Think about the menopause and the symptoms that spring to mind are hot flushes, night sweats and irregular period. But according to a new study, thousands of women are unaware that declining hormones in their 40s and 50s could also be behind symptoms such as depression and anxiety.
The research, carried out by menopause campaign group Pausitivity, also found GPs are often not connecting these psychological symptoms with “the change” leading to misdiagnosis.
Now campaigners are calling for greater awareness of the full range of health issues of menopause.
Menopause typically occurs around the age of 51 and usually starts with perimenopausal symptoms from early 40s.
Menopause is when the ovaries no longer release an egg every month, resulting in the end of the menstrual cycle and, therefore, reproduction.
At the same time, hormones, including oestrogen and progesterone, made by the ovaries are reduced.
The survey asked 850 women in the UK aged between 40 and 55 about their understanding and experiences prior to the diagnosis of menopause.
The women were questioned both about the symptoms they presented to their GP and those that led to the diagnosis.
Results showed that hot flushes were the most known-about symptom (20%), followed by night sweats (16%), mood changes (11%) and vaginal dryness (9%).
However, when asked to reveal the symptoms they discussed with their GP prior to a diagnosis, emotional and psychological problems came out top.
These included depression and anxiety (13%), sleep problems (12%) and mood changes (11%).
Despite this, the issues that the women felt were key to their diagnosis were hot flushes (17%), night sweats (14%), irregular periods (14%), sleep problems (10%), mood changes (10%) and depression and anxiety (9%).
In addition, almost 60% of women reported they had to wait more than a year for diagnosis of menopause after their first visit to their GP.
Elizabeth Carr-Ellis, one of the founders of Pausitivity, believes the survey is concerning.
She said: “We’ve heard many times of women who say they don’t feel right during their menopause years, but to see psychological and emotional symptoms take the top three spots in our survey is still eye-opening.
“Everyone knows about hot flushes and irregular periods, but this shows that women are going through many other symptoms without realising it.
“The fact that the majority of women suffer more than a year before some sort of diagnosis, despite being of classic peri-menopause or menopause age, shows that women and GPs are failing to join the dots in a woman’s medical history.”
Pausitivity, which launched last year, is the driving force of a campaign to distribute #KnowYourMenopause posters to GP surgeries, and further afield, so that greater numbers understand that menopause is more than hot flushes.
The poster details more than a dozen symptoms, such as headaches, tiredness, palpitations, joint pains, sleeplessness, loss of libido, as well as anxiety and depression.
Elizabeth, from Canterbury, Kent, said: “Our survey also revealed that the vast majority of women had to do their own research, through the internet, menopause groups or books, to discover the symptoms of menopause.”
A growing number of menopause groups and cafes, as well as TV programmes such as those led by Scottish journalist Kirsty Wark and Norwegian-Scottish presenter Mariella Frostrup, have also helped to spread awareness recently.
Helen Kemp is a trustee of the new Scottish charity, Menopause Cafe, of which Wark is the patron.
She agrees that in her experience many women do not know the full range of menopause symptoms, especially the psychological aspects.
Helen, 48, of Bridge of Cally, Perth & Kinross, said: “To start with, I don’t think women realise they are of perimenopausal age in the first place.
“For example, I had a hysterectomy at 40 but I was not aware of the many symptoms and I didn’t even realise I would have an early menopause.
“In addition, the women I speak to and hear from do not then think to link issues such as low mood, depression and anxiety to the the decline in their hormones.
“They end up with these significantly debilitating mental health issues in their 40s and 50s but they don’t understand why.
“It’s only though campaigns like Pausitivity and a growing number of menopause cafes, as well as TV programmes, that greater awareness of all the many symptoms can be better known.”
The Scottish Government also supports the growing bid to raise awareness of menopause issues. The 2019-20 Programme for Government includes a commitment to deliver a Women’s Health Plan, which will underpin actions to tackle women’s health inequalities.
A government spokesperson said: “Menopause has been a taboo subject for too long and should be discussed as a natural part of life for women.
“Society needs to better understand the symptoms that women face, how menopause can impact lives and what health services, employers and families can do to support women going through it.
“As part of the Women’s Health Plan we will focus on is improving services for women undergoing menopause, including increasing the understanding and knowledge of women, families, healthcare professionals including GPs and employers.”
Two case studies
‘The label of depression would not go away’
Karen Kenning, 50, of Elgin, Moray, believes she suffered unnecessarily with menopause symptoms, including low moods and anxiety, for 16 years.
It was after the birth of her second child in 2003, that the mum was required to have a hysterectomy.
She was left with her ovaries intact and she reports that she was unaware that they could fail and lead to early menopause.
However, within weeks, Karen was experiencing a wide range of health issues.
She said: “My symptoms included severe sweating, which was so bad doctors diagnosed and treated me for what they thought was hyperhidrosis.
“I also had sore joints and palpitations. I started to feel anxious, I couldn’t sleep and I felt like I was losing my mind.
“I would get times when this led to a total crash in my mood and I would burst into tears, which was unlike me. The moods came and went in peaks and troughs.”
In the end, the GP diagnosed depression, but Karen was convinced this was incorrect.
She said: “I had previously suffered with depression and taken anti-depressants for that. What I was feeling after the hysterectomy wasn’t the same. It wasn’t a constant depression, rather a cycle of low moods and anxiety.”
Finally, after doing her own research on-line, Karen began to connect her symptoms with menopause.
She said: “I came across a menopause community website and I read about all the symptoms that I had been dealing with. It was like a light bulb went on.”
In 2019, Karen, who is married and now has a son aged 17 and another aged 20, started HRT.
She said: “The difference that the HRT patches have made is incredible. The extra dose of oestrogen makes a real difference to how I feel.
“It took many years to make the connection between my symptoms and menopause, although I don’t blame the doctors.
“I think that there needs to be far greater awareness of symptoms and appropriate treatments, not only amongst medics, but also women themselves.”
‘I knew it was not depression’
Gillian Green is not surprised by the results of the study. The 51-year-old from Lanarkshire was diagnosed as suffering with depression around four years ago.
A GP recommended anti-depressants although, in the end, she decided not to take the treatment.
It was only when watching a TV programme about the menopause that Gillian made the connection between her mood and peri-menopause.
She said: “I went to the GP complaining that I wasn’t sleeping and said that I felt anxious and that I suffered with black moods for a few days at a time.
“There is a history of depression in my family, although I had never felt depressed myself before and this led the GP to the diagnosis.”
But Gillian wasn’t convinced and she put her low mood down to a busy job and a home life with teenage children.
She said: “I was sure I wasn’t clinically depressed but I still felt rotten for a spell each month. I thought I must be going mad because I couldn’t work out what was wrong with me.”
The married mother-of-two describes Scottish journalist Kirsty Wark’s The Menopause and Me, which aired on the BBC in 2017, as an epiphany.
She said: “I listened to Kirsty and her guests describe many of my symptoms. It wasn’t just the black moods and tiredness but also sore joints and paranoia.
“The next day I booked an appointment at my doctor’s’ surgery, asking for an older lady GP, and I told her I thought I was going through menopause.”
This time, the GP suggested Hormone Replacement Therapy (HRT) and Gillian reveals it changed everything.
She said: “HRT has been my saviour. Within weeks the low moods and anxiety disappeared and I was back to feeling like myself.
“I wished I had realised before how much the hormonal changes at this age can affect women.
“I think there needs to be a much greater awareness so that women are not misdiagnosed.”
Dozens of menopause symptoms
While many people know about hot flushes and night sweats there are dozens more symptoms associated with perimenopause and menopause.
They include anxiety, low mood, low self-esteem, reduced motivation, fatigue, panic attacks, poor concentration, low energy, sleeplessness, breast cysts, weight gain, reduced libido, brain fog, memory loss, mood swings, itchy skin, hair loss, joint pains, muscle cramps and heavy and erratic periods.
Treatments for menopause
Hormone replacement therapy (HRT) is claimed as one of the best treatments for a wide range of menopausal symptoms, including emotional, as it replaces the body with oestrogen.
There are many different types and doses of HRT, including tablets, patches and gels, and they all contain oestrogen.
If a woman still has her womb, she also needs a progestogen does.
Some women also need to take the hormone testosterone because it can be reduced in menopause.
This hormone is important for libido and also can help to improve mood, energy and concentration.
Helpful menopause resources
Some, but not all, NHS health boards provide specialist menopause clinics. Ask at your GP surgery for information.
In other areas, health boards provide menopause care through general practice and specialist referral when needed.
The British Menopause Society lists menopause specialists.
A growing network of menopause cafes, events and festivals. See www.menopausecafe.net.
Let’s Talk Menopause. See letstalkmenopause.co.uk
Downloadable #KnowYourMenopause Pausitivity poster and information at
Menopause Matters. See www.menopausematters.co.uk
Sandyford Menopause Service, NHS Greater Glasgow and Clyde: www.sandyford.org
- A version of my article appeared in the Sunday Post.