The midlife mental health crisis around menopause: Part one

The conversation surrounding menopause symptoms has gone from hushed up to headline news in recent years, but one aspect of this story remains under-reported. This period represents a staggering risk to mental health, with an estimated 70 per cent of those who are menopausal experiencing psychiatric symptoms as a result of fluctuating hormones—from anxiety and depression through to psychosis and suicidal ideation. 

Devastatingly, some go on to act on those thoughts; suicide rates for women aged 45 to 54 have risen by 6 per cent over the past two decades. These are shocking statistics to which there are no easy answers. But as we’ve learned from the conversation that’s come before, honest disclosure can be a catalyst for change. On the following pages, you’ll hear from six women for whom menopause represented a terrifying departure from their typical temperament, disposition, and emotional well-being. They’re opening up to help others feel less alone, while asking questions about who’s been left out of the conversation so far—and if the UK’s healthcare system is equipped to manage this psychological fallout. Here, they tell their stories, in their own words...

LISA STIRLING 51, former model, based in Birmingham

In the year before her death in 1995, she was no longer the mother I knew. The generous, vital woman who taught yoga classes, radiated positive energy, and thrived amid the motions of motherhood seemed to harden and fade. Her symptoms read like a diagnostic criteria for menopause: hot flushes, trouble sleeping, low mood. But despite that, doctors told her she was depressed, only offering her antidepressants that failed to help her.

I was 24-years-old when I walked into her bedroom one morning and discovered that she’d taken an overdose. Once the shock of those first few weeks had subsided, anger set in. How could she leave me and my siblings? We were so young. The fact that I didn’t understand why made the grief all the more difficult to process, and I missed her desperately in the decades that followed. When I’d experience big life events, like marrying my husband and the arrival of our children, her absence was particularly painful.

Despite the weight of my grief, I built a life I loved. By my early 40s, I was a gregarious mother-of-four, never happier than when hosting a crowd of friends or heading off on a group trip. My husband would affectionately quip that I’d get cabin fever if I was ever home for more than a few days. 

But I began to feel increasingly disconnected from the woman I used to be. By 46, I was an anxious, insecure shadow of her. Socialising required energy I could no longer give and anxiety left me struggling to leave the house. Then the true darkness descended. I began to believe that my husband and children would be better off without me. It was as if someone else was in control of my mind; I still remember the first time I fantasised about how I might end my life.

Without a mother figure to pass learnings down, I was clueless. I only heard the word ‘menopause’ when Jayne told me that she’d been through something similar. She recommended I seek advice from Louise Newson, a GP and menopause specialist. It was only by doing so that I finally connected the dots between my mum’s experience and my own.

I now understand the extent of the psychological turmoil my mum must have been navigating—something that’s transformed the nature of my grief. I can truly empathise with what must have been a terrifying, isolating experience; one she was left to navigate alone because doctors didn’t know how to help—nor did we, her family, given issues around menopause and mental health were never discussed. I’m still angry—enraged, even—but it’s now directed at a system that failed her.

I’m so grateful that, by the time the menopause threatened to rob me of my own life, I could be prescribed HRT medication—without a doubt, it’s saved my life. Not every day is a breeze but, emotionally, I feel like myself again. I try to eat fresh food as much as possible, lift weights three times a week and diarise regular fun with my friends. There’s a sense of purpose to the way I live my life now: I live it to the full because my mum didn’t get to.

SUZI TAYLOR 52, part-time carer, based in Surrey

It had happened before. My second son was weeks old when I woke one morning suddenly scared of him. Feeling overwhelmed and suffocated, all I could do was run. Too much noise would trigger my fight-or-flight response in a way that literally made me flee. I’d run from the house, leaving my husband to care for our baby and other young son while I walked the streets, slept on friends’ sofas or checked into a hotel until I felt safe to return. 

Coming out of these episodes of what I now recognise as ‘depersonalisation’ would take days, sometimes longer. During those hours, it would feel like I was dreaming; as though I was outside of my body, looking on. At six weeks postpartum, I was diagnosed with psychosis, but a lack of understanding about the mechanics of hormones meant my doctors didn’t know how to support me, except prescribe the antidepressants I’ve been taking since my teens. 

For 15 years, my psychosis persisted–becoming more debilitating still after the birth of my third son. Horrified by my family’s suffering, I became determined to identify the cause, enduring some—still painful—medical gaslighting in the process. One GP told me I was attention-seeking; another said I was imagining mysymptoms. 

But, with time, patience, and courage, I identified a pattern. I hadn’t experienced a psychotic episode until my thirties, but tracking it back revealed hormonally triggered psychological symptoms going back decades. My psychotic episodes appeared monthly, returning immediately after ovulation and remaining until the first day of my menstrual cycle. My family witnessed my character change overnight—severe anxiety, depression, and suicidal ideation—triggered by what we now know was premenstrual dysphoric disorder. 

UK's healthcare system needs to acknowledge, urgently, that mental health issues in puberty increase postnatal and menopausal vulnerability. My theory that my psychological symptoms were caused by fluctuating hormones was routinely dismissed, until two gynaecologists, John Studd (who I found during extensive research) and Nick Panay (who I was referred to), finally offered validation and compassion. In 2012, I became one of the first women in the UK to have a hysterectomy for mental health. 

Removing my womb and ovaries triggered surgical menopause. I had a few years of relative stability, helped by HRT, before the psychosis returned. Some days, I wanted to run again; on others, painful joints left me bedbound. That I found myself plunged back to that place was a shock—to doctors as well; they now believe that, while surgical menopause caused my hormones to nosedive, this latest episode was my body triggering my ‘real’ or ‘natural’ menopause. 

By then, it was 2020. Amid pandemic pressures, securing the HRT implant—that I urgently needed to manage my oestrogen levels—on the NHS proved impossible. My oestrogen levels were so low that the private doctor who eventually treated me was shocked; it took five implants, over three years, for my levels to stabilise.

Now, I feel great. I have no drawn-out depersonalisation or psychoses, my mood is level and I feel strong. Knowing my limits is key; my week is structured around part-time work and rest time is non-negotiable. Good-quality sleep, exercising and eating properly are fundamental. So is speaking out loud what once felt unutterable: I tell my husband whenever suicidal thoughts resurface and, thanks to his support, I’ve not acted on them. But I never take that stability for granted, my mind can change everything in a moment

MEERA BHOGAL, 55, nursery owner and menopause campaigner, based in London

Before long, my anxiety grew so acute that I retreated indoors. It wasn’t rational; I was an outgoing person who loved company. But I felt increasingly uneasy. I existed in a state of panic, catastrophising about everything that could go wrong; feeling utterly inadequate. 

When my yoga teacher suggested I might be perimenopausal, I dismissed the idea. And when I mentioned the term at a routine smear test, the nurse confirmed my suspicions–that I was too young. Instead, I went to my GP complaining of anxiety, leaving with antidepressants that I knew, deep down, weren’t the solution.

So, I muddled through: managing my symptoms with yoga and strength training while cutting out sugar and alcohol. And being diligent about my health habits did turn down the dial on my anxiety. But it was, initially, a solo pursuit–and the isolation was compounded by the fact I hadn’t been raised with the same language to speak about my body as my white friends, who I’d witness discussing women’s health issues—menopause included—with ease.

My Indian Hindu Punjabi family was educated and forward-thinking—but it’s embedded in our culture that pregnancy and periods—or lack thereof—are to be quietly endured. People in South Asian communities  weren’t discussing symptoms like mine; nor did anyone who looked like me appear in awareness-raising articles or broadcasts. I’ll never forget the moment one Indian woman told me menopause was a ‘white woman’s disease’.

The invisibility of South Asians in the menopause narrative isn’t just disappointing, it’s dangerous. It was only after doing my own research that I uncovered evidence suggesting we experience menopause differently: the average age of menopause in Indian women is 46, much lower than 51—the average in western countries. Researchers are currently exploring variances in symptoms’ duration and severity, too.

This manifests in a lack of information about dietary changes that work with Indian cuisine and our not having the language to advocate for ourselves. Despite employing 45 people at the nursery I run, I didn’t have the words to articulate to my colleagues that I needed support—or even to vent about the hot flushes that left me changing my sheets multiple times a night.

That the onus is on women to educate their partners on the menopause—as well as their symptoms and how they need to be supported—exacerbates the situation. I’m grateful that my own husband is calm in the face of my mood swings, anger and tears—supporting me in practical ways, such as making sure I eat when I’m feeling overwhelmed.

Awareness isn’t everything when it comes to supporting women’s mental health through menopause, but it’s a vital part of the puzzle. The menopause is brutal and isolating; progress should be for all.

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