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  • Tania Elfersy

Perimenopause, menopause and mental health

perimenopause, menopause, mental health

Many women experience a level of emotional turmoil during perimenopause and menopause. Some find themselves facing intense mental health challenges for the first time.

The dominant narrative around midlife change suggests that increased rates of depression, anxiety, panic attacks and even suicidal ideation are caused by changes in a woman’s hormones.

Having coached women in perimenopause and menopause for the last eight years, and having witnessed women’s mental health challenges disappear without them needing to “fix” their hormones or another supposed chemical imbalance, I know the dominant narrative is untrue. Deep and lasting inner peace is reached through understanding the human experience. No pharmaceutical product can deliver that.

If mental health challenges in perimenopause and menopause were caused by hormones, we would see a correlation between certain levels of hormones and mental health – there is no such correlation.

Women can have the same fluctuations in hormones but experience very different levels of well-being. The hormones are NOT the variable we should be measuring. Instead, we should focus on our state of mind and an awareness of our innate mental health.

While hormone levels DO NOT determine mental health, hormone fluctuations do create a sensitive time. As I have previously discussed in this blog, women journey through sensitive times during adolescence, pregnancy, postpartum and during midlife change. If our lives are out of balance at these times, we can quickly experience intense feelings and symptoms.

Feelings and symptoms are the only ways that the body can alert us and wake us up to changes that we need to make in our emotional and physical lives. Perhaps we need to examine stress, diet, movement, slowing down, sleep, exposure to sunlight and other lifestyle factors.

If we carry perceived trauma through to perimenopause and menopause, if we live with a misunderstanding of how we can innocently create stress and let it snowball into chronic distress, then we may well experience a drop in our sense of well-being.

Some women claim that taking HRT has helped them feel more emotionally stable. Since no studies have succeeded to confirm a causal relationship between hormone levels and mental health, we can assume that since HRT sometimes helps reduce night sweats and hot flushes, which can interfere with a woman’s sleep and day-to-day activity, perhaps better sleep and reduced stress from fewer night sweats and hot flushes are causing some women to feel better in general.

It’s dangerous to make false claims about hormones, mental health and HRT. Such claims wrongly forecast biologically determined doom and gloom for women who are in perimenopause and menopause.

The majority of women don’t go on HRT. There are women who choose to journey through perimenopause and menopause naturally. There are also women who can’t go on HRT because of side-effects, or because of their personal or family medical history.

When claims are made in the media that the occurrence of mental instability is due to hormonal changes, it can become a self-fulfilling prophecy – “Oh, I must be depressed because of my crazy hormones…and if I can’t take HRT, there’s no way out.” Can you see how that can lead to disaster?

So, how have so many become convinced that it’s our hormones that create mental health challenges? Is the female body innately designed to throw us into ill-health?

The womb was once considered to have the ability to wander, just like “a living thing inside a living thing.”

According to some ancient Greek writers, whose influence ran over centuries, just like an animal with a mind of its own, the womb could supposedly travel through your body, interfering with organs and cause, among other maladies, female hysteria.

Although hysteria (derived from “hyster” the Greek word for womb) was an umbrella term for a wide-range of symptoms and behaviours labelled as “abnormal,” it wasn’t until the 18th century that medicine associated hysteria with the workings of the brain rather than of the womb, and made the claim that men could experience it too.

In the first half of the twentieth century, a bout of “hysteria” could swiftly get you sectioned in an asylum where you would likely meet many post-menopausal women. But today, who needs costly asylums when women can be offered such a wide variety of medicines to supposedly restore their sanity?

The modern woman is no longer afflicted by a wandering womb animal within. Instead, she has her hormones that apparently behave with a similar spirit of their own.

Although a woman’s body is intelligent enough to allow her heart to beat, her lungs to inhale and exhale, her eyes to blink, her gut to digest food, and so much more, her female hormones, we are told, act as if…they are a living thing inside a living thing – on their own “crazy” trajectory.

Can you see how we have come full circle?

Sometimes, I can’t quite believe the misogynistic theories still upheld as truth by so many doctors.

In recent weeks, one of the most prominent menopause specialists in the UK has been sharing an interview with a woman, Lynsey, and her husband, who’s a GP. They describe how Lynsey’s mental health rapidly declined in perimenopause leading to intrusive thoughts and attempted suicide.

In the short clips and summaries shared on social media, we are offered a simple story: a woman’s perimenopausal hormone levels caused her great suffering. Only when her husband demanded she start HRT, did her mental health return.

You see, declares the menopause doctor, HRT can prevent suicide.

I am truly happy for Lynsey and her family that she is now feeling better.

I am only discussing her personal case because it’s being used to make sweeping conclusions about perimenopause, menopause and mental health. These conclusions are dangerous.

When we listen to the full interview with the woman and her husband, this is what we discover:

The woman is in her mid-40s and a mother of two. She appears to have an online business while her husband is very busy in his medical practice. The woman states she had no prior experience of mental ill-health.

In the spring of 2022, she started experiencing anxiety about every-day things – what to wear, what to cook for dinner, etc – and she states: “A load of antidepressants were started.”

Within a few weeks, her anxiety had become much worse and she started experiencing palpitations. Within a few months, she was having intrusive thoughts, had attempted to end her life and was sectioned under The Mental Health Act.

Lynsey describes feeling a loss of love for her family and her pets. While under psychiatric care, it was also suggested that she might be bipolar.

There are many questions that, if we are going to hold up this case as an example of what women can experience, need be asked:

1. Why is a mild case of anxiety treated with “a load of antidepressants?” And why was a non-pharmaceutical route not tried first? This speaks volumes to the level of misunderstanding of our innate mental well-being that runs throughout the NHS and other health services.

2. Was the doctor who prescribed antidepressants not aware that such drugs rarely outperform a placebo in clinical trials? The website Mad in America, which exposes the science of psychiatry, states: “Seven out of eight people treated with an antidepressant will be exposed to the adverse effects of the drug without gaining any additional benefits beyond placebo in the reduction of depressive symptoms.”

3. Was no-one (not any of the doctors who treated the woman, not her husband GP and not the menopause specialist who claims to have a background in psychiatry) aware of the many known side-effects of antidepressants? These include: Palpitations, depersonalization, derealization, psychosis, an increased risk of violence and suicide, as well as nausea, vomiting, insomnia, sedation, constipation, fainting, sweating, headaches, rashes, weight gain, blurred vision, tremors, shivering, high fever, seizures, abnormal bleeding, confusion, mania and sexual dysfunction.

4. Was the woman in this case offered complete informed consent with all risks disclosed to her when she was suffering from mild anxiety and handed a prescription for a “load of antidepressants?”

Of course, these questions are not asked because the menopause specialist is keen to use anecdotal evidence provided by the confused details of individual cases to draw “scientific” conclusions about perimenopause, menopause and mental health.

Doctors often see what they wish to see, and share what they wish to share.

The scientific method and large randomized controlled trials exist for good reason – to independently determine benefits and risks of medicines, such as HRT.

Declarations about HRT and suicide prevention made by menopause influencers are unscientific and dangerous.

Telling women that they are likely to be suicidal because they have reached a certain time in their natural lifecycle is the type of “menopause awareness” that can have far-reaching negative consequences.

So why are these harmful theories promoted?

The ancient and persistent mistrust of women’s bodies keeps the false “crazy hormones” story alive. In turn, the story drives the profits of the multi-billion-dollar hormone industry and a growing number of private menopause clinics.

If we recognized that women’s hormones can’t possibly “wander” and disconnect themselves from the body’s divine intelligence, and if we placed our trust in the magnificence of the female body, we would understand what is actually happening to women in perimenopause and menopause.

We would become aware of the imbalances that we have innocently created in our lives. We would see that the discomforts that we experience arise from the chaos that we surround ourselves with, when we fall off the harmony of nature’s path.

When challenges on the emotional and physical level appear during our lifecycles, women don’t need to go it alone. Support and compassion for women in perimenopause and menopause can ease our journeys, but we need to be informed as to what we may expose ourselves to when seeking help. Could a supposed “cure” end up making matters worse?

Unfortunately, the medical system is too often driven by profits over patient care, and still operates with the patriarchal approaches to women’s health that can cause short and long-term damage.

It takes courage to say it, but we, as sovereign women, are responsible for our own well-being, even while our hormones are in flux. Let’s make wise choices when seeking support at this time. Let’s work with the brilliance of the female body, instead of against it.


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