aAt her lowest point, Karen Arthur was just a short distance away from killing herself. After being signed off from her teaching job with anxiety, which she had not yet associated with menopause, the 51-year-old booked away from home for a few days in an attempt to clear her mind. A long walk in the country brought her to a place notorious for suicide attempts.
At that point, she says, she wasn’t thinking about how to kill herself, but had arranged her affairs for the sake of her two daughters, who were out of college. “I thought it would be easier if I wasn’t here. The kids would have the house, and the mortgage would be paid off.”
She says this moment was her turning point. “I remember thinking about how desperate it must be…and thinking very clearly: ‘I don’t want to die, I don’t want to kill myself, it’s so real to me. ‘” Instead, she walked to the nearest bar ordering chips and hot chocolate with rum. Then “I pulled out my journal and decided I wanted to live. I started writing about the things I wanted to do. This was the lowest point but also the highest point – it brought me back from the brink.”
Arthur quit teaching, took up therapy, embarked on a new career in fashion design, and six years later—in the wake of the murder of George Floyd, amid the rise of the Black Lives Matter movement—created the positive aging podcast Menopause While Black, after finding a few distressing resources that catered to Especially black women. Research shows that, on average, they enter menopause earlier than white women, and are more likely to experience some symptoms, including depression. When she first saw her GP about her anxiety, she mentioned she was experiencing hot flashes but, she says, had not been offered hormone replacement therapy (HRT), and at the time, she thought menopause was the least of her worries. Little did I know that anxiety and depression could be related to menopause. Everything I know about my journey, I know later.
Midlife mood swings, anger, and forgetfulness can be some of the funny things about Instagram. But, as Arthur discovered, for many women in perimenopause (the transitional stage that leads to the cessation of menstruation) and menopause (defined as having gone a year without a period), it’s no laughing matter. A survey of 2,000 women commissioned by the House of Commons Commission on Women and Menopause Equality in Action last year found that 75% reported problems with memory or concentration and 69% reported feeling anxious or depressed – not necessarily at clinical levels, but often be enough. To reduce focus and confidence at work. And in rare cases, these mood swings can be severe.
Last month, actress Kathy Burke told The Observer that she experienced very dark suicidal thoughts in her early 50s, which she linked to menopause. Unable to take HRT because of the other medications she was taking, Burke said she struggled for years. Meg Matthews, a menopause activist and ex-wife of Oasis star Noel Gallagher, described such anxiety in her late 40s: “I couldn’t leave the house for three months.”
Yet the mental health of menopause remains surprisingly unexplored, with the waters tumbling in the way it coincides with a period of broader turbulence in women’s lives. It’s the emotionally turbulent years of children leaving home, aging parents getting sick, midlife divorces, and work transitions that can make it hard to separate cause from effect. Do you feel mentally unwell because your life is in a state of flux? Or is your life in flux, at least in part, because of your hormones?
Dr Louise Newson, a general practitioner and specialist in menopause, recently worked with the Royal College of Psychiatrists to train its members on the mental health effects of menopause. Most of the patients she cares for at her private practice in Stratford-upon-Avon cite mental and physical symptoms of menopause and many, she says, are despondent. Some have tried everything from electroconvulsive therapy to spending thousands of pounds on experimental treatments. “We’ve seen people who were taking ketamine, clinics who were giving ketamine—and it really scares me,” she says. (Ketamine is a licensed narcotic, sometimes used illegally as a party drug and sometimes prescribed “off-label” for depression.)
The research on mental health during menopause is still “not quite as good as it would like,” Newson says, but it’s now well established that the hormones estrogen and testosterone, which decline in middle age, play important roles in brain function. “We know that anxiety and memory issues, bad moods, and decreased motivation are very common in menopause. Whether it’s the actual level of hormones or fluctuations in hormones—anything that changes in the brain has a knock-on effect.” Those who suffer from bouts of depression – as happened with Burke – or postpartum depression may be at particular risk of declining mental health in menopause. So women with severe premenstrual syndrome or its cousin premenstrual dysphoric disorder (PMDD) may experience it around the time of their periods.
Not all mental health problems in middle-aged women are hormone-related, Newson stresses, and HRT isn’t a magic cure-all. “I often improve hormones and then see what it does to a patient’s mental health. Some women need antidepressants.” But the link between menopause and depression is now sufficiently recognized that the NHS watchdog, the National Institute for Health and Care Excellence, recommends HRT as a first-line treatment for bad mood or anxiety in menopausal women. Still, Newson says, she still sees women who have been turned away by doctors with nothing but antidepressants. One of the reasons she created Balance, a free app that helps women recognize and record menopausal symptoms, is to help doctors and patients join the dots. We’ve long been told that menopause is about hot flashes and vaginal dryness. We weren’t told it could affect your mood, energy, or focus,” she says. “Women are told to be patient and silent all the time.”
That resonates with Kate Duffy, who was 44 and a single mother to children ages 4 and 2 when she went to her GP complaining of anxiety, insomnia, and severe mood swings along with more baffling physical symptoms, including hair loss. Her doctor diagnosed depression, but Duffy was convinced it was more complicated. “I was thinking, I’m not saying I am Not Depressed, but I think it has to do with menopause,” she says. I kept coming back and saying it, but they didn’t listen. I’d been banging my head against a brick wall for a year, it was so frustrating. At night they try to figure out what’s wrong with them, saying, “My marriage is over, I can’t do the job I’ve been doing for 30 years, I can’t think straight, I feel suicidal…”
It was only after her first hot gush, she says, that her GP — who thought she was too young to be perimenopausal — ordered blood tests that confirmed her hunch. Even then, Duffy says, she had to fight about HRT. And only when another woman reported it to a specialist menopause clinic in her home city of Oxford, she was retroactively diagnosed with PMDD, explaining a long history of severe mood swings around her periods. “It just made sense for the last 30 years of my life, going up and down like a yo-yo, going in and out of my GPs, saying, ‘I feel like I want to kill myself… Oh no, I’m fine now. It was totally cyclical.” Duffy now works as a “patient educator,” sharing her experiences with clinicians in training to help counter what she sees as “a lack of awareness, a lack of training in women’s healthcare — it’s an absolute shame.” It’s as if we’re not worth the search.”
At 55, her moods are now more stable, but the experience has left its mark. Feeling unable to return to her old desk job, she now makes more flexible living-board furniture and upcycling furniture. Shockingly, a survey of 4,000 women commissioned for the recent Channel 4 documentary Davina McCall: Sex, Mind and Menopause found that one in 10 had quit their job because of menopausal symptoms – whether mental or physical – while 14% cut back hours her job. “I know women sign non-disclosure agreements and performance management outside of jobs is done at a very high level [because of menopause symptoms]says Kate Muir, author of Everything You Need to Know About Menopause, who produced the Channel 4 documentary.
Muir, who had chronic “brain fog” in her late 40s that she feared she might have Alzheimer’s, says her memory improved dramatically within a week of starting correct HRT. But she remains fascinated by the connection between mental health and chronic insomnia that middle-aged women often experience, sometimes without realizing that it can be a symptom of menopause. “One of the indicators of future dementia is lack of sleep. It’s really important, and it’s a sign of depression, too.” For many working moms, there is a particularly cruel irony of struggling through the sleepless haze of early motherhood, only to be professionally crushed by the broken nights again just as their children finally grow up.
Lauren Sherin, 54, was in her early 40s and working as a senior executive in financial services when she found herself struggling to remember things. She wasn’t just forgetting the odd name, she said: One night she came home from work, welcomed her son and his nanny, and then packed her bags again to head out to work. “I forgot I left for the day. I was losing the plot.” Her confidence plummets, and she begins to avoid speaking in meetings for fear of revealing gaps in her memory. Convinced she had early onset dementia, and afraid of how she would cope as the single parent of a child with lifelong medical needs, Cherine negotiated an exit deal and quit. “I left the job because I honestly felt like I was running out of time, and I would have to find someone else to take care of my son,” she says. When blood tests from her doctor confirmed she had gone through early menopause, she was flabbergasted: “I thought that was something that happened to older women, and that it would be an occasional hot flush.”
Chiren now runs a training company, Women at a Point, offering awareness training to employers to support employees through menopause, as well as personal coaching for women to keep their careers on track. She helps her clients recognize and track their symptoms, research what she calls “small tweaks” at work that can help them cope, and consider lifestyle changes like getting more exercise and improving their diet. (Not everyone can take HRT, she points out, and some don’t want to.) Her first event in the City of London was so crowded that it was only standing space, but she realized several attendees fainted. Today’s diary “so people wouldn’t know they were there.”
Shireen says it’s still difficult for some women in competitive environments to talk about menopause at work. “They have often worked very hard to get where they are. They don’t want anything that marks them as weak or weak.” Meanwhile, women who go through this period relatively easily may be reluctant to announce the presence of restlessness and forgetfulness in middle age, afraid that it will become just another excuse to write off older women.
Yet, as Arthur points out, the awkward silence that can shroud mental health problems in menopause leaves many women woefully unprepared to recognize the symptoms. When it happened to her, she says, she felt completely alone. “My thinking now is that the more of us talking, the less lonely we’ll feel.”
In the UK and Ireland, Samaritans can be contacted on 116123, or email firstname.lastname@example.org or email@example.com. In the United States, the National Suicide Prevention Lifeline is 1-800-273-8255. In Australia, the Lifeline crisis support service is 13 11 14. Other international helplines can be found at befrienders.org.