Depression In Menopause

Adapted from Rachel’s book – Magnificent Midlife: Transform Your Middle Years, Menopause and Beyond.

Depression in menopause is sadly not uncommon. That and anxiety can often raise their nervous heads during the menopause transition. It may be just greater overall sadness, but that can also tip over into depression. Especially if you don’t take steps to rectify it.

If you think of premenstrual syndrome (PMS), it’s only natural that as hormones fluctuate more in perimenopause, our nerves may be more on edge. Women can become suffer low mood around this time and are often offered antidepressants by their doctor, when what they really need is help balancing their hormones.

depression in menopause

But don’t automatically blame menopause! There’s potentially a ton of other causes that may be making you sadder than usual. You may be suffering the effects of ageism and sexism and all those negative narratives about who you are now, not to mention the global pandemic and the economic and political instability we’ve all been coping with.

How about dealing with teenagers and older parents at the same time? Or the end of your dreams of fertility or an empty nest? There’s so much going on! There’s also the U-curve of happiness which shows midlife as the dip in our lifetime happiness – it generally gets better after this time, I promise!

Antidepressants may help you through a difficult patch, but often, in midlife, it’s more about balancing our hormones and dealing with some of the emotional issues that surface around this time. Like hormone therapy, antidepressants can enable us to function, but they may mask symptoms we need to deal with, whether or not we take medication. Obviously, for some women, antidepressants are essential, but jumping straight to prescribing them for a midlife woman is not really giving her the duty of care required, in my opinion.

Statistics on menopause and mental health can also appear alarming. For example, there’s an unfortunate correlation which keeps being raised in the UK media, between menopause and the age at which there is the highest rate of suicide for women. It’s true that women aged 50-54 exhibit the highest rate of suicide in the UK, but the actual rate is only 7.4 women per 100,000 population. This rate compares with 6.9 women per 100,000 in the 45-49 age range and 6.5 in the 55-59 age range.

Of course, any rate of suicide is awful. But this is a tiny increase between age ranges, and the rate of male suicide is greater than that of women in every age group except 15-19. I think conflating the age at which there is the highest rate of female suicide with menopause is irresponsible, especially without context, and plays on women’s fears about this time. I’ve written more about this and how correlation does not equal causation. I asked the UK Samaritans for their view on these media narratives.

I believe there are many other factors that build up for women in midlife that impact our mental well-being. Sometimes I feel like the great menopause defender: “It’s not her fault!” If you’re experiencing low mood and or anxiety, I encourage you to be curious about what’s going on underneath and how you can deal with it.

There are plenty of things that can help, whatever the root cause. Here are some:

  1. Try any or all of the general hormonal balance tips you’ll find at the bottom of this article relating to diet and lifestyle.
  2. Remember, if you’re a drinker, alcohol is a depressant, and your body may may not be able to cope with it as well as it once did. I recently took an extended break from alcohol and my mood and anxiety levels both improved significantly.
  3. Try Cognitive Behavioral Therapy (CBT) and or a regular meditation/mindfulness practice. This will help ground you and bring you back to living in the moment. Good mindfulness/meditation apps to try are Calm, Headspace, Buddify, and Insight Timer (which is free). CBT is great for getting a handle on runaway thought patterns. Leafyard is a powerful online self-help program for mental health.
  4. Exercise and being outdoors are great for low mood and anxiety. Go for a walk in the park (or in a forest, if
    you can find one). Look around yourself and enjoy a bit of nature. Get your heart rate up and enjoy some post-exercise endorphins.
  5. Breathe! Box breathing is a great technique to slow things down if your mind is racing. With box breathing, you breathe in for four seconds, hold for four seconds, breathe out for four seconds, and hold for four seconds, all while visualizing moving round the sides of a square.
  6. EFT (Emotional Freedom Technique), otherwise known as tapping meditation, can also be very helpful for depression and anxiety. It has been found to be particularly effective for veterans suffering from PTSD. I really like The Tapping Solution app.
  7. I discovered essential oils and am finding them very powerful for changing my mood. I’ve been experimenting with blends in a diffuser to help me focus, boost my energy, balance emotions, and calm me down. Click here for some of my favorite blends.
  8. Remember that menopause doesn’t make you any less of who you are. You are still the fabulous woman you’ve always been. You know the same stuff and can do the same things. Believe in yourself and your power.
  9. If you’re really struggling with depression in menopause and think HRT will help, then ask the doctor about that. But don’t forget you still need to have a healthy diet and lifestyle to thrive in menopause and beyond. You’ll likely also need to deal with any underlying and unresolved emotional issues eventually!
  10. If anxiety and low mood have tipped over into depression, be sure to visit your doctor and get whatever help you need. The longer you leave it, the worse it may get.

Hormonal Balance

I’ve written extensively elsewhere about how to achieve better overall hormonal balance. Here’s the quick guide.

1. Balance your blood sugar and sort out your diet. Fluctuations in your blood sugar levels are going to exacerbate the hormonal fluctuations of perimenopause so helping your body out with the right food and not putting in under extra stress makes sense. Stress can be external or what we create in our bodies with how we live, making them think they need to go into fight or flight mode by causing our blood sugar levels to be imbalanced. This happens either because we haven’t eaten when we should have, and blood sugar has dropped, or we’ve consumed the wrong thing that makes our blood sugar level spike. For example, caffeine, alcohol, sugar and refined foods can all cause our blood sugar to spike and then plummet when their effects wears off. Natural plant-based phytoestrogens in the form of flaxseed or soya are also great for balancing out hormonal fluctuations. Jackie Lynch’s book The Happy Menopause is a brilliant guide to nutrition in menopause.

2. It’s expensive, but eat organic if you can for most food types. Pesticides used in agriculture are known to impact our hormones negatively as well as generally not being very good for you. Certain fruit and vegetables have higher proportions of pesticide residues on them than others. So some you don’t need to worry about so much if they’re not organic and others you may want to avoid unless organic. I’m still grappling with this but have printed out the lists of the worst offenders for reference. You can get these lists for the UK at Pesticide Action Network or in the US at the EWG.

3. Consider also what toxins are in your home environment and whether you can cut back on those. Household cleaning products are full of chemicals, some of which are thought to interfere with hormones. Personal products like deodorant, moisturizers, shampoos etc. often come laden with potentially suspect ingredients (there’s still controversy about parabens) – can you identify everything in the ingredients list of your favorite product?

4. Try to lower your stress or improve how you deal with it. Hormone fluctuations are exacerbated by stress and stress makes low mood much worse. Reduce levels of stress in your life, maybe adopt a meditation practice as above, or do some restorative yoga. Both of these will help you lower stress levels overall and potentially reduce menopause symptoms, especially the sadness that seems to affect many of us around this time.

5. Up your exercise. As we age we need more exercise not less and many women swear by exercise to help them manage menopause symptoms. Exercise can immediately improve our mood. Click here to learn why lifting weights becomes so important as we age.

Don’t let depression in menopause ruin your life. Get the help you need!

You may also like: Menopause And Depression – Giving Context To Statistics and Top Tips For Dealing With Perimenopause Anxiety

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Menopause And Depression – Giving Context To Statistics

Please bear with me… I’m having a bit of a rant!

I’m often moved to write about menopause because I see a fact or statistic on social media and I question its validity, whether it’s been communicated with context, why it’s been mentioned at all and whether it’s true.

I watched a really great little video on Instagram about normalizing menopause. The video itself is really empowering and I thought, wow that’s great. Shame I’m not in it. But in the blurb that went alongside this video about menopause was the following comment:

“We can talk about empowerment all we want, but [a] lot of us are having a hard time, in our bodies as well as our minds.  Let’s not forget that according to the latest numbers from the UK Office for Statistics, the age group with the highest rate of suicide is women ages 50 to 54.”

menopause and depression sad woman

What do the statistics really tell us?

This is a statistic I often see connected to menopause. But the last statement is actually plain wrong. It’s true that amongst women the highest rate of suicide is the age group 50-54. But the age group with the highest rate of suicide overall is men 44-59 and the figure is three times that of women. In fact men in all age groups have a far higher rate of suicide than women.

So it’s simply not true to say that the age group with the highest rate of suicide is women ages 50-54. The rate of male suicide is greater than that of women in every age group except 15-19.  It is true to say that the group with the highest rate of suicide for women is ages 50-54.

Below is the chart from the Office of National Statistics in the UK where you can see that even in this group we’re only talking about 7.4 women per 100,000 of population in the 50-54 bracket compared to 25.5 men per 100,000 in the 45-49 bracket. This compares with 6.9 women per 100,000 in the 45-49 age range and 6.5 in the 55-59 age range.

Yes, any suicide number is awful but knowing the context, doesn’t it take away some of the sting of the statistic mentioned above? Even when the statistics are correct, context is still crucial.

What really upsets me, and which I keep seeing mentioned in the media and suggested by others, is this correlation between the higher rate of female suicide and menopause. I believe this is pure conjecture and not based in fact nor research. This article presents a case that not only are there errors in the facts we believe about menopause, but there are also so many other things going on to cause anxiety and depression during the menopause years.

Menopause may be a contributing factor to midlife malaise in women and if you are suffering from depression, please ask for help. But I believe it is irresponsible and verging on scaremongering to suggest that menopause is responsible for this highest rate of suicide in women figure.

I’ve sat on this for ages and the time has come to put fingers to keyboard! I feel a need to set the record straight on misrepresented menopause statistics that suit a particular agenda.

Women, menopause and work

I hate it when facts are taken out of context, or are just plain wrong, especially when it relates to menopause. Women so need truth about this topic! At time of writing I’m trying to speak to ITV to get a ‘fact’ corrected which has been on their website for five years and which has been quoted even by a UK Member of Parliament, but is actually false.

This ‘fact’ is that one in four women considers leaving work because of menopause issues. ITV claims this is based on a research survey they did with women’s health research charity Wellbeing of Women in 2016.

I have spoken to Wellbeing of Women who told me there was no such joint survey and also to Professor Myra Hunter, Emeritus professor of clinical health psychology at Kings College London, who did the menopause research for Wellbeing of Women, and who said “I am not aware of this survey being published nor who authored it.”

There was a research survey done on menopause in 2019 by Wellbeing of Women and Professor Hunter, but ITV was not involved and there was no finding that one in four women consider leaving work because of menopause issues.

The ITV claim is blatantly false. Some women may consider leaving work because of menopause but there is no published research or evidence of this. Professor Hunter also said, “In my reading of the research literature, the evidence of women’s work performance being adversely affected specifically by the menopause is inconclusive.”

I have complained on ITV’s website, I have emailed them and I have tried to speak to them on Twitter. They continue to ignore me. I’m not going to include the article link here because I don’t want to give it more credence, but if you search for women considering leaving work due to menopause in Google you will find it.

This false statistic has become truth and is quoted ad infinitum. It adds weight to negative narratives about menopause but is simply not true. It is not based on credible research. If the 2016 survey was done at all, it was done by ITV without Wellbeing of Women and it was neither published nor peer-reviewed.

Why does ITV quote this ‘statistic’ and leave it on their website five years after the program aired? Because it helped them originally get viewers for their program about menopause and continues to make them money from advertising now.

When it comes to how menopause, and aging in general for women, are regularly presented, I have found there is often money lurking somewhere in the background.

What else might be going on concerning menopause and depression?

So returning to the suicide statistic, what else might be going on for women aged 50-54 to make it when there are more suicides than at other times? I have lots of ideas about that!

  1. Women are taught from a very young age that we are only valuable when we are young and fertile. Girls are told that they become women when they go through puberty so what does that mean for us older women when we go through puberty in reverse? Do we stop being real women? I think many women actually fear this to be the case! It’s the ultimate confirmation that life is on a downward slope. I know when I went through early menopause at 41, my initial reaction was to see myself destined to a life as a shriveled up old prune sitting in the corner and of no value to anyone. Society taught me to view menopause in that way, because in the West we worship youth, the fertility that goes with it, and the beauty and value that we ascribe to it. So is it any wonder that we might be a bit anxious as we go through our 40s and into our 50s about what it all means? I would argue it’s not menopause to blame for this midlife malaise, but rather how we have been taught to feel about it.
  2. Have you heard of the U-curve of happiness? Yes it’s a real thing. It’s been scientifically proven (with actual research this time) that we’re happiest at the beginnings and ends of our lives. Research shows that 47 is our most unhappy age. There may actually be nothing in particular making you unhappy; it’s just a natural phase of life. And it affects men and women. It’s the middle that can get us down, simply because it’s the middle. Feelings of discontent, restlessness and even sometimes worthlessness are not unexpected. Plus the big birthday soul-searching can make it all the worse. Yes that’s a thing too and the big 50 is a pretty major milestone for most of us. We’re still tied to those outdated ideas of what we should have achieved by a particular age, forgetting as we are wont to do, that we all have different lives, are on different trajectories and that comparison is the thief of joy. We may suffer depression in the middle, but hopefully once we’re through that, the only way is up. If your 40s and 50s are gloomy, there’s every chance that later the fog will begin to lift. Clearly there are other factors that may prevent that, but all things being equal that’s the normal trajectory of life. The U-curve holds.
  3. We’ve been taught to perceive midlife (which is when menopause usually happens) as a crisis. Just search midlife in Google and all you get back is midlife crisis. But I prefer Brené Browns’ interpretation of midlife as an unravelling: “a series of painful nudges strung together by low-grade anxiety and depression, quiet desperation, and an insidious loss of control.” For women especially, it’s when we often start questioning who we really are and what we want from life. Hormonal changes can add to our sense of discombobulation. Menopause is a big life marker reminding us of how long we’ve already lived and highlighting what time we likely have left to do whatever it is we want to do in this world. So yes it’s a time of introspection and potential inner turmoil but again, it’s not the actual menopause transition that’s responsible, rather, various different elements all coming to a head and exacerbated by the fact that our hormones are impacting us as much as they do during puberty.
  4. Midlife is also a time when women in particular are subject to a whole litany of other stress and depression inducing circumstances. We may be coping with difficult teenagers or struggling to adapt to an impending or actual empty nest. We may be caring for older parents and shouldering the brunt of those responsibilities. We may be encountering ageism in the workplace, feeling side-lined and ignored when previously we were on an upwards trajectory, just like a man would be in his 40s and 50s. But the insidious combination of sexism and ageism makes it far more difficult for women to get visibly older than men. Men become silver foxes, women are accused of letting themselves go if they embrace their natural older hair color. Thank you patriarchy. Again follow the money: a lot of people get rich persuading us that actually looking like an older woman is bad, making us fight getting older. And when do we see the most accelerated signs of aging in women? It’s often in our 50s when our faces and bodies really begin to change if they haven’t already. Another contender for the midlife malaise.
  5. Women simply don’t have enough good information about how to manage their menopause so, as well as the distressing emotional impact already discussed, the physical symptoms can become debilitating. Doctors often aren’t much better equipped, prescribing drugs for depression rather than recognizing that hormones could be out of balance and the impact that can have. But this absolutely shouldn’t be the case. I was able to reverse my early menopause diagnosis by making dietary and lifestyle changes. My mission now is to ensure that women have the information they need, when they need it, which is often earlier than they think, so that they don’t need to struggle with menopause. Just sorting out their diet and balancing blood sugar levels can have a major impact on women’s experience of menopause, but the majority of discussion is still concentrated on trying to fix it, usually by taking hormone replacement therapy. I have written extensively about how I believe menopause symptoms are actually the body’s early warning system. It’s trying to tell us that there are things we need to change about how we live if we want to enjoy long-term health. This includes cutting back on things like caffeine, alcohol, processed food and sugar which we may have enjoyed in our youth, but which our menopausal bodies are less able to cope with. It can mean adding in things we didn’t necessarily consider before, like more vegetables and natural phytoestrogens in the form of flaxseed and organic soy, for example. It also includes cutting back on the toxins in our environment, whether that be in the food we eat by going more organic, or the personal and household cleaning products we use. It means perhaps losing some weight if we’re a bit too heavy, making sure we get enough exercise which has been proven to reduce menopause issues and working hard to optimize our mental health because if anything is going to cause us to suffer during menopause, it is stress. I have no doubt that it was stress that caused my early menopause diagnosis.

Please help me set the record straight

So please, let’s all stay curious about menopause statistics that are quoted as fact. Find out where they come from and whether it’s a reputable and trustworthy source. Follow the trail back to the actual research before assuming it is true. I had assumed ITV was reputable but they have had false menopause statistics sitting on their website for years!

If you hear these particular statistics being quoted, please direct people here or tell them that the information is false or inconclusive. I want the world to stop blaming menopause by default for the majority of what can go wrong in midlife, leading to sadness and even depression. Instead I want women to embrace it as the gift prompting us to get our lives sorted that it can be.

And let’s stop scaring women, both those in menopause and the ones coming up behind, by upholding a doom and gloom approach to this important and empowering transition in a woman’s life.  

Let’s instead start listening to our bodies, being curious about what else is going on and working to improve all of that rather than lumping the problems all on menopause and ignoring the rest. It’s working on all of it that will reduce suicide rates for women in midlife. Not just making menopause better.

Yes let’s talk lots more about menopause, but not in isolation. That’s not doing women any favors and will not bring about the overall change that women and society so desperately need.

You may also like: Top Tips For Dealing With Perimenopause Anxiety and Menopause Matters – Resources To Help

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