Most people, both women and men, associate the menopause with a few classic symptoms, such as hot sweats and brain fog. But there is so much many more physical and mental difficulties that many women have to deal with at this time. This article looks at mental health and also reveals how exercise and sport and help, or not.
Mental health & menopause
One day, while sorting my end-of-year accounts, I went in search of… it was a thing that I needed to hold receipts together… it was small and I knew I had tons of them in my desk drawer… they were colourful wee things that were always useful on these occasions. But for 30 seconds, perhaps even a minute, I couldn’t remember what they were called.
I reeled mentally and I grappled with sudden anxiety and shock. Then the words, “paper clips”, swam into my head. “Thank goodness for that,” I thought.
But I was left with a nagging sense that something wasn’t right. I recalled the many times in the past year that I had struggled to remember people’s names, often embarrassingly so when meeting them or attempting to introduce them to other people.
I had also forgotten birthdays, events and work deadlines. I had started making more and more notes in my diary.
As someone who previously prided myself as having an excellent memory, I was starting to worry I had early on-set dementia. It had not helped that I had recently watched the film, Still Alice, about a woman who was diagnosed age 50 with Alzheimer’s Disease.
However, it turned out – and I only discovered this at a later point – my reduced memory was due to peri-menopause (the stage that leads up to menopause).
The reduced memory and a loss of words and names was combined with other mental symptoms, such as brain fog, reduced ability to concentrate, mood swings and, subsequently, anxiety and reduced self-confidence. At times I became so worried about making a fool of myself that I preferred not to mix with other people and I became concerned that my work as a journalist was suffering.
I felt as if I wasn’t really myself and this led to anxiety, frustration and, sometimes, anger.
The mental difficulties came with other peri-menopause issues for me, which included severe muscle cramps that stopped me being able to swim and walk or run uphill, severe migraines, itchy skin, muscle weakness and a rise in UTIs.
What is menopause?
Peri-menopausal symptoms can start from early 40s, while menopause typically occurs around the age of 51. 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 main culprit of both physical and mental health issues in the menopause years is reduced oestrogen.
Physically, this can include hot flushes, sleeplessness, anxiety, joint pain, muscles cramps, hair loss, migraines, incontinence, reduced libido.
Reducing oestrogen can also cause mental health issues including decreased cognitive function, such as memory loss and brain fog, as well as mood swings, irritability, anxiety, panic attacks, low self-esteem, reduced motivation and depression.
The science of menopause
There is some limited research about menopause and mental health. I would like to see more research in this area – and also in the field of sport and menopause.
- A study by menopause campaign group Pausitivity discovered thousands of women are unaware that declining hormones in their 40s and 50s could also be behind symptoms such as depression and anxiety. Read my blog: It’s time to change the way we view menopause.
- An article in the New York Times that suggests two-thirds of women suffer menopause-related cognitive impairment.
- In another scientific article, Pauline M Maki, a professor of psychiatry and psychology, reports” declines in oestrogen around menopause are associated with declines in cognitive functioning.
- The menopause makes me feel really, really angry.
Case studies: Menopause and mental health
I have spoken to many women about their peri and menopause symptoms. I am not shy about the discussion and often when I speak about it others share their stories and anxieties. It can help that we feel we are dealing with the issues together.
These case studies are people I know through sport. I find it interesting how sporty women reveal their experiences and realate it to the benefits of exercise but also feel thatin many cases, exercise is limited by the menopasue.
I have written about the physical symptoms before. Read: The menopause monster: Some of the things I have learned about menopause. This article focuses on mental health.
Vicky is 46 and suffers with what is classically described as “brain fog” and also anxiety. She says: “I actually noticed the brain fog when I started my MSc when I was 43.
“I wasn’t sure whether it was because I was doing something new – a new environment, new learning, new people – and I hoped it might alleviate as I settled into the new routine. But that wasn’t the case.
“I had to be really careful about only listening to what I thought was important, listing and attending to tasks, otherwise it would all became overwhelming.
“To me, it felt like knowing that you know there are things you can do, or should be able to do, but you can’t clear enough space in your mind to get to them.”
Vicky believes that the brain fog then led to a growing anxiety. She says: “I had increasing anxiety about seemingly ‘common’ tasks and a dread around encountering any difficulties however small or large.”
Vicky has had to learn a new approach to her participation in sport as a result of the effects of the mental issues. She says: “I have had to acknowledge a reduced ability relative to my age and relative to the effects of the brain fog and anxiety.
“An example of this would be literally feeling anxiety while cycling. The feelings would be an inability to relax, tightness in chest, buzzing thoughts, lack of concentration and all relative to what I previously felt in this environment.
“To help with this I have done lots of visualisation of the rides before I go, including who will be there, where we will go, how hard I will have to ride and at what point I am happy to step back from it all and say, ‘see you all later.’
“This might mean that right from the first pedal stroke I am out of it…”
Vicky is very aware that the overall health benefits of being active mean that we always feel better after the effort and she has never had a particular problem with motivation to “do” or be active.
However, she adds: “I think that shifting – and that’s part of admitting – my participation in sport to exactly that has ensured that my confidence levels to participate aren’t affected, but that’s just personal to me.”
It took Susan, 52, many years to understand that it was her hormones, relating to peri-menopause, that were causing a range of mental and physical health issues.
She says: “I felt very low at times in my forties and this led to a lot of self doubt and one very bad period of suicidal thoughts.
“I also had a number of physical symptoms that had additional mental effects. For example, really bad and sore joints prevented me sleeping. A lack of sleep caused massive tiredness and all of this led to feelings of anxiety.”
While watching a TV programme by Kirsty Wark about the menopause, Susan experienced a lightbulb moment. She realised that many of the symptoms being described by other women were similar to her experiences.
Susan visited her GP and was prescribed HRT, which she says has been the biggest help. She adds: “The HRT has generally improved the low and depressed feelings. It hasn’t stopped the chronic tiredness.
“I also started exercising partly to see if it would help with all of the symptoms and it definitely has. However, I go through periods of feeling like I have no mojo and it takes all my willpower to do the exercise. If I don’t do it, I feel mad at myself so it can be a double-edged sword.”
Nicola, 48, has struggled with symptoms of brain fog and mainly in the work environment. Nicola is an estate agent.
She says: “I struggle to pull tools out the bag so to speak when I’m dealing with situations and it’s only later I think, ‘Why didn’t I suggest that’ or ‘how on earth did I forget that.’
“I work with males and they just don’t seem to have that problem, which frustrates me even more in this day and age of women struggling with equality.
“I’m worried they get a sniff of me struggling because there’s no place for ‘bumbling hormonal women’. While the confident voice in my head says they probably won’t even notice, I do still worry.”
During her life before lockdown, Nicola was a regular at the gym or she would attend a swimming session. She says: “Just switching off my brain while my body performs repetitive actions is so nice to wind down. I feel no pressure, and I like that someone tells me swim sets or instruction and I just have to follow it.
“But, it’s been quite some time since I got a real buzz from working out, it’s more a form of relaxation for me these days.
“I’m also frustrated because I find myself excusing myself from really hard workouts by saying, ‘Nic, you’re almost 50 years old.’ But, equally, I want to scream, ‘f**k this, I’m not ready to be old and unfit.’
“I want to be motivated and get that buzz again. I want to fight for my sparkle back – the sparkle that the hormones appear to have affected – but I am finding that HRT is a minefield and I’m already feeling defeated at the magnitude of trial and error and potential rollercoaster of moods. I guess I’ll stick with it though to see if it makes a difference.”
Christina is 53 and still in the peri-menopause stage. She says: “Just now I have low-level anxiety when I think about the menopause itself approaching, rather than being caused by it. My main anxiety issues, which are caused by this stage, are around sleep disturbance.”
She describes the issues: “Being an early bird, I know when I wake in the night, even if I’m awake for hours, that I’ll still wake at the same time in the morning and then have a day feeling really yuk with sleep deprivation. This in itself causes anxiety and further impairs my ability to get back to sleep.”
Chris has found that exercise is an aid. She says: “When I’ve exercised I’m much more likely to sleep well. The flipside of this strategy though is that I know that, if for any reason, I’ve not been able to exercise during the day then I’m at risk of a poor night’s sleep so I then worry about not having exercised, which can then lead to sleeplessness.
“In addition, if I exercise too late in the day this can cause a delay to my sleep.”
My own menopause coping mechanisms
It is interesting to read about other women’s experiences through the peri-menopause and menopause and so much resonates with me. I feel lucky to be living in an era where women are more vocal about issues, especially mental health, and there is a growing wealth of information and an increasing range of resources to support women throughout the menopause.
Many men also describe the relief of discovering why their female partners or friends sometimes behave differently.
I have found a number of ways to cope with almost a decade of peri and menopause symptoms. Firstly, HRT has been a huge saviour. Although it is not a cure-all it has taken the edge off many symptoms, especially some of the worst physical effects such as muscle cramps.
I also feel that my mental agility and memory is improved, although, again, it depends on the rollercoaster of my hormone patterns. One day I can feel sharp and alert, only to wake up the next day feeling foggy and brain tired.
The times when my HRT has been in short supply or unavailable due to a general nationwide shortage has made me anxious and very emotional. But I have been fortunate so far.
Exercise has also been very important for both physical and mental well-being. I have accepted that I am slower and less motivated to be competitive but I started on a path to become stronger in my 50s and this has helped me to feel as though I am not “failing at everything I was once good at”.
“The good for age” motto swims around in my head and I grasp it when I need some mental support.
I think that circuits sessions for strength and conditioning, as well as regular yoga, are vital parts of staying fit and healthy, especially as we age. Also, we need to allow ourselves more time for recovery.
A brilliant group of supportive friends – and a husband who is very understanding – have made the ups and downs of the hormones feel a lot more bearable, too. How on earth our mothers, grandmothers etc got through all this in silence is beyond me. Problems shared are so much easier.
And, I feel fortunate, because I can write about how I feel and how others feel. Being a journalist has allowed me to spread the word about the issues of menopause, especially for sporty women, and to tell people about the greater resources now available.
Take home points
- Most women will tell you that the more we talk about the subject of menopause the easier it is to cope. So talking and sharing information is a good thing to do.
- Men have also found it helpful to join and listen to the discussions so they can understand what their partners or friends are going through.
- Menopause does finally end and many post-menopausal women report that their cognitive functions improve once the hormones resettle.
Support groups and websites
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
Menopause Matters. See www.menopausematters.co.uk
Sandyford Menopause Service, NHS Greater Glasgow and Clyde: www.sandyford.org.