortly after, a consultant at the clinic confirmed I had primary ovarian insufficiency, which lay behind my premature menopause. We tried again, this time using a donor egg, but during a scan at around seven weeks, I was told I’d miscarried. I knew I could endure no more.

In the weeks that followed, I found myself utterly bewildered; struggling to countenance motherhood no longer being my path, while spending my working week helping other women create their own families. After having flashbacks to my miscarriage while performing a routine scan, I realised I needed to heal myself before I could continue my work here—and I transferred to a private fertility clinic.

The change of scenery helped; so did my husband’s and friends’ compassion. But premature menopause is a lonely place. Defined as menopause that occurs before 40, it affects just 1% of women—an isolating statistic made more so by the fact that all my friends were having children while I couldn’t. In the early days, I continued to ‘like’ the pregnancy announcements on Instagram, showed up at the baby showers and cooked food to take to friend’s houses in the newborn weeks. But as more of my friends became mothers, the labour of performing these acts became too much.

The grief was compounded by a loss of confidence, in both my body and myself. That other women could do this vital thing that I couldn’t left me feeling like a failure—the only one with a body not functioning as it should. 

Reaching my forties made the heartache that bit easier to navigate. For years, people would tell me I was ‘still young’, that I could ‘keep trying’ to have a baby with a donor egg—comments that made me feel like I was failing in another way. Society expects you to pursue parenthood at all costs; no one talks about how to make the difficult decision to stop for the sake of your own mental health.

It’s taken years to move forwards with this silent grief; silent, because others may not have noticed—my bad days played out in private. Determined to find some positives from my experience, I completed a master’s in reproductive medicine. I’m now working on a PhD looking into the lived experiences of the often invisible group of women who go through premature menopause in their twenties and thirties. It’s time for us to be heard.

KAREN ARTHUR 61, speaker and host of podcast Menopause Whilst Black, based in East Sussex

I was catching up with work from my sofa one evening when I realised something was drastically wrong. I’d just made myself a sandwich and I was typing on my laptop when I glanced at the clock in the corner of the screen and saw it was 8pm. 

My tiredness was bone deep, but I knew if I slipped beneath the duvet now, morning would come—and I’d have to live this day, these feelings, all over again. I put down my laptop and sobbed.

It was 2014, and I’d grappled with menopause symptoms for months. I was aware of the hot flushes and brain fog, albeit without being able to label them. But I hadn’t comprehended that my mental health was in freefall. When the boiler broke while I was home alone that winter, I didn’t think I deserved heat enough to get it fixed.

While there’s a lot of talk about how partners can offer their support during menopause, it’s a lonely life stage for single women; made lonelier still when you never see or hear the experiences of women who look like you. After that tearful evening on the sofa, I confided in a friend, who encouraged me to go to my GP. (I’d return to my doctor many times before anyone made the link between my hormones and my mental health.) After I was signed off sick from my job teaching at a boy’s school, I realised I no longer had the energy to do the job required of me—and decided to resign. I was only 52.

If I hoped leaving my job would help, it only left more space to be ‘ill’. Without the distraction of work, my mental health deteriorated—until I became convinced the world would be better off without me, a symptom I now recognise as a suicidal ideation. I updated my will and made sure my daughters would be able to access my accounts.

One February morning, when I was walking along the cliffs in Eastbourne, I watched the waves crash on to the rocks and thought about how desperate people must be to decide to end their lives. In that moment, I made a conscious decision to live; I went to a nearby pub, ordered a hot chocolate (with a dash of rum), and started recording my feelings in a notebook.

After that day, I was determined to get better. I’d been having therapy since leaving teaching, and regular sessions with a Black therapist helped me feel understood. I also adjusted my lifestyle. I deepened my morning yoga practice and used mindful meditation to help me ground myself. Wearing bright outfits and clothing I loved injected a feeling of positivity on days when it was harder to come by. 

Several years later, I started on a low dose of HRT, too. It was only after confiding in my Black friends that I noticed a disconnect. While we were discussing menopause among ourselves, the outside world wasn’t including us in the conversation. At the time, most menopause imagery was of older white women with greying blonde hair. Then George Floyd’s murder sparked the Black Lives Matter movement—and my follower count on Instagram soared with mostly white women. 

With growing rage over the way women like me were being excluded, I researched Black women’s menopause experience and, in October 2020, launched Menopause Whilst Black, the podcast. I talk a lot about racial ‘weathering’—the way in which chronic racial stress can affect long-term health–and how menopause research is starting to reveal the nuances of race. A recent study found that Black and Hispanic women begin menopause up to two years earlier than their white peers, and it’s vital that doctors are trained in these differences.

My journey has been painful, but now I’ve come out the other side, I value the voice menopause has given me. I’ll keep using it to help others feel less alone.

This piece originally appeared in the November 2023 print edition of Women's Health UK.