Advisory: this episode contains themes of suicide and topics which listeners may find upsetting.

In this week’s podcast Dr Louise Newson is joined by Lisa, who shares her deeply personal and challenging journey through perimenopause, mental health struggles, and the impact of her experiences on her family.

Lisa discusses the devastating effects of her mental health decline, which led to a crisis point and ultimately a prison sentence for attempted murder. She also reflects on her time in prison, the realisations she had about her health, and the transformative impact of HRT on her recovery.

The conversation also delves into the impact of hormonal changes on women’s mental health and the often-overlooked connection between hormonal imbalances and criminal behaviour. Dr Louise and Lisa also discuss the importance of education around hormonal health, especially during perimenopause and menopause, to prevent tragic outcomes such as suicide and criminal behaviour.

Click here to find out more about Newson Health.

Contact the Samaritans for 24-hour, confidential support by calling 116 123 or email jo@samaritans.org

Transcript

Dr Louise Newson: [00:00:11] Hello, I’m Dr Louise Newson. I’m a GP and menopause specialist, and I’m also the founder of the Newson Health Menopause and Wellbeing Centre here in Stratford-upon-Avon. I’m also the founder of the free balance app. Each week on my podcast, join me and my special guests where we discuss all things perimenopause and menopause. We talk about the latest research, bust myths on menopause symptoms and treatments, and often share moving and always inspirational personal stories. This podcast is brought to you by the Newson Health Group, which has clinics across the UK dedicated to providing individualised perimenopause and menopause care for all them in. So today on the podcast, I’ve got the most incredible person with the most amazing and very inspirational, but also very sad and frustrating story with me today. So someone called Lisa who actually came to one of our events and shared her story. And my staff said, oh my goodness me, you’ve got to talk to Lisa. And so on a Saturday morning, I spoke to Lisa. and said, please, can you come and share your story on the podcast? It’s going to be a hard listen, but it’s a really important story. So welcome, Lisa. [00:01:37][85.9]

Lisa: [00:01:37] Hi, thank you, Louise, for having me today. [00:01:39][1.8]

Dr Louise Newson: [00:01:40] So it’s a long story, so we’re going to try and keep it as brief as possible so we can get as much information out. So if you just don’t mind, just by starting, Lisa, how old are you? [00:01:48][7.9]

Lisa: [00:01:48] I’m 54 now, nearly 55. [00:01:50][1.9]

Dr Louise Newson: [00:01:52] So we’re similar ages, and you’ve got two sons. [00:01:54][2.4]

Lisa: [00:01:55] I have, 22 and 24. [00:01:56][1.8]

Dr Louise Newson: [00:01:58] So tell me about things before it came to the bigger story, how your sort of health was and how you were and whether you knew much about the sort of perimenopause and menopause. [00:02:07][9.4]

Lisa: [00:02:08] I had sort of researched, knowing my age, I had researched about the perimenopause and the menopause and obviously I just did actually visit the GP with my concerns that I might be around the age and I was also struggling at the time I just lost my mum and there was a couple of events going on in the background. But I visited the GP twice, one was five months before what’s happened in this incident and I did request HRT then six weeks before my incident of what the story is about today. I did visit the GP once again, and it was just put down, I did say I was struggling, and they took me off the contraceptive pill and still wouldn’t put me on HRT. I just had a lot of brain fog. I was the one who did the research first around my age, and they just totally overlooked it and put me on antidepressants, for low mood. [00:03:04][55.8]

Dr Louise Newson: [00:03:05] And as we know, the role of hormones, in fact, all our hormones but oestrogen, testosterone and progesterone can have really beneficial effects in our brain. And the more we look at symptoms. the more we understand that obviously hot flushes and sweats can occur, but the commonest symptoms affecting people that we hear in the clinic, we see on the balance app where we’ve had thousands of people reporting their symptom, is the brain fog, the anxiety, the low mood, the memory problems, the poor sleep. [00:03:32][26.8]

Lisa: [00:03:32] That was me. [00:03:33][0.5]

Dr Louise Newson: [00:03:33] And we know that for many women, it’s really important, yeah. And you know, our hormones work as neurotransmitters and they can affect all sorts of pathways and antidepressants can help, of course, with people who are clinically depressed and they help serotonin levels, mainly they can help in other ways, but also oestrogen and testosterone can help serotonin levels, but they also help dopamine and they also help various parts of our brain to light up so we’re more likely to remember, more likely to have pleasure, more likely to sleep, just feel connected with life and our thoughts and our actions as well. So then what happened? [00:04:13][39.7]

Lisa: [00:04:14] You’ve explained it quite well. You do feel quite disconnected. You feel like, you know, you’re not being heard. So six weeks prior to what happened was I did go to the GP and obviously carried on struggling, not aware myself. And two weeks before Christmas, my son became ill and I just had this extreme anxiety off the scale. I cannot explain. I know I’ve always been a bit of a natural worrier, but I just knew this was something, I was just living in daily fear of everything and my mind was overthinking. I started to work in palliative care which was extremely distressing seeing the sights that I was seeing. So I was putting it down to events in life, but I was just so emotional I couldn’t stop crying and total brain fog. You just feel like you’re in a constant hangover state. You can’t explain it to anyone and you just feel completely different, out of sorts, you know. [00:05:08][54.1]

Dr Louise Newson: [00:05:09] So then what happened? [00:05:09][0.4]

Lisa: [00:05:10] So in between Christmas and New Year, something’s just clicked. I don’t know what happened. I beat myself up every day. How I’ve got to this point, but suddenly I was researching about my son’s illness and then there was some searches down in Google on the next rows down about peaceful way out and little did I know I had sort of started with suicidal thoughts, not wanting to die or anything or, but I just couldn’t see. I just got ended up in the darkest place that I can imagine, just thinking it was events. And you feel different and you just want the anxiety to end and I think it’s this irrational fear every day. I could feel myself, my mental health declining. I was looking after everybody at work and at home, but what I didn’t realise was my own mental health was declining and just trying to cope, but I just felt incredibly disconnected, in fear of everything. So I just couldn’t see a way out of everything. And then the suicidal thoughts started to occur. And then I actually contemplated suicide. But I couldn’t leave the boys behind. And I knew my son was struggling at the time. Two weeks before Christmas, I could feel myself declining even more. My son was poorly. So this overthinking just happened even more. I was going into bed overthinking and just really intrusive suicidal thoughts, which I’ve never had. I couldn’t see a way out for all of us. I actually thought I was protecting us all with this irrational thought process that has never been like this at all. And I did actually try to take my own life and my two boys. I’m, I’m totally mortified, ashamed, horrified. I ended up getting arrested and ended up in prison for almost three years. And it wasn’t until I ended up in prison, I didn’t even know then, and all I was doing was beating myself up every day wondering how have I got to this point. I’m in total shock, trauma, disbelief, and it was only when I started to see the TV in prison and ever so coincidentally, the timing of Davina McCall starting to raise awareness. It all started to click into place and I thought, oh my goodness, you know, this is exactly how I felt of all the other ladies. I had books sent in to prison. Everyone said it sounds like you’re on the menopause. I had no resources to research any of this in prison. So I had books sent in and this is when I started to realise the symptoms that other ladies and mainly celebrities were talking about were exactly the same feelings I had had. And it was just that turning point. And then I found out the ages of 50 around this age is the highest rate of suicide in women. And I just cried when I read that. And I thought, I’m in prison, nobody’s listening to me. [00:08:14][183.7]

Dr Louise Newson: [00:08:14] Yeah, I mean, there’s one thing knowing about the psychological impact of the metaphors is something else thinking about suicidal thoughts or feeling very, like you will do want to end your life. And I didn’t realise how common it was until I exposed myself to so many patients and so many women. women. Also, when I did psychiatry many years ago, I never was taught that any of these feelings could be related to hormones. And it’s only because giving hormones back to people and seeing the transformational difference to their brains, to their thoughts, to their intrusive thoughts, their dark thoughts, knowing it’s not just a placebo, it’s actually having a really important physiological effect in people’s brains. So you were in prison and I know in prison it can be very hard to access the right medical health. [00:08:58][44.4]

Lisa: [00:08:59] That’s right. [00:08:59][0.0]

Dr Louise Newson: [00:09:00] But you managed to see a doctor, didn’t you, in prison? [00:09:02][2.6]

Lisa: [00:09:03] I did, yes. [00:09:04][0.7]

Dr Louise Newson: [00:09:04] And they prescribed your HRT, didn’t they? What happened? [00:09:06][2.7]

Lisa: [00:09:07] Yes they did. I was prescribed HRT eventually and within not even two weeks it was just like a switch turning on and I’m in the worst environment, the worst situation, not knowing what I was going to receive as a sentence but all of a sudden I had this urge to fight, I had more energy, less brain fog, I still wasn’t sleeping in prison because it’s so difficult to sleep, you’re sharing rooms, there’s no privacy, but all of a sudden I just had this massive determination that I wanted to live, I wanted to fight but… I was still suffering in silence, I was invisible, nobody would understand. I was trying to convince my solicitor, barrister, all male solicitor, male judge, male barrister and it was brought up in the, I had to have a psychological assessment for the case and even they had mentioned menopause but this was not mentioned in court. [00:10:01][54.2]

Dr Louise Newson: [00:10:02] So did you have your sentence reduced at all? [00:10:04][1.9]

Lisa: [00:10:04] Only because they said to me if I pled guilty, they would consider less time and I would know, I would find out sooner. And to be honest, the state was in, I was in such shock, they said I could go to trial but I just knew I wasn’t up to that. So I did go down the route of pleading guilty. I was completely honest when I did get arrested that I just said I thought I was protecting us all and, you know, I didn’t feel right at all. But none of this was taken into consideration. I was actually initially told it was an eight year sentence, then it was down to five years, four months due to the guilty plea. But even then I was absolutely devastated. I was hoping I might get care in the community that people might realise that it was a menopausal and hormonal issue, which in turn also goes to the mental health side that’s been brought on or exacerbated by the menopause. It’s the fact, it’s the perinmenopause as well, is the fact you don’t, because you’re still having periods, you think you’re not on the menopause. [00:11:10][65.8]

Dr Louise Newson: [00:11:11] Yeah, absolutely. And you were in more than one prison as well, won’t you? [00:11:14][3.0]

Lisa: [00:11:14] Yes, yes, so you’re just transferred five -minutes’ notice, so one minute I’m in one prison in Cheshire, then I’m given five minutes notice, you go into another prison in Staffordshire, then I did open prison for four months in York. I came out of prison and had to go to a female hostel and I had to do that for three months, whether I wanted to or not, in Liverpool, nowhere near home again, and just the mental. It’s the worst environment and the way you’re treated. It’s the worst treatment for any kind of mental health, menopause. And it’s just, you cannot, you just feel invisible. It feels so archaic in this day and age. [00:11:52][38.4]

Dr Louise Newson: [00:11:55] It’s quite something. I’ve, as some people listening, and you know, I worked in Styal prison, women’s prison, many years ago, actually, in 2000. I did a week’s work and I’ve still got my notes there from when I used to admit people that came in. But the stories women told me, and it was very different. I’ve watched, I love Louis Theroux, and I’ve watched a lot of his documentaries about prisons, but it’s been in male prisons, and male prisons are very different. The crimes that they commit are very different. The way that they’ve lived their lives have been quite different. Whereas the women who I met, and I’m sure you met a lot, were quite almost naive, very vulnerable, lots of mental health issues. And also a lot of them had been abused in the past and felt they deserved the life that they lived. They couldn’t see a way out. And the more work I’ve done now about mental health and hormones, the more I’ve read not just about perimenopause, but also about PMS, PMDD. women are more likely to commit a crime in the days before their periods. And that’s because our hormone levels are lowest then. And someone called Katharina Dalton wrote about this many, many years ago. She actually was an incredible doctor that no one listened to and she went to my old school as well. Sadly, she’s died now, but she writes about going to trials, listening to women and knowing that it was related to their hormones and everyone just thought she was being ridiculous and she was ridiculed really. And she wrote some amazing academic papers about this, but people just still laughed about her and she was giving not just oestrogen but quite high doses of progesterone especially to women with PMS and PMDD with transformational results. But again, people didn’t like it. They didn’t like what she was doing, but it’s all there actually. And we also know that if people are addicted to certain drugs, especially class A drugs, more likely to switch off their ovaries, more likely to have lower hormone levels. A lot of these people have very poor diets. If they don’t eat well, then again their periods are likely to go off. If they’ve got sort of just a chronic illness and also a lot of the antidepressants and some of the antipsychotic medication that are often prescribed for the mental health issues will switch off our own hotmones. And so I’m sure most women in prison will have some hormonal issue, which is not being addressed at all. And I’m so keen to try and help educate people, but also a lot of people that work in prisons will be of menopausal age, as they are in other areas of work. And the people that work in prison, it’s a hard, really hard job. It’s a relentless job. They’re trying to do the best they can with very limited resources, with people in very difficult situations as well. And so to be perimenopausal or hormonal or menopausal when you work in a prison it’s really difficult as well. [00:14:52][177.0]

Lisa: [00:14:51] Amongst other women, yes. [00:14:52][1.2]

Dr Louise Newson: [00:14:53] But they’re a forgotten group of people, actually, a lot of the time. And as you say, you know, you put you away, that’s it, but you’re very eloquent the way you talk. You’re not someone who’s ever committed a crime in the past. You know, you love your children. It’s very irrational what you did. And I feel that it’s really sad that so many systems had let you down by not being able to think. [00:15:18][25.6]

Lisa: [00:15:18] That’s how I feel, yeah. [00:15:19][0.7]

Dr Louise Newson: [00:15:19] What’s the reason? Was there something else? And I know since you’ve come out of prison, you’ve had your HRT optimised a bit more. So you’ve got on the right dose and type of oestrogen, you’re on some testosterone and your brain is feeling different to how it was before, isn’t it? [00:15:36][17.4]

Lisa: [00:15:37] Totally. I mean, I was placed, I didn’t have a choice of which HRT I went on in prison, obviously. So I was put on a basic, you know, treatment, but there was still a massive difference and it was that realisation to me as well, that you just can’t explain it, to be honest. You know, when I was put on the HRT, you cannot explain to anyone how the clarity you start feeling, the brain fog has gone, but it’s the intrusive thoughts have gone and the anxiety has gone and I’m in the worst, most intimidating situation in the worst hell on earth situation. And then when I came to consult your clinic and I was placed on the latest treatment again, there was a massive improvement again. I’m now sleeping better, just full of energy. Just back to my normal bubbly self, how I was probably a good four years ago, even before prison. You don’t realise the decline that you’re going under due to lack of oestrogen and, and how it does, you don’t even know your own body and it’s frightening, really can be frightening how I look back. [00:16:43][66.1]

Dr Louise Newson: [00:16:44] Yeah. Absolutely, and I think the problem is we’ve all spoken about the menopause related to periods and so everyone is fixated on periods and when I was working with NHS England, the National Menopause Programme, somebody who was leading it said to me, we’ve spent hours discussing about periods, whether it should be, are they changing in frequency or are they changing in pattern or are they changing in the amount of bleeding? And I said, but do you know what, it doesn’t actually really matter. And he said well you’re telling me that women don’t know about their periods enough, so how do they know about their symptoms? I said because a lot of us have a period, it comes and goes, we don’t mark it in our diaries, we’re not bothered about it. But what we are bothered about is the way our brains work, the way our bodies work, the way we’re changing. So we need to get away from just thinking about periods. Women should not be defined about their periods. And a lot of women don’t have periods, or they might have unnatural periods if they’re on contraception. So what we should really be thinking about is about our hormones and the roles that they have in our bodies, regardless of when our ovaries actually finally stop working, as in the menopause. So it’s that sort of decline and change before, and we know with suicide rates, actually, they increase around seven times in women in their late 40s, and there’s a lot to make us believe that actually it’s worse in the perimenopause or it’s worse when hormone levels are changing. to change. Because our brains like homeostasis. They like everything the same. So that’s why, you know, our bodies are better if we sleep the same, if we eat at the same time, if we don’t abuse our brains, as in if we, you know, drink alcohol, we feel dreadful the next morning, because our brain doesn’t like any sort of metabolic change occurring in our body. But we know in the perimenopause, our hormone levels fluctuate. They go up and they go down, quite quickly sometimes. And so that change can really trigger a lot. So a lot of people, once they’re menopausal and they’ve got very low levels and they last forever, very low, actually their mental health might be affected but not to the way that you’re describing as you were before. And so we’re, as you know, we’re funding a PhD student from Liverpool looking into suicide prevention in the perimenopause and menopause. And she’s been interviewing quite a few of our patients actually and really getting to understand more. Because we need to have ways of being more aware, not just as healthcare professionals, but actually for women and their families and friends to understand so we can recognise it in others as well. [00:19:18][154.3]

Lisa: [00:19:18] That’s right, it affects everybody surrounding yourself. I mean, like you said, I didn’t even have problems with my periods ever, so I only went to the doctor’s thinking I’m around the same age, and even when I researched on the internet at the time, there was nothing about suicidal thoughts. You just see the physical symptoms online at the time, but it only seems now since I’ve come out of prison and I’ve started to do my own research that now, due to lovely, thankfully, people like yourself and other celebrities at the moment raising the awareness. I think the research is now coming out more so and going, you know, informing women about the mental health side. But I still think you don’t realise until you’re going through it how important hormones are. Yeah, you just feel, this is why you feel totally disconnected. [00:20:03][44.8]

Dr Louise Newson: [00:20:04] Yeah, and so many people, including myself, it’s not until we’ve got our hormones rebalanced, the right dose and type for us, that we look back and think, goodness, no wonder things are so hard. [00:20:14][10.0]

Lisa: [00:20:15] And then you start trying to tie everything in, thinking… [00:20:17][1.7]

Dr Louise Newson: [00:20:18] And obviously, you know, you’ve got a son that was poorly, you’ve had things going on, and you always, not ‘you’ always, but people contribute it to other reasons. They’ll say, well, I’m going to feel like that because I’ve had a difficult time or because of this or because of that. But actually, we’re all bad as women. Well not all, but lots of us are that we don’t reflect and internalise ourselves. And I think the other message is if we don’t get the help, care, advice, treatment from the first healthcare professional we see it’s really important to try and it’s difficult, I understand, to be the best advocate so you can go back and ask. And, you know, I think that’s the same with any treatment. You know, if you’re refused a treatment that you think is right for you, it’s okay to say, could you just give me a reason why you’re refusing it? Can you just tell me why I can’t have X, Y, Z? And that’s not just for HRT, that’s for anything. [00:21:10][52.0]

Lisa: [00:21:10] Yes. [00:21:10][0.0]

Dr Louise Newson: [00:21:10] You know, if I had an infection on my arm and the doctor said you can’t have antibiotics and I thought I needed them, I would like to challenge that in a nice positive way. And that’s the same, I think, with HRT and also testosterone. You know, we need to be thinking as women. Why aren’t we allowed our own hormones back? [00:21:27][16.6]

Lisa: [00:21:29] Well, you do trust the doctors too much. You do trust that they know what they’re talking about and you are putting your life in their hands. And this is how, you know, I took their advice. But I do, I know now, if I had have been put on HRT before this, I know I would not have ended up in this situation for definite. And that’s what’s so upsetting. This could have all been so prevented. It’s not just myself who’s suffered, my whole family, my friends. They said, it’s so out of character, you know, I’m so bubbly and caring, absolutely doted on my boys, did everything for them. They said they felt like mum had died when they’d gone into prison. And, you know, they’ve had three years of not being able to see me. We also went into COVID lockdown when I was in prison. So I was on double lockdown, couldn’t see any friends or family. I then caught COVID in prison as well. So I thought I’m going to die in prison. It was terrifying. I’m not an aggressive person. you’re put in with a lot of very aggressive women unfortunately and you know with really very serious crimes, you know, mine was as well but it’s just you just cannot get your head around how am I in this situation? It’s horrific. [00:22:41][71.6]

Dr Louise Newson: [00:22:42] Well, obviously, it’s horrendous. And I can’t, and I don’t think many people listening can really, really imagine what you’ve been through, Lisa. But what I’m incredibly grateful for is that you’ve been strong enough and brave enough to share your story. And what I don’t want to do in this podcast is say that every perimenopausal woman is going to think about committing a crime or end up in prison. Of course not. But there are women who are not being listened to, who we should be thinking more about how to help people in different ways and also how to address this inequality of care in prisons and to improve education about hormones in prisons as well. [00:23:22][39.2]

Lisa: [00:23:23] I think it’s also the NHS as well though because really they should have picked up that it wasn’t the usual, I know it’s a unique, terrible, horrific crime, but really, you know, I think maybe I should have had hospital care at the time or trying to get to the root of what has sent somebody to this extent when, you know, there was no thought gone into it at all, you just suddenly, you know, you’re just sent to prison. And I think they’re so snowed under these health practises that there’s not the correct process there either in place to distinguish, you know, whether somebody should be having care in the community or hospital care or whether they should go to prison, there’s no distinction at all. [00:24:02][39.0]

Dr Louise Newson: [00:24:02] So there’s a lot we need to do, a lot we need to change, and I really hope us all working together can hopefully make a difference. But before we end, Lisa, I’d really like to just ask you three take-home tips. So really three things that you think me, you, us, people listening could do to help the community of people in prisons, including those working in prisons. What three things do you think would make the biggest difference? [00:24:25][23.4]

Lisa: [00:24:27] Information for definitely. More awareness, people not just going off the awareness side of hot flushes, you know, I think there’s so many women suffering in silence, not knowing and you’d feel like you’re going mad, you really do. They need to be more explicit with that information. I think also there does need to be a lot more research of looking at someone’s age in relation to how they’re feeling and not just taking like you said the first answer from the doctor if they’re saying, you know, you’re fine or, you know, you don’t need HRT. Try and get a second opinion and fight for it. I was too soft. Again, just research it yourself more, to be honest. I think a massive point was for me, a turning point was Davina McCall’s Sex, Myths and Menopause documentary that was totally, this is the other reason. I thought, oh my God, this is what’s happened to me. and she’s stated everything in the documentary. How women aren’t getting diagnosed, they’re not being treated. [00:25:29][61.8]

Dr Louise Newson: [00:25:30] So there’s a lot we need to do, we need to educate people, we need to allow people to be advocates of themselves and we really need to just learn and talk and share. And it’s been brilliant having you today and I’m again really, really grateful for your time. Thank you. [00:25:46][16.5]

Lisa: [00:25:47] It’s okay. I’m doing it to save other women’s lives because it’s only when I came out of prison that I realised and I started to have the resources, the internet and everything to do my own research and realise how many women have committed suicide and it’s about raising awareness. If I can save one or two lives. It is horrific. I’m totally mortified having to share the story. I’m so ashamed. But I do realise now I have, it helps to know it was, what the cause was, was down to hormones. I’ve been treated on the correct medication. If I can help other women now, that would be worthwhile, you know, going forward. And I am here to help raise awareness now and work with people. You’re the first person I’ve shared this story with because I trust you so much. And you’re the only one who really understands apart from Davina McCall when I saw the documentary. And I can’t thank you enough for all the work you’re doing. [00:26:41][53.6]

Dr Louise Newson: [00:26:41] Thanks, Lisa. [00:26:41][0.4]

Lisa: [00:26:42] So thank you. [00:26:43][0.8]

Dr Louise Newson: [00:26:48] You can find out more about Newson Health Group by visiting www.newsonhealth.co.uk and you can download the free balance app on the App Store or Google Play. [00:26:48][0.0]

ENDS

The post Perimenopause and mental health in prison: Lisa’s story appeared first on Balance Menopause & Hormones.

• Menopause can bring relationship issues to the fore and prompt the desire to divorce
• Divorce litigation can be costly, stressful and emotionally damaging
• Alternative dispute resolution methods are well worth considering 

It’s becoming increasingly clear that divorce and menopause often go hand in hand. In a poll of almost 1,000 women, 7 out of 10 (73%) respondents blamed the menopause for the breakdown of their marriage [1].

RELATED: Menopause puts final nail in marriage coffin

However, many women find divorce and accompanying litigation paperwork extremely burdensome. Menopause symptoms such as brain fog, anxiety, insomnia, mood changes and depression (to name but a few) can make it difficult for women to remember facts of their case or meet court deadlines and deal with complex legal arguments when it comes to splitting the money or sorting arrangements for their children.

RELATED: Assessing the impact of menopause and divorce on women

Why is divorce litigation so tough?

Divorce litigation is replete with risks – there can be extensive legal costs, it can be emotionally damaging for family and loved ones, and outcomes are hard to predict since you are largely putting your trust in the hands of a single judge at trial.

There are better ways to deal with divorce and its aftermath than court litigation, especially for perimenopausal or menopausal women who want to achieve outcomes with less hostility and better efficacy. The thought of giving evidence in the witness box can be daunting, especially if you are experiencing brain fog, cognitive impairment, and anxiety.

But throwing in the towel is not an option either if that means giving up on splitting the assets fairly or accepting arrangements for yourself or your children that are far from ideal.

RELATED: Podcast: divorce, perimenopause and menopause with Farhana Shahzady

What are the alternatives to divorce litigation?

Alternative dispute resolution (ADR) can help you navigate a difficult divorce. Several ADR options are available and worth considering alongside your family lawyer. These include:

Mediation

Mediation is a voluntary process where an independent, professionally trained mediator can help you find solutions to issues you are experiencing when going through a divorce, separation or dissolution of a civil partnership and all the related issues involving finances and children.

Mediation is a safe and constructive place for open and honest conversations to take place and decent mediators can skilfully guide you in discussions to help find a way forward after divorce or separation.

The job of the mediator is to seek to bring everyone together to reach a fair resolution.

One of the key benefits of mediation is its flexibility and lower cost. Mediation can be conducted at a pace that suits both the parties involved, unlike the court process, which can be slow and inconvenient.

It also allows both parties involved to set the agenda and discuss what is important to them in an environment and pace that suits them. Where appropriate, it may also be possible to involve children in the process, enabling their voices to be heard.

Costs of mediation are a fraction of those involved in court proceedings so it’s worth considering mediation in most cases.

RELATED: read more relationship articles in the balance menopause library

Collaborative process

This process involves all parties, including collaboratively trained family lawyers, sitting around a table to discuss and work through the issues surrounding divorce or separation, instead of having decisions imposed upon them by the court.

The collaborative process is completely confidential, and it allows both parties to stay in control of their personal situation. This often establishes a more flexible, creative approach to financial and childcare arrangements than may have been possible with the traditional court process.

RELATED: Podcast: families, relationships and the power of connection with Julia Samuel

Solicitor-led negotiations

Solicitor-led negotiations can take place at any point during a divorce or separation and can often reduce conflict in the relationship, ultimately making the experience less stressful for everyone involved. It can also be used during court proceedings, to help negotiations and to reach settlement before final trial if possible.

Usually taking the form of round table meetings or telephone and letter correspondence, solicitor-led negotiation can be particularly useful for families where children are involved. It offers parents more control, and a chance for them to work together to decide the best care arrangements for their child.

As with mediation and the collaborative process, a family therapist can be used to help with any emotional issues that are causing difficulty in reaching an agreement.

Arbitration

So long as both parties agree on using the arbitration process, an arbitrator can adjudicate on all the issues and can take the time to understand what is involved, whether it’s to do with finances or child arrangements. This will give the parties involved a fair, impartial and binding decision on the specific concerns they have.

Arbitration is an effective alternative to the court deciding the way forward and, like the other dispute resolution processes, offers greater control and the ability to tailor what is needed.

The family courts are currently extremely stretched, and the arbitration process is instead designed around the parties’ needs and timescales.

RELATED: Menopause and relationships – a guide for partners booklet

Emotional support and family coaches

Family consultants, therapists and coaches are regularly used to reduce the emotional stress and impact for clients throughout divorce or separation and often work side by side with the family lawyer in a complementary way. They can help shock absorb some of the added stress that comes from menopause and divorce.

Thankfully there is growing awareness amongst some family lawyers that litigation should be a last resort and it is vital that women find a sympathetic family lawyer skilled in the latest dispute resolution techniques. These techniques are appropriate for many cases that otherwise find themselves in court.

Farhana Shahzady is senior family lawyer, collaborative practitioner and mediator at Beck Fitzgerald as well as being a menopause campaigner and founder of The Family Law Menopause Project.

References

1. Family Law Menopause Project and Newson Health Research and Education, 2022

The post Menopausal and getting divorced? How to make your split as smooth as possible appeared first on Balance Menopause & Hormones.

• HRT is the recommended treatment for menopause and perimenopause, while antidepressants can be helpful for women with moderate or severe depression
• You can be both perimenopausal and menopausal and depressed so treatment should be tailored to your individual symptoms
• What to do if you’ve been prescribed antidepressants but think you’re perimenopausal or menopausal, not depressed

Changes to moods, emotions and state of mind during perimenopause and menopause are extremely common; it is often the primary reason menopausal women first go to see their doctor or nurse.

In a Newson Health survey of 5,744 women, 84% reported feeling anxious or stressed since becoming perimenopausal or menopausal, while 79% felt more overwhelmed, 72% felt low or tearful, 67% felt angry or irritable, and 55% felt flat or blunted [1].

Other psychological symptoms can include low self-esteem, having reduced motivation or interest in things, panic attacks and mood swings. Many women struggle with sleep with sleep during this time, and insomnia can be closely associated with lethargy and feeling emotionally labile or tearful.

RELATED: Low self-esteem and menopause: why it happens and what to do about it

How can hormones influence mood during perimenopause or menopause?

Levels of oestradiol (oestrogen) and progesterone fluctuate during perimenopause then become low during menopause and remain consistently low. While some studies have shown that the reduction in oestradiol leads to a lowering of mood, others have shown it is the fluctuations in hormone levels that cause the problem [2, 3].

Your hormones oestradiol, progesterone and testosterone can help to regulate several hormones, for example serotonin, noradrenaline and dopamine, which often have mood-boosting properties as well as other beneficial effects in your brain.

Progesterone is commonly thought of as the “relaxing hormone” as, for most women, it has calming, anti-anxiety (anxiolytic) properties and is thought to have mood stabilising effects. It can also improve sleep.

Testosterone regulates serotonin levels and plays a role in its uptake in your brain, which can help to improve overall mood. Testosterone also stimulates the release of dopamine, another neurotransmitter responsible for your feelings of pleasure.

Some pre-existing conditions may put women at greater risk of developing mood changes during perimenopause and menopause, these include a history of premenstrual syndrome or postnatal depression, high levels of stress, and poor physical health.

RELATED: PMS, PMDD and the menopause

How is low mood or depression diagnosed during perimenopause and menopause?

It is clear to see why low mood during perimenopause and menopause could be mistaken for clinical depression. In our article Am I depressed or menopausal?, psychiatrist Dr Louisa James outlines how some symptoms can overlap, and what to consider when distinguishing between hormonal low mood and clinical depression.

Just as it’s important that healthcare professionals consider hormones when making a diagnosis of clinical depression, ‘it’s worth noting that you can have more than one diagnosis – you can be menopausal and suffer from clinical depression too,’ says Dr Louisa.

When Sam was 42 and going through a very stressful period of life, she was prescribed citalopram. She had been taking antidepressants in the past so it was diagnosed that she was experiencing a mental health issue. Yet tests showed she had a low oestradiol blood level and even when she was prescribed a different antidepressant, plus clonazepam, a type of sedative, Sam experienced suicidal thoughts, would wake in the night in a panic soaked in sweet, and was tearful.

Sam’s psychiatrist suggested ECT for treatment-resistant depression but instead Sam had private treatment of ketamine infusions, which her psychiatrist prescribed for her. For several years she continued with this but still experienced symptoms. At the age of 45 she started taking HRT. She says: ‘I have gradually felt better. I no longer burst into tears. My energy, motivation and capacity for joy is returning. I feel more sociable and I enjoy rather than fear and avoid interacting with others in social events. During the last 12 months, I’ve gradually reduced and stopped taking antidepressants and anti-anxiety medications. And I’ve increased the interval between the ketamine infusions. I have found HRT to be more effective at treating my mental illness symptoms than any of the psychiatric medications that I’ve been prescribed, with none of the side effects and lots of long-term health benefits.’ Read more about Sam’s experiences: My story of treatment-resistant depression, ketamine and HRT

Can antidepressants be prescribed for menopause symptoms?

Menopause guidelines are clear that antidepressants should not be used as first line treatment for the low mood associated with perimenopause and menopause. This is because there is no evidence that they help improve psychological symptoms of perimenopause or menopause.

Despite this clear recommendation, a Newson Health survey found that when seeking advice from a healthcare professional about their perimenopausal or menopausal symptoms, over a third of respondents (39%) said they were offered antidepressants instead of HRT as the first course of treatment [1].

While 26% of these women were offered one type of antidepressant, 8% were offered two types and 5% said they were offered more than two types [1].

Antidepressants are not effective for the low mood and anxiety associated with perimenopause and menopause as they are not treating or addressing the underlying cause of low hormone levels.

RELATED: HRT or antidepressants for low mood?

How should hormonal low mood be treated?

Because mood changes during perimenopause and menopause are caused by altered hormones, the most effective treatment is to stabilise hormone levels with HRT, often with testosterone too. A Newson Health study of 510 women – who had already been using HRT (transdermal oestrogen with or without a progestogen) – who were treated with transdermal body-identical testosterone for four months, found significant improvements in cognition and mood. Among symptoms most likely to improve were ‘loss of interest in most things’ (56% of women reported an improvement) and ‘crying spells’ (55%) [4]. 

Many women find that they feel calmer, their motivation and interest in things returns, along with a greater sense of energy, and they are generally much happier after a few months of being on HRT. There will usually be an improvement in other menopausal symptoms as well, such as hot flushes and night sweats, insomnia, vaginal dryness and many other symptoms.

Research has shown that if women are given HRT when they are perimenopausal, this can reduce the incidence of clinical depression developing [5].

Many women who start HRT and have been incorrectly given antidepressants in the past, find that their depressive symptoms improve on the right dose and type of HRT, to the extent that they can reduce and often stop taking their antidepressants.

This is something Jaany experienced when she was 44, and was prescribed for her perimenopausal symptoms of rage, aching joints, brain fog, social anxiety, changes in periods and lack of energy. But after she researched perimenopause, Jaany requested and received HRT. She says ‘Everything changed after this. I emerged from a very unfamiliar place where I didn’t recognise myself, to one of familiarity. I slowly realised that with the necessary hormones flowing through my veins again, I had actually regained myself. Now, a year down the line, my symptoms have all lessened considerably.’ You can read more of Jaany’s experience: My story: Losing and regaining my sense of self

Can HRT and antidepressants be used together?

For women who have been diagnosed with clinical depression, and who are also experiencing perimenopause or menopause symptoms, both HRT and antidepressants can be prescribed and taken safely together.

There is some evidence that oestradiol can enhance the effectiveness of a type of antidepressant called a selective serotonin reuptake inhibitor (SSRI), such as citalopram, fluoxetine, sertraline [6]. Ensuring you have optimal levels of oestrogen is therefore helpful in dealing with symptoms of low mood.

RELATED: Menopause and antidepressants: Kim Goulding & Dr Louise Newson

What else can I do for menopausal low mood?

For most women experiencing low mood, anxiety, irritability, or mood swings, combining appropriate treatment with lifestyle adjustments is key.

A healthy diet with lots of fruit and vegetables and limiting overly processed foods, excess salt and sugar and white refined carbohydrates, can be beneficial. Foods high in essential fats such as omega 3 oils, and those rich in B vitamins, calcium and vitamin D can help improve your mood.

There is evidence that the bacteria that live in our guts can be helpful for mood and anxiety [7].  Eating fermented and high fibre foods help to ensure we have lots of different healthy bacteria. Find out more about looking after your gut in Dr Louise Newson’s podcast Irritable bowel, bloating and digestive health with the gut experts.

Regular exercise boosts endorphins – hormones that relieve pain and reduce stress.

RELATED: How walking can ease your mind 

Talking therapy such as cognitive behavioural therapy (CBT) has been shown to help with menopausal low mood and anxiety, and interestingly, even physical symptoms such as hot flushes.
Remember, individualisation of treatment is key. ‘If you have not had episodes of depression in the past and have now been prescribed antidepressants for your low mood or anxiety associated with your menopause or perimenopause, consider whether this is the right treatment for you,’ says Dr Louisa.

‘If you have had depression in the past but this feels different or your usual treatment has been ineffective, it is worth considering whether hormone deficiency may be hampering your recovery,’ Dr Louisa adds. ‘Also think HRT first if you have a history of mood changes related to periods, fertility treatment or pregnancy.’

Dr Louisa suggests tracking symptoms using the balance app to start a conversation about perimenopause, and seeing a doctor who specialises in the menopause for individualised advice.

References

1. Newson Health, Experiences of Perimenopause and Menopause, 2022
2. Albert KM, Newhouse PA. Estrogen, Stress, and Depression: Cognitive and Biological Interactions. Annu Rev Clin Psychol. 2019 May 7;15:399-423. doi: 10.1146/annurev-clinpsy-050718-095557
3. Musial N, Ali Z, Grbevski J, Veerakumar A, Sharma P. Perimenopause and First-Onset Mood Disorders: A Closer Look. Focus (Am Psychiatr Publ). 2021 Jul;19(3):330-337. doi: 10.1176/appi.focus.20200041.
4. Glynne S., Kamal A., Kamel A.M. et al. (2024), ‘Effect of transdermal testosterone therapy on mood and cognitive symptoms in peri- and postmenopausal women: a pilot study‘, Arch Womens Ment Health. https://doi.org/10.1007/s00737-024-01513-6
5. Gordon JL, Rubinow DR, Eisenlohr-Moul TA, Xia K, Schmidt PJ, Girdler SS. (2018), ‘Efficacy of Transdermal Estradiol and Micronized Progesterone in the Prevention of Depressive Symptoms in the Menopause Transition: A Randomized Clinical Trial. JAMA Psychiatry. ;75(2):149–157. doi:10.1001/jamapsychiatry.2017.3998
6. Estrada-Camarena E., López-Rubalcava C., Vega-Rivera N., Récamier-Carballo S., Fernández-Guasti A. (2010), ‘Antidepressant effects of estrogens: a basic approximation’, Behavioural Pharmacology 21(5-6) pp451-464. DOI: 10.1097/FBP.0b013e32833db7e9
7. Kumar A, Pramanik J, Goyal N, Chauhan D, Sivamaruthi BS, Prajapati BG, Chaiyasut C. Gut Microbiota in Anxiety and Depression: Unveiling the Relationships and Management Options. Pharmaceuticals (Basel). 2023 Apr 9;16(4):565. doi: 10.3390/ph16040565.

The post Antidepressants and menopause appeared first on Balance Menopause & Hormones.

Content advisory: this episode includes themes of mental health and suicide

In this week’s podcast, Dr Louise Newson is joined by Consultant Psychiatrist Dr Rachel Jones to delve into the critical role hormones, particularly progesterone, play in women’s mental health. They discuss the importance of understanding hormonal changes throughout a woman’s life, the differences between natural and synthetic hormones, and the need for individualised treatment plans.

The conversation emphasises the significance of balancing hormones and considering lifestyle factors that impact mental health. Dr Louise and Dr Rachel share insights on how natural progesterone can help with mental health symptoms, including mood and anxiety, and encourage women not to give up on finding the right hormonal balance for them.

Click here to find out more about Newson Health.

Find out more about Dr Rachel on Instagram @the_hormone_clinic

Contact the Samaritans for 24-hour, confidential support by calling 116 123 or email jo@samaritans.org.

Transcript

Dr Louise Newson: [00:00:11] Hello. I’m Dr louise Newson. I’m a GP and menopause specialist, and I’m also the founder of the Newson Health Menopause and Wellbeing Centre here in Stratford-upon-Avon. I’m also the founder of the free balance app. Each week on my podcast, join me and my special guests where we discuss all things perimenopause and menopause. We talk about the latest research, bust myths on menopause symptoms and treatments and often share moving and always inspirational personal stories. This podcast is brought to you by the Newson Health Group, which has clinics across the UK dedicated to providing individualised perimenopause and menopause care for all women. So today on the podcast, I’m going to talk about an area of hormones that is really, really important. And the more I do work in menopause, perimenopause, but also women with PMS, premenstrual syndrome, PMDD, premenstrual dysphoric disorder, I worry actually about so many people not understanding the role of hormones in the brain. So I’m really delighted today to have with me Dr rachel Jones, who’s a psychiatrist I’ve recently connected with. And many psychiatrists are fantastic in mental health, but they don’t always know so much about hormones. So to find a psychiatrist that not only understands but also prescribes hormones is quite unique. So I’m really, really honoured to have Rachel with me today. So thanks for coming, Rachel. [00:01:51][100.0]

Dr Rachel Jones: [00:01:51] Thank you so much for inviting me. [00:01:53][1.6]

Dr Louise Newson: [00:01:54] So I know when we spoke a while ago, when I first met you, we were both being quite open about we’ve learned so much over the years. And actually, if I had this conversation with you maybe 20 years ago, I think it would be a very different conversation. It would be for me, definitely. But would it be from you as well? [00:02:09][15.3]

Dr Rachel Jones: [00:02:10] Absolutely. And actually, even if I’d had this conversation with you, probably five years ago, it would have been a different conversation as well, because all of my knowledge and interest and learning has occurred since then, since I was working in general psychiatry and I started to see patterns in presentations of women throughout the lifespan. So I’m not just talking about sort of, you know, women in their late 30s, 40s, 50s. I’m also talking about sort of from 18 onwards. So yeah, so I began to notice all sorts of patterns. [00:02:38][28.5]

Dr Louise Newson: [00:02:39] It’s really interesting isn’t think because one of the first things that you learn as a medical student is it’s all in the history. You have to take a really good history. And it’s not just what’s happened to the patient on that day, it’s the lead up. What else has been going on? And I think we sometimes lose that, especially because it’s so easy now to order tests and investigations. Medicine is quite fast paced if you’ve only got ten minutes, so you sometimes forget to put things into context. But I was talking to my daughter. My oldest daughter is 22. She recorded a podcast with me a few months ago now talking about her PMDD. And she uses transdermal oestradiol, so she uses natural hormones. And she said to me yesterday, Mummy, I was saying to some of my friends, I feel the same mentally every day of my cycle. And all her friends, without exception, said, What? What do you mean? How do you do that? And she said, I hadn’t realised and I thought, wow, actually, do we just normalise the fact that our hormones change and affect the way we feel? And it’s often I mean, people can get physical symptoms, but certainly for this podcast, I really want to concentrate on the mental health symptoms because for so long it’s just her hormones. ‘She is a hormonal person. Don’t worry, she’s due on soon’. Yeah, but actually should we be normalising it? [00:03:58][78.4]

Dr Rachel Jones: [00:03:59] No. And also, we know for some women it can be really, really quite severe. So the type of women that I will see in psychiatric services, for example, have made it to psychiatric services. So their symptoms that they’re presenting with very severe and even with thoughts of harming themselves or suicide and they may have harmed themselves and they may have acquired diagnoses such as emotionally unstable personality disorder. But as you say, it’s all in the history. And when you spend time asking them questions in detail and in particular about their menstrual history, which interestingly is not part of the standard history and mental state examination that we use in psychiatry, it’s one that I’ve sort of developed is that you you see a clear pattern where these women are often feeling relatively okay in the first half of their cycle, but will then have thoughts about harming themselves. They may even harm themselves and having thoughts of suicide. But there’s a pattern to it and it’s focusing on that pattern and understanding the pattern in the context of the menstrual cycle, which is really key. [00:04:59][60.3]

Dr Louise Newson: [00:05:00] Absolutely. And I think also we forget don’t we, some of us might remember from biology days at school but our hormones naturally change throughout our cycle. So when people are having, you know, regular periods, we get a peak of the oestradiol, progesterone, even a little bit of testosterone as well, surge when we produce an egg or ovulate. But it’s the second half of the cycle, isn’t it where we have this huge rise actually in progesterone and less so, but still a rise in oestradiol, the natural oestrogen and then they plummet quite quickly, don’t they, before we have a period? [00:05:33][32.9]

Dr Rachel Jones: [00:05:34] Yes, yes they do. And it’s that period where some women just find from a mental health perspective, find it so debilitating. And that’s what I’m interested in, really, certainly seeing the women I see in psychiatric services. And if you can help them from a hormone perspective there, it reduces the need to prescribe other medication, you know, with associated side effects. So I think it’s really important to understand their mental health symptoms in the context of their menstrual cycle. [00:06:02][28.4]

Dr Louise Newson: [00:06:03] Yeah. And I remember sitting in a clinic many years ago, actually, where there was a lady who came in who was quite young. She was a follow up patient and she’d been diagnosed with PMDD, premenstrual dysphoric disorder. She had had a dreadful time a few days before her periods. Very classic history. And the doctor had prescribed her some natural hormones. So oestradiol, progesterone and he’d also given her testosterone, had added that in and she’d been a patient for about a year of his. And when she was being reviewed, she was just saying how her life had been transformed. And afterwards she left the consulting room and I said to the doctor, But what? Why are you giving hormones? Like I’ve always been told, you give antidepressants for two out of four weeks or we can think about lifestyle and everything else. And he said, Louise, you’re just replacing what’s missing. You’re topping up those hormones that have become low and having a problem in some women. And I thought, Yeah, that’s so simple, but it’s almost so simple it’s been forgotten, hasn’t it? [00:06:58][54.7]

Dr Rachel Jones: [00:06:59] It has. In terms with antidepressants, I think sometimes there is a place for antidepressants and they do take the edge off. They will take the edge off symptoms. But then you’re not treating the problem with the right thing. And natural hormones are natural, as you say. They’re replenishing what’s missing, what needs to be rebalanced. And as a consequence, there are minimal side effects. Women respond incredibly well. And as you said and many of my women tell me that it’s life changing and that they will go and not even know that that period is arriving. So they’re surprised they’ll get the period and think. But I had no symptoms leading to this to my period and and they almost can’t get their heads around how how transformative it’s been for them. [00:07:39][40.1]

Dr Louise Newson: [00:07:39] Yeah and it’s interesting because we mentioned these three hormones, but I’d like to just spend a little bit of time, if I may, talking bit about progesterone, because progesterone means different things to different people because we’ve got the progesterone only pill. We know the combination pill contains progesterone and we know implants, Depo-Provera contains progesterone. But and the big caveat here is they are all synthetic so they’re chemically altered. They’re not the same as the natural progesterone, and I can’t seem to say it enough. And even when I say it to doctors, they’re like, Hang on, say that again, because it’s all called progesterone. It’s very confusing, but it’s not progesterone. We have progesterone we produce ourselves. We make it in our ovaries, we make it in our brains, we make it in other tissues, the natural progesterone. But all contraceptives are not natural, are they? [00:08:30][51.1]

Dr Rachel Jones: [00:08:30] Absolutely not. And they are not the same. So I can’t tell you how many women I’ve seen in my clinic who have not tolerated the progesterone only pill. They haven’t tolerated the combined pill. They haven’t tolerated the Mirena coil, for example, evenly. And then you prescribe the natural progesterone and they tolerate it. They respond and their symptoms improve and disappear. So they’re not the same. They really aren’t the same. [00:08:58][27.5]

Dr Louise Newson: [00:08:59] No. And I often say to people, our hormones, obviously are chemical messengers. But I think if you think of them as like a key and the receptors like a lock, which are the receptors on cells, and once the key goes into the lock and unlocks, you have these lovely biological processes that occur. Now, the synthetic progesterone or the synthetic hormones, they’ve been chemically altered so they might fit into the lock. So they might stimulate the receptor, but they won’t unlock it. So we’ve all had dodgy keys in the past where you think oh great, go in and then it doesn’t turn. And it’s that sort of thing. So I think has a double negative effect because it blocks any natural hormone working and it doesn’t have the same effects. And there are a lot of women, certainly in my experience and I’m sure in yours who have quite severe PMDD or PMS, and they tell me that they cannot tolerate any progesterone at all. Like they’ve literally gone mad even with the Merina coil, for example, or tried to rip out their implant. And they’re so scared of progesterone because they think it’s all the same but when they have the natural progesterone, they often respond even better than other women. [00:10:08][69.5]

Dr Rachel Jones: [00:10:09] Yeah, they do. I think that progesterone, for me, it really is the key hormone that is forgotten about from a mental health perspective. It’s just fantastic for mood, for anxiety, for irritability, for rage, for sleep, all of those symptoms. And if you prescribe the natural progesterone, it changes women’s lives. And every single day I’m in my clinic, I’m speaking to women that just can’t speak highly enough of how they responded to natural progesterone. [00:10:40][31.7]

Dr Louise Newson: [00:10:42] Yeah, and it’s very interesting. I mean, when I was first learnt about hormones, it was almost you have oestrogwn as the main hormone. You have progesterone if you’ve got a womb because it protects the lining of the womb. And testosterone is only for really reduced libido when women are taking HRT. But when we look at how our hormones are manufactured, they’re come from progesterone, progesterone is like the main hormone. And then then you get testosterone, which is, you know, gets aromatased to oestradiol. But also progesterone forms cortisol and corticosterone as well. Which are really important, associated with inflammation, but also stress as well. So it’s almost like a seesaw, isn’t it? If your progesterone goes down, your cortisol can go up as well, so your stress hormone can go up. So that’s also like something that I think a lot of people don’t think about. [00:11:31][49.7]

Dr Rachel Jones: [00:11:33] These hormones don’t exist in isolation. They form an equilibrium with one another. And if one gets low, that impacts the other hormones and if one gets too high that impacts the other. So it’s about finely tuning them alongside one another. So I always, as you say, I’ve always got this cascade in my head of what’s converting to what. And understanding that they need to balance. They don’t exist in isolation. And I think that leads me on to saying that progesterone, in my opinion, bearing in mind I’m looking at it from a mental health perspective and as a psychiatrist, in my opinion, should not just be prescribed to keep the lining of the uterus thin. It’s got many, many, many more benefits than that psychologically. [00:12:14][41.6]

Dr Louise Newson: [00:12:16] Yeah, and I totally agree, especially when we think it is a neuro steroid. It’s a hormone that’s produced in our brain. So it’s produced in our brain for a reason because it has these beneficial effects. And like you say, very calming actually, really can help anxiety reduce. It can help with sleep. It can just help with mental thought processes as well, actually, and clarity of thought. And I first sort of saw quite a few people who’d had a hysterectomy. They’d been on HRT and then their gynaecologist said, well you haven’t got a womb now you don’t need progesterone. And they’d come back and say, But I can’t sleep. I’m really anxious… And no one thought about their progesterone, they said, But I had some left over. So I took it and everything improved. So, you know, they learnt themselves almost. But then when you read how the hormone works, so we’ve got a lot of work from Katharina Dalton, who was very inspirational, way ahead of her time doctor who prescribed a loss of progesterone to women with PMS, PMDD and really incredible results. Also postnatal depression as well. Yeah. But you know, she was reported to the GMC, the General Medical Council. The gynaecologists tried to strip her of her registration, but she was quite formidable. I’ve spoken to quite a few people who were her patients and she actually went to my old school, so she came and lectured when I was about 13 and she was quite, you wouldn’t really argue with her. She was very forthright, very outspoken. She was really understood the difference between natural and synthetic hormones in a way that I don’t think anyone has spoken about it in the way she has until recently when we’re all connecting and joining the dots again. [00:13:54][97.7]

Dr Rachel Jones: [00:13:54] Yeah. And I feel the same about the, I have the same issue with women actually, who are on natural oestrogen and have a Mirena coil because that’s not the same as having natural systemic progesterone. And often I will have women come into my clinic who are anxious, they’re low, they’re not sleeping, they’ve got migraines, and they’re not on any progesterone. So I prescribe progesterone and they get better. It’s often as simple as that. [00:14:24][30.3]

Dr Louise Newson: [00:14:25] Yeah, I think we certainly do. And I see lot of women whose sadly, doctors have refused to prescribe progesterone because they’ve got a Merina coil in. But it is a natural hormone and it is really important, but it’s about having the right dose and type because sometimes people take a little while to get used to the progesterone, don’t they? Sometimes when they start it, they can sometimes feel a bit worse and making sure that they have it in the right way, that it’s absorbed in the right way, the right dose for them. Some people need higher doses. Some people prefer as a pessary, there’s options, which I think is also really important as a doctor to allow people to know that there are options even with the progesterone, the way that you can have it and the dose because that’s important too isn’t it? [00:15:12][47.1]

Dr Rachel Jones: [00:15:13] Yeah, I think absolutely and for women not to give up. So another thing, that I will see women coming to the clinic they’ll say, I didn’t. I just didn’t tolerate the progesterone. I had to stop it and that was the end of it. So then to sort of, you know, extend the conversation and say, well, that doesn’t mean that it’s not going to work, that we can’t make it work for you, as you say, in different doses or different forms of taking it. One shouldn’t give up if they’ve just tried it and they’ve said they haven’t tolerated it. That’s not a reason just to give up and not try again. [00:15:42][29.5]

Dr Louise Newson: [00:15:43] Yeah. And I think also, like you said before, these hormones all work together. And so balancing the hormones is really important. So it’s not just about keep going with oestrogen as much as you can and then don’t worry about the other hormones. You know, it is looking at how they balance with progesterone and also testosterone as well. Someone said, a while ago there’s like a triangle really of the hormones. And I think that is really right. And actually, even Katharina Dalton spoke a lot about nutrition and making sure people ate regularly. They weren’t putting too much stresses on their body, especially with glucose and insulin. And I think that’s really important too, certainly looking holistically at how we do anything to reduce anxiety. [00:16:26][42.8]

Dr Rachel Jones: [00:16:28] Very much so. [00:16:28][0.3]

Dr Louise Newson: [00:16:28] But that can be very hard unless you’ve got your hormones balanced. [00:16:30][2.1]

Dr Rachel Jones: [00:16:31] Yeah, and absolutely. And as you said, because you said earlier that testosterone can convert to oestradiol. So whenever I’m prescribing testosterone, I’ve always got in the back of my mind. Well, some of that is converting to oestrogen. So therefore, we’re going to have to balance with even more progesterone than we would have if they weren’t on testosterone. So it’s always considering what you’re prescribing, what doses you’re prescribing and making sure that they’re adequately balanced with the progesterone. [00:16:57][26.0]

Dr Louise Newson: [00:16:58] And I think that is so important because, you know, about just over 50% of people we see in our clinic are already taking hormones. Now they’re not coming because they want to come to our clinic. They’re coming because they’re still having symptoms. And that individualisation of care is really important, isn’t it? [00:17:16][17.8]

Dr Rachel Jones: [00:17:17] It’s so important. Certainly from a mental health perspective. I mean, I, I rarely see if I’m completely honest when I obviously the type of women that I see in my clinic have quite debilitating, significant mental health, psychological symptoms. And it’s never, ever, ever a one size fits all approach. They all respond individually and you have to go very, very carefully with the doses, with the individual hormones that you prescribe and gradually titrate them over time until you get the balance right for them. And likewise with you. So many of the women that come into my clinic have either taken HRT and have given up or are still on HRT and they haven’t got the right balance and are about to give up. And that’s not the end of it. It’s about getting the right doses for them. [00:18:06][48.5]

Dr Louise Newson: [00:18:06] Yeah. And it’s interesting when we think about some of the psychiatric medication that people are taking, and I did quite a lot of psychiatry as part of my training, I’m very interested in mental health, but I hadn’t realised Rachel the impact of mental health on hormones until like you say pattern recognition. So we see a lot of women who are on Quetiapine, an antipsychotic. They’ve been on two, three, four, sometimes five different antidepressants with not good effect. I’ve seen quite a few women. I’ve lost count, actually the number who have had electroconvulsive therapy. Increasingly, I’ve seen women who’ve had ketamine infusions. Yet, like you say, it’s not built into the history taking asking about any potential hormone changes, thinking about periods and so forth. But one of the things that we noticed and we’re just writing up some data is that women, once they have their hormones balanced, obviously we keep them on the same medication because they’ve been on it. They start to then be able to deprescribe some of their medication. And we found that when people on a combination of all three hormones, they can deprescribe better than just on oestrogen, for example. Yeah. And I think that’s really interesting because I think it’s a bit like a Venn diagram with mental health and hormones. I think there’s some people who it’s all a psychiatric condition and it’s nothing to do with hormones. I think there’s some people it’s probably mostly due to their hormones and it’s not been diagnosed. And I think there’s some in the middle that are both, so there… and that’s always difficult, isn’t it, to know which they are. I think getting across everything is so important, isn’t it? [00:19:43][96.9]

Dr Rachel Jones: [00:19:43] Yeah. And the approach that I take, firstly, I always listen to them because they’ve always got usually got a pretty good idea of themselves, of what’s happening with their cycle and their patterns. And they will often come to me and say, I’m sure it’s my hormones, or I’m sure my hormones got something to do with it. So that’s the first thing is I really listen to what they say because they often know deep down. The second thing is I always say I’m not, especially if they’re under psychiatric care from another psychiatrist or another team, and they come to me, and even if they’re my patient, I’ll always say, I’m not going to change your psychiatric medication at the moment and I’m going to just focus on your hormones and balancing, replenishing finely tuning your hormones. And only when we’ve done that and where we see how much improved you are, how far we can go with that, will we then be in a position to even contemplate looking at your psychiatric medication and potentially reducing it and stopping it in a very gradual, controlled way. Firstly, because if you do more than one thing at a time, you never know what’s what’s doing what. No, you just won’t know. And secondly, I think you do have to tread carefully with their medication when you start to address it. I mean, they’re often obviously, understandably, very keen the moment they they feel better once they’re on their hormones, they want to stop it immediately. But I, I really say to them no, it’s got to be done in a really controlled, careful way. Often one at a time and titrating according again to their response. So it does have to be done very carefully. I don’t want to tread on anyone else’s toes, on any other psychiatrist’s toes. I make it very clear that what we’re doing is focusing on the hormones first, and only after that may we start to address that psychiatric medication. I think that’s really important. [00:21:33][109.6]

Dr Louise Newson: [00:21:34] Is so important. And certainly, you know, I did a lot of deprescribing as a GP and in the clinic we do it. But even just I say ‘just’ in inverted commas, antidepressants, I will reduce very, very slowly, especially when people have been on them for a length of time. And actually I have this unwritten rule that I’ll only start reducing them in the springtime when the crocuses come out. Yeah, because like you say, sometimes people are in a real rush to stop but in the winter months, unless there’s a real reason, I would just say, Look, you’ve been on them for a while. Let’s just wait till the clocks have changed. We see some spring flowers and then we do it really, really, really gradually. [00:22:11][37.0]

Dr Rachel Jones: [00:22:12] Really slowly. [00:22:12][0.6]

Dr Louise Newson: [00:22:13] Yeah. And I, I can’t emphasise how slowly actually with these medications, just because just in my clinical experience, people have less problems coming off the when it’s very slow. Whereas when they do it quick that’s when they get more side effects. [00:22:29][15.5]

Dr Rachel Jones: [00:22:29] Yes. And a rebound, a rebound, depression rebound low mood. I’ve seen that so many times. So and I’m exactly the same with you really, really slowly. I mean ofte I do it over a period of nine or ten months and tiny, tiny, tiny bits over a period of time because there’s no harm in doing it that way. It’s important to keep the patient on side because they just often want to stop it and be done with it. But it’s really, really important to do it like that. [00:22:53][23.9]

Dr Louise Newson: [00:22:54] Absolutely. And we have a psychiatrist actually working with us in the clinic. So some of the drugs like Quetiapine and the Pregabalin stronger drugs, I feel a lot confident doing it in conjunction with a psychiatrist, but it’s a team effort as well. So the patients feel really supported. And it’s also looking at what else might be affecting their mental health. And as you know, often when our hormones are balanced, we’re more likely to eat a better diet. And, you know, the effect of the way we eat or what we eat on our mood is huge, but you don’t realise until you sort of start to eat better. And that can have an effect. But if you are very low in your motivation, low in your mood, you’re not going to be thinking about how to have a nutritious meal. So a lot of people comfort eat, don’t they, or snack. And then they have the, yeah. So all of these can make a huge difference. [00:23:41][46.9]

Dr Rachel Jones: [00:23:43] Yeah. And the same with exercising. The last thing that you feel like doing when you’re feeling depressed, when you’re feeling anxious, when you’re feeling irritable, when you haven’t got any motivation is to do any exercise. So I always say when they start to feel better, it’s just little, little steps. Gradual, gradual changes over time build up to big changes. So yeah, but absolutely emphasising that lifestyle changes are also key alongside the hormones. [00:24:08][24.8]

Dr Louise Newson: [00:24:09] Absolutely. And I also think very much with our brain, our brain likes homeostasis, everything the same, doesn’t it? So anything that can be routined is also very important. You know, even the way that some people respond very differently than others. So like you were saying, it’s not everybody that gets PMS or PMDD. Some people have these hormonal changes, don’t notice. And it’s a bit like being hungry. Some people, when they’re hungry, their mood goes and other people, it doesn’t matter. They’ll just eat because they need to, but they don’t have that same, you know, change in the brain. And it’s the same with anything. Is that the way people respond to alcohol, for example, is different. Our brain is so interesting. But there are some people and we don’t know whether it’s a genetic thing or what that are definitely respond more. And those women with PMS, PMDD, more likely, it’s not guaranteed, are going to have a more difficult time in the perimenopause as well, aren’t they, With mental health? So it’s a sort of warning almost, to sort of make sure you don’t want to wait until you’re perimenopausal before you think about hormones. I much prefer helping people younger. [00:25:21][72.0]

Dr Rachel Jones: [00:25:21] Yes, absolutely. I think these, as you call them, hormone conditions, whatever you call them, again, a bit like hormones themselves they all blur into one another. They don’t really exist in isolation. So women who suffer with PMS or PMDD are more likely to have postnatal depression after the birth of a baby and in my experience, are more likely to suffer from a mental health perspective through perimenopause, menopause and out the other side, unfortunately for them. So the earlier that you can get on top of it for the earlier you can balance their hormones and go on the journey with them as they age and go through the different, you know, periods, in their lives, the better the prognosis and the better response they make to the hormones. [00:26:06][44.5]

Dr Louise Newson: [00:26:06] Yeah. I saw someone in my clinic yesterday who’s 30. She’s quite young, and she’d been diagnosed with PCOS, but only on a scan. It didn’t really show the classical. Just one of her ovaries was a little bit enlarged, but she’s got definite PMS or PMDD depending, and she’s responded really well just on a small amount of hormones. And she was worrying about what’s the diagnosis is. And I said, Well, actually it doesn’t really matter. I know she wanted to know, but whether she might have PCOS, she might be PMS. It doesn’t actually, well she has hormonal changes and all I’m doing is topping up her hormones. It’s not going to worsen her fertility. It might improve her fertility if she wants or when she wants to become pregnant. But it’s done in a very natural way. And increasingly, and I understand why younger people don’t want to have contraception, they know more about it. They know that they’re synthetic. And so knowing that there’s a choice, it’s not going to be contraception because the dose is low and it’s a natural hormone. But it doesn’t mean we can’t give these hormones to younger people, does it? [00:27:12][65.3]

Dr Rachel Jones: [00:27:12] No, it doesn’t. And I used to see women in the clinic who would come in with PMS. But actually when you explore and look at their symptoms in detail, they also have symptoms of either PMS or PMDD so, you know, quite debilitating psychological symptoms before their period. And actually they respond very well in my experience, to well, to progesterone again. So absolutely. And often I don’t know whether you found this as well that I find a lot of women’s symptoms of PMS and Pmdd start once they’ve been on the oral contraceptive combined pill for a significant period of time. So they never had it before. They go on the pill, they come off and then all the problems start moving forward for them. [00:27:51][38.8]

Dr Louise Newson: [00:27:52] Yeah, absolutely. And like I say, some of these people, especially when they’re young, they might only need for progesterone, they don’t always need all three hormones because they’re producing them themselves of course, aren’t they? [00:28:01][9.7]

Dr Rachel Jones: [00:28:02] Yes. Yeah, absolutely. For me, progesterone seems to be this wonder hormone that sort of like helps with all the conditions all the way through. And post-natal depression as well, progesterone is very effective in treating that too. So yeah, I think progesterone mustn’t be the forgotten and left behind hormone. It’s absolutely key in treating mental health in the context of hormone depletion or hormone imbalance. [00:28:25][23.6]

Dr Louise Newson: [00:28:26] Yeah, no that’s been so useful. It’s really good just to dig in a bit deeper actually. And like I say, some of it is so obvious, but often in medicine, we forget the most obvious things. Yeah, go for something more complicated. So I’m very grateful for your time Rachel. [00:28:40][14.0]

Dr Rachel Jones: [00:28:41] It’s a pleasure. [00:28:41][0.2]

Dr Louise Newson: [00:28:42] Before we end I always ask for three take home tips. So can I just ask you for three reasons why you think progesterone is such a great and important hormone especially in context of mental health? [00:28:54][11.6]

Dr Rachel Jones: [00:28:55] Because it seems to treat everything. It seems to help with everything. It helps with sleep, which we know can be so debilitating to mental health. It helps with anxiety. It’s a calming, soothing, natural antidepressant and it seems to be a buffer. So it sort of balances everything out. So it sort of changes throughout the menstrual cycle. It seems to balance out changes in mood, mood swings. It balances out anxiety, it calms down, it lifts mood. It seems to have an effect across the whole range of symptoms. That’s the first thing. The second thing I say about progesterone is don’t give up. So women become very disheartened. They often hear that progesterone is good for their mental health. They try to take it. They don’t react well to it. They give up and they say, that’s it, I can’t have it. So that would be the second thing. Don’t give up. And certainly don’t assume that synthetic progesterone and natural progesterone are the same thing because they’re not. And the other thing that I would say is consider progesterone throughout the lifespan. So not just for perimenopause, menopause, certainly not for just maintaining the lining of the womb, but from a mental health perspective. So all the way up PMS, PMDD, postnatal depression, perimenopause, menopause and out the other side. So consider it throughout the lifespan is what I would say. [00:30:19][84.3]

Dr Louise Newson: [00:30:20] Really great advice. So thank you so much. [00:30:22][2.3]

Dr Rachel Jones: [00:30:23] Thank you so much for inviting me. [00:30:24][1.6]

Dr Louise Newson: [00:30:29] You can find out more about Newson Health Group by visiting www.newsonhealth.co.uk and you can download the free balance app on the App Store or Google Play. [00:30:29][0.0]

ENDS

The post Natural progesterone: what mental health benefits can it bring? appeared first on Balance Menopause & Hormones.

• Perimenopause and menopause can be a lonely time of life
• Loneliness can be detrimental to your physical and mental health
• Discover ways of building up layers of connection

In today’s busy world, most of us are surrounded by people – be it at work, home, through social clubs or friendships, or caregiving or volunteering. And yet according to the Office for National Statistics, women (24%) are more likely than men (20%) to feel lonely at least some of the time [1].

When we think of loneliness, we often associate it as something that happens later in life, maybe an old person alone in a care home, or we’ll recall times as a child or a teen when feeling that no-one “got you” was part of the norm. It can be perfectly possible to feel lonely, and it’s something that even social butterflies or successful businesswomen experience. Being surrounded by people is no barrier to feeling lonely.

Is loneliness bad for you?

Make no mistake, spending time alone and enjoying your own company is perfectly healthy – sometimes there’s nothing nicer than shutting the doors on the outside world. But if you feel lonely, that’s been shown to have detrimental effects on your physical and mental health.

Social isolation has been found to rival smoking, obesity and physical activity in terms of increasing risk of premature death [2]. It’s also associated with a 50% increased risk of dementia, plus higher rates of depression, anxiety, and suicide [3].

RELATED: Am I depressed or menopausal?

Even if you are not socially isolated – you have people in your life but still feel lonely – this can have a negative effect on your health, especially during the menopause.

Why can menopause make you lonely?

Midlife can be a liberating, freeing period of life full of possibility and change. If you have children, they may be older and require less of your time; you might be flourishing in your job and feel secure in your relationships. On the other hand, it can also be a time of loss – an empty nest if your children move away, you may have elderly relatives who need care or struggle with their health, and if you’re entering the menopause, you may feel a sense of loss over your fertility or overwhelmed by what the next chapter of life might bring.

RELATED: How do I cope with grief during menopause?

Perimenopausal and menopausal symptoms can be challenging. Some women find their mood dips or they have increased feelings of anxiety or irritability. Symptoms can have a knock-on effect on your relationships – with your partner, friends and family, and at work. This can lead to a loss of confidence and you may feel others don’t understand what you’re experiencing. Conversely, it’s been found that as women’s levels of loneliness increase, so too do their menopausal symptoms [4].

How can I tackle my loneliness?

Acknowledging you feel lonely can help – understand that it’s not a reflection on you as a person but is about your circumstances. Consider what’s at the heart of your loneliness.

For some women, it’s menopause itself. In the Department for Health and Social Care’s ‘Women’s Health – Let’s Talk About It’ survey of nearly 100,000 people in England, less than 1 in 10 participants said they have enough information on menopause (9%) [5].

The free balance app is full of resources to help you track and learn about your symptoms. There are also community pages – just knowing other women are experiencing similar things can help you realise you’re not alone.

The same government survey also found that 70% are comfortable talking to friends about the menopause, and 64% are comfortable talking about it with healthcare professionals (compared to 61% with family members). These conversations can help you build up a circle of support.

If your relationship with your partner is a contributing factor to your loneliness, consider if you’ve grown apart or any reasons you might not be connecting. Some couples bond over shared caring commitments of children but then when the children leave home, discover they don’t have as much in common. Your partner also may not understand how your menopausal symptoms can affect you – and they can’t be expected to know unless you tell them!

RELATED: Emotionally supporting each other through the menopause

Similarly, friendships can take work, and that can feel hard when you’re not feeling your best. If you’re feeling lonely, consider your closest relationships. Robin Dunbar is a biological anthropologist and founder of Dunbar’s number, a theory about the number of social relationships a person can maintain. His research suggests most people have an inner circle of five people, usually made up of family members and up to two or three close friends. These relationships need investment to help them to thrive. If you’ve lost contact with a friend and their friendship is valuable to you, pick up the phone or send them a message. It can be tricky to socialise if you’re not feeling your best but you don’t have to be the life and soul of a night out – a walk with a friend can be beneficial for both of you.

RELATED: Friendships and menopause: how conversations can be transformational

According to Dunbar’s theory, we have successive layers of friends, contacts, acquaintances, and people you recognise. These require less work but they can still be of value in combatting loneliness. Saying hello to a neighbour as you walk your dog in the morning, for example, is a connection.

Consider joining a group to help to help find a sense of purpose and of belonging. It might be an exercise group or starting a new hobby or joining a committee at work. Think of your midlife as a time to discover yourself – it’s OK to question who are. What might you like to do or try now?

RELATED: Why menopause can be your second spring

References

1. NHS Health survey for England 2021

2. National Academies of Sciences, Engineering, and Medicine. 2020. Social Isolation and Loneliness in Older Adults: Opportunities for the Health Care System. Washington, DC: The National Academies Press. https://doi.org/10.17226/25663.

3. National Academies of Sciences, Engineering, and Medicine. 2020. Social Isolation and Loneliness in Older Adults: Opportunities for the Health Care System. Washington, DC: The National Academies Press. https://doi.org/10.17226/25663.

4. Bayri Bingol, F. , Demirgoz Bal, M. , Yilmaz Esencan, T. , Ertugrul Abbasoglu, D. & Aslan, B. (2019), ‘The Effects of Loneliness on Menopausal Symptoms’, Clinical and Experimental Health Sciences, 9(3) 265-270. doi:10.33808/clinexphealthsci.533511

5. Gov.uk: Results of the Women’s Health – Let’s Talk About it Survey

The post Loneliness and menopause appeared first on Balance Menopause & Hormones.

Advisory: this article contains themes of mental health and suicide.

Newson Health’s new research on absorption, highlighting that some women need higher doses than others for adequate absorption through their skin, can be found here.

It’s taken me 17 years to learn how to manage my menopause symptoms. At 33, I began to feel exhausted, my body ached, I couldn’t think clearly, and I began to experience premenstrual syndrome (PMS). I went from being a hardworking, active woman, regularly travelling around the world as part of my job as a geologist to being completely debilitated.

I was diagnosed with chronic fatigue syndrome (CFS) but over the following year, I developed acne, blinding headaches, tinnitus, skin that was so itchy I would scratch it until it bled, palpitations, UTIs, allergies and my PMS escalated. My periods changed to a 21-day cycle and were so heavy I thought they resembled what the collapse of the Hoover Dam might look like.

My GP diagnosed perimenopause, and I was told if I wanted children, I’d need to get a move on. Fertility tests revealed I had premature ovarian insufficiency (POI) and through IVF, my husband and I successfully conceived our beautiful baby girl.

When I was 41, my headaches became worse and were accompanied by visual disturbances and vomiting. One time I abruptly became unwell with a migraine whilst on holiday in Wales – I threw up in a shop doorway and had to return to the campsite to be looked after by my four year old. By my mid-40s, I had a migraine for 16 days out of every month.

My mental health began to suffer. I’d been struggling with postnatal depression and PTSD after a traumatic birth and the depth of despair during PMS episodes was so uncontrollable it greatly impacted my ability to function.

RELATED: Postnatal depression, PMDD and menopause: Wendy’s hormone journey

RELATED: All about progesterone: PMS, PMDD, postnatal depression and menopause

During this time, I had retrained as a teacher, so life was stressful. I had also relocated so had attended a different doctor’s surgery – my GP never talked about perimenopause, instead I was given antidepressants. Eventually I was referred to a gynaecologist who suggested a drug to quieten down my ovaries – it left me so exhausted I wasn’t able to function, and the migraines became worse.

My blood pressure was high and I experienced my first major palpitation, whilst I was teaching. My colleague took me to the hospital where I had an ECG. Again, this was put down to stress.

After charting my migraines and discovering a cyclical pattern, I learned about the link with menopause and joined the dots. However, my GP didn’t agree as I wasn’t experiencing hot flushes.

RELATED: Migraines and menopause: what’s the connection?

In January 2020 I saw a locum GP who got it straight away. She prescribed HRT: 40mcg of Elleste Solo HRT patches and a progesterone tablet. It dramatically reduced my symptoms. However, this only lasted a couple of months, so my dose was increased to 80mcg of Elleste Solo patches.

During the summer of 2020 I was advised to stop HRT because I wasn’t experiencing hot flushes. After I stopped, I did experience hot flushes, so HRT was re-implemented.

I plodded on and between 2021 and 2022, my symptoms began to ramp up and I became extremely anxious. My career as a teacher, in a high pressure, high workload environment exacerbated the situation, but I felt like I was going insane. I thought I was having a breakdown and was signed off work for two weeks.

However, a week into the crisis, the acute anxiety and depression flicked off like a switch. I was suddenly normal again. It lasted for about three days, before the next cycle began. I had no doubt what I was experiencing was hormonal in nature. I asked my GP if I could be referred to a menopause specialist and asked about more HRT but was told that 80mcg was the highest possible dose and that I could not have vaginal HRT and transdermal HRT patches together. When they asked what I hoped to achieve by seeing a menopause specialist, I realised that I wasn’t going to get the support I needed so I turned to a private menopause clinic.

RELATED: HRT doses explained

The day I had my appointment at Newson Health in Easter 2021 was a moment of recognition and hope. I was clinging onto my life, career and sanity. After talking about my symptoms, I was prescribed 100mcg Estradot, testosterone and vaginal oestrogen (I already had the Mirena coil for my progesterone).

Within two weeks, I felt so much better, almost superhuman. I bounced back like Zebedee and was myself again for the first time in a decade. But it didn’t last. After a couple of weeks, the migraines and low mood began to re-emerge. I contacted the specialist who went through my symptoms and recommended increasing the HRT dose. I gradually reached a dose of 150mcg and remained well for several months. I went on holiday without struggling with symptoms and I climbed a mountain for the first time in ten years.

I began the new school year with vigour but in October 2021, I had a mental health crisis that resulted in more time off work. This time, however, I had immediate access to my Newson Health specialist who was brilliant. She recommended lowering my HRT dose over several months to ensure the mental health symptoms I was experiencing were not due to having too much oestrogen.

My GP recommended I take an antidepressant. It was horrific – I was anxious, jittery, and couldn’t sleep. I decided to stop when I started hallucinating.

RELATED: Am I depressed or menopausal?

My symptoms appeared to be uncontrolled, and I felt like I couldn’t do my job. I was concerned that if I didn’t take action to reduce the distress I was experiencing, I may have taken my life, so I resigned from my teaching role.

After investigating my HRT dose and testing absorption, it was decided that I needed more oestrogen, and my dosage was slowly increased. I began to get closer to myself again.

For the remainder of 2022, my medication was periodically optimised by Newson Health and I got better and returned to teaching part-time and an active lifestyle.

In 2023 the financial pressures of private care and the introduction of the HRT prescription prepayment certificate (a one-off prescription fee giving annual access to HRT at a reduced cost on the NHS in England), led me to transition my treatment back to the NHS. My GP expressed concerns about my HRT dose – I was on 350mcg oestradiol patches – and ordered an oestradiol blood test. The test showed that my levels were in the normal range so although I was on a higher dose, I still wasn’t absorbing it all.

My doctor’s surgery said it was seeking guidance on my dose as it was above the licensed levels. My prescription was reduced without consultation – I only discovered the change when I picked up my prescription in May 2024.

I raised concerns about the potential impact of this reduction on my mental health, including the risk of suicidal ideation, and was referred to the gynaecology team. They advised against the drastic reduction in my dose, initiated further tests, including a womb scan and DEXA bone density scan, and confirmed that I was a poor absorber of transdermal HRT. They recommended continuing the 350mcg dose.

However, my surgery refused to prescribe it, citing concerns that this would place their clinicians outside of NICE guidance, which could invalidate their medical insurance. This was frustrating as

NICE guidelines acknowledge that some women with POI may require high doses of HRT for symptom relief. Both private and NHS specialists had recommended a course of treatment that works for my individual circumstances, yet I was having to fight to receive it.

The financial burden of private treatment, combined with the loss of earnings due to sick leave and reduced hours, has left me in significant debt totalling tens of thousands of pounds.

Thankfully, I’ve now been referred to secondary care in the NHS and they are prescribing the agreed dose of oestrogen. I believe 350mcg is the optimum dose for me. I might still have the odd fluctuation of hormone levels, but I can recognise the signs when I need extra oestrogen, which I can apply through my pump pack. These fluctuations are becoming less frequent as I get older and I know I can call my specialist so I’m not alone anymore.

I am living again – I’m achieving things outside of my career that I could only have dreamed of, I’m a much more energetic and engaged mum, and am trying to make as much noise as I can about the impact of menopause.

Contact the Samaritans for 24-hour, confidential support by calling 116 123 or email jo@samaritans.org.

RELATED: What is the right dose of HRT for you? Hormones and premature ovarian insufficiency

Resources

Newson Health: HRT is not a “one size fits all” treatment

Glynne S., Reisel D., Kamal A., Neville A., McColl L., Lewis R., Newson L. (2024), ‘The range and variation in serum estradiol concentration in perimenopausal and postmenopausal women treated with transdermal estradiol in a real-world setting: a cross-sectional study’, Menopause. DOI: 10.1097/GME.0000000000002459

The post ‘Specialists agree I need higher dose oestrogen, so why has it been such a fight?’ appeared first on Balance Menopause & Hormones.

With all the organisation that goes into creating the ‘perfect’ Christmas day, the pressure to keep family and friends happy, and the financial burden of paying for the festivities, it’s unsurprising that December can be a stressful time of year.

Add in the hormone changes and symptoms such as low mood, anxiety, fatigue and hot flushes that can occur during perimenopause and menopause, and things can soon feel overwhelming.

So, how can you protect your wellbeing this Christmas? Here, we offer some tips on thriving during the festive season.

RELATED: Menopause and mental health: wellbeing at Christmas

Consider your relationships

Christmas is a time for family to gather but this in itself can be stressful. A survey by counselling charity Relate found that 70% of UK adults said they were worried that Christmas put extra pressure on their relationships [1].

Your perimenopause and menopause may also bring additional stressors to your relationship. Menopause has a clear and negative impact on divorce, separation and relationships – a survey of 1,000 women found that more than seven in 10 women (73%) who responded blamed menopause for the breakdown of their marriage [2].

RELATED: Read more about our menopause and divorce survey here

Relate advises you to have conversations with your family and friends about everyone’s expectations of Christmas well in advance. That way you can deal with any difficult demands and make compromises that suit everyone.

How to diffuse or avoid family arguments

If you have a house full of guests and tempers are starting to fray, suggest leaving the house for a walk to break things up a little. This gives everyone the chance to chat to someone different, or even to stay at home if tension is building.

Rebecca Lewis, GP and menopause specialist at Newson Health, says talking about your menopause with your loved ones can help. ‘During perimenopause, you may feel detached and isolated even among your friends and family,’ says Dr Rebecca. ‘Talk to them about what you are experiencing, and explain that it is caused by your hormones changing. This can really help people to understand and respond with empathy.’

RELATED: HRT: Is a repeat prescription on your Christmas to-do list?

Take the pressure off

The notion that Christmas must be ‘perfect’ means you can heap extra pressure upon yourself.

‘We can often feel overloaded by this pursuit of Christmas having to be incredible,’ adds Dr Rebecca.

‘But if your brain is feeling a bit foggy due to perimenopause, and you’re also working, and thinking about all the presents that you need to get, and stocking up on all the food needed, and ensuring the house is ready for guests, you may not be feeling very joyful. It is no wonder we can feel overloaded – it is such a barrage.’

Simple steps can help make your Christmas overload and menopausal symptoms more manageable.

Set realistic goals, try to get some exercise outdoors every day, delegate jobs to others and do one thing at a time, Dr Rebecca says. ‘Take time to do the things that help you. That might be some yoga, practicing mindfulness, a few minutes to meditate or go for a dog walk.’

Also suggest to friends and relatives this Christmas could take a simpler approach. ‘After all, it is your Christmas as well and you should be able to enjoy it,’ says Dr Rebecca.

Alcohol and hot flushes

It may be the season to eat, drink and be merry, but Dr Rebecca advises being sensible when it comes to alcohol. ‘While reaching for a drink feels the right thing when stressed, it often increases tiredness by disrupting sleep, can make hot flushes worse, increases anxiety and lowers mood,’ Dr Rebecca says.

About 80% of women will experience hot flushes [3]. The exact cause of hot flushes isn’t known, but it is thought to be related to changing oestrogen levels impacting on the areas of the brain involved in maintaining temperature [4].

In addition to alcohol, there is some evidence that spicy foods and caffeine can also exacerbate hot flushes, which is worth bearing in mind during the festive period.

Manage anxiety

Falling levels of oestrogen and testosterone in your brain can increase your anxiety. This can make socialising and planning Christmas events harder, especially as your confidence may have dipped, says Dr Rebecca.

If you’re finding this Christmas hard, you might not realise your anxiety could be linked to menopause. ‘Perimenopause and menopause can really affect your self-esteem and confidence, and bring feelings of paranoia,’ says Dr Rebecca.

Pause to think if the way you are feeling could be menopause related. If you’re unsure, use the symptom tracker on the balance app to record how you are feeling, and take this information with you to a healthcare appointment.

Being aware of the issue and informing your friends and family can help. ‘Involving others can help, so be open if you are struggling,’ says Dr Rebecca.

RELATED: Why is the menopause so stressful?

Prioritise your sleep

Get enough good quality sleep is important over the busy Christmas period. Sleep boosts brain power, immunity, heart health and curbs hunger hormones.

But during perimenopause and menopause, declining levels of hormone can have a significant impact on sleep. Some women find it difficult to fall asleep when they go to bed, others struggle to stay asleep for long periods and wake frequently during the night, never feeling they have gone into a deep sleep, while some women find they wake up way too early every morning and can’t drift back off.

Having a regular evening routine, going to bed at the same time, even during Christmas, can help, as can keeping your bedroom cool. HRT will improve perimenopause and menopause symptoms such as night sweats and urinary symptoms like frequent urination, which can in turn improve your sleep.

RELATED: Sleep and hormones factsheet

Resources

Relate

References

1. Relate, ‘Sex at Christmas’

2. Menopause puts final nail in marriage coffin

3-4. Deecher, D.C., Dorries, K. (2007), ‘Understanding the pathophysiology of vasomotor symptoms (hot flushes and night sweats) that occur in perimenopause, menopause, and postmenopause life stages’, Archives of Women’s Mental Health, 10 (6) pp.247–57. doi.org/10.1007/s00737-007-0209-5

The post How to cope with Christmas and menopause appeared first on Balance Menopause & Hormones.

• Navigating emotions during hormonal changes and grief
• Why processing grief is so important
• Approaches to dealing with grief and accessing support

Perimenopause and menopause can be a challenging time in your life but if you’re also grieving, it can be particularly tough. You might feel you need to be strong for your family or feel so floored by your emotions and your menopausal symptoms, you’re not able to see the wood for the trees.

Leading psychotherapist Julia Samuel MBE, author of Grief Works, says: ‘Perimenopause and menopause are times of transition, where you’ll need to psychologically adjust to a new phase of your life. If a significant person in your life dies at this time, it can rock an already wobbly system. You are grieving while experiencing a living loss. This is an important context, because often women feel they are “doing it wrong”, but acknowledging the level of loss you are facing is an important factor in supporting yourself.’

Julia says it is important to take your physical and mental needs seriously. ‘The support you receive at the time of the death and following the death is the single most important factor in your capacity to grieve effectively. This means you need to give yourself permission to support yourself, and not pour all your energy into supporting everyone else.’ 

RELATED: Emotionally supporting each other through the menopause

How do I know if how I’m feeling is due to grief or menopause?

Grief cannot be fixed. However, perimenopausal and menopausal symptoms can be managed and improved with individualised treatment. Seeing a healthcare professional can help with this.

Some women find it difficult to pinpoint if their feelings – of sadness, hopelessness, anger, numbness, etc – are due to grief or menopause. Psychological symptoms are common during menopause common – in a Newson Health survey of 5,744 women, 95 per cent of respondents said they’d experienced a negative change in their mood and emotions [1]. There is also a significant increase – approximately three times higher – in the likelihood of depressed mood during the perimenopause and menopause than in other life stages [2]. 

If you’re overwhelmed by your emotions but unsure of the cause, consider if you’ve had similar symptoms in the past? How did you used to feel before your periods, or when you were pregnant, in times of hormonal fluctuations? Alongside your emotional symptoms, do you have physical symptoms, such as hot flushes, dry skin, palpitations, genitourinary symptoms? These don’t usually occur due to depression or grief.

However, it is possible to be menopausal and grieving, and you can have a bodily reaction to your grief. This is why it’s important to track symptoms and share this with your healthcare practitioner. Sometimes grief can lead to clinical depression but there are subtle differences between low mood due to menopause and clinical depression. In general, women who experience hormonal low mood, know how they are feeling isn’t right – they have insight and want to feel better. With clinical depression people tend not to have that insight nor care about how they feel. Your healthcare professional will be able to help you explore your emotions and possible diagnoses.

RELATED: Am I depressed or menopausal?

How can I handle my grief?

Julia stresses that grief is not something to fight and there is no one single approach to coping with grief. Here are some of Julia’s suggested strategies to consider:

Get support

‘We need to allow grief to process through us, and it is often experienced as waves of pain crashing through us. In order to withstand those waves, you need to access support. Support will look different for different people but it needs to include time to focus on your grief. You need time to feel the pain and face the reality of the person’s death. This could be with a friend, a family member, a therapist, or with the Grief Works app. Or all of them. It helps to create structure around it, so perhaps block out time to walk and talk to a friend. Or create a habit of journalling after exercise in the morning. If you can only manage small bites of support, connect with people who love you. When the person you love dies, it is the love of others that enables you to survive.’

RELATED: Families, relationships and the power of connection with Julia Samuel

Regulate your body

‘Choose to do things that help regulate your nervous system, because grief often feels like fear. This includes taking regular exercise (by this I mean moving your body, not running a marathon!) and remembering that whatever you do, who you see, what you watch, what you eat, what you drink, how much you sleep, all has an impact on your capacity to regulatory effect. And get outside for a walk, run, bicycle.’

Feel the pain

‘Grief is a tidy word that describes a complex and messy process. The task of mourning is to face the reality of the death, to let yourself know that the person has died, that their death is irreversible. Unfortunately, the mechanism for that is allowing yourself to feel the pain – pain is the agent of change. The model that is helpful to think about is the dual process: loss orientation where we, cry, emote, express our pain and then oscillating to restoration orientation where we have a break from the pain, do tasks, allow ourselves to be distracted, get on with life. Recognising the movement between the two orientations is helpful. Allow time for both.’ 

Accommodate your loss

‘Whilst culturally people often think of grief as something to ‘get over’, what we understand now is that we don’t get over someone’s death. Instead we learn to live with it, to accommodate the loss into our life. Which means we build our life around the loss. The intensity of the pain changes, grief is naturally adaptive so we have the capacity to live and love again, but we may find a wave of grief wash over us many decades after the loss.’ 

RELATED: Loneliness and the menopause

Create touchstones

‘The other important understanding is that the person we love has died, and we need to adjust to their physical absence. But our love for them never dies. Our love continues, and we have touchstones to memory that keep the person connected to us. These touchstones may be writing to the person, wearing something of theirs or cooking their favourite recipe. Creating a playlist in memory of your person can be helpful, or lighting a candle in their memory. I find that people instinctively know what to do once they have the idea of continuing bonds, and touchstones to their memory.’ 

Find hope 

‘My final thought is that hope is the alchemy that turns a life around. Hope isn’t just a feeling, it is a plan A and a plan B, and the belief we can make it happen. Picturing how you want to live your life now, whilst accommodating the person’s loss, will help you get there.’ 

RELATED: How friends can ease your menopause

Julia Samuel is a leading psychotherapist and author of Grief Works: Stories of Life, Death and Surviving. Her app, Grief Works, was created to help navigate grief after the death of a loved one.

References

1. Experiences of the perimenopause and menopause, December 2022
2. Freeman EW. Associations of depression with the transition to menopause. Menopause. 2010;17(4):823-827. doi: 10.1097/gme.0b013e3181db9f8b

The post How do I cope with grief during menopause? appeared first on Balance Menopause & Hormones.

• Up to 70% of women say irritability is their main mood complaint during perimenopause
• Fluctuating levels of oestrogen, progesterone, serotonin and cortisol affect your brain
• You may not be to blame for angry outbursts or simmering rage

Emotions can run high during perimenopause and menopause. Some women find they’re more teary than usual, others fearful, and some can feel full of rage. In a Newson Health survey of almost 6,000 women, an overwhelming 95% of respondents said they’d experienced a negative change in their mood and emotions so if you’ve been feeling angry or irritable, you’re not alone [1].

It’s worth highlighting this as anger is an emotion that many women are uncomfortable feeling. You might be surprised by your outbursts – especially if they’re triggered by something trivial or targeted at loved ones – or feel that you don’t recognise yourself and worry that this is the new you. Anger can also present itself in different ways. You might feel irritable – one piece of research found irritability was the primary mood complaint for up to 70% of women during perimenopause [2] – or experiencing a sudden red mist and loss of control.

Understanding what’s happening in your brain during perimenopause and menopause can help – it can be reassuring to know there are reasons behind your mood instability.

RELATED: Menopause, depression and anxiety

What causes anger during the menopausal period?

There can be very real, legitimate reasons to feel angry at this time of life. However, there are also physiological changes that contribute to an increase in irritability and anger.

Demands of life

Psychotherapist Jennifer Cox says: ‘Women at this point of life have reached peak pressure in terms of the demands expected of them. I see many women grappling with the emotional demands of taking care of teenagers combined with the need to care for the older generation. Working lives too can be fraught with frustration and disappointment at this life stage. Workplaces have typically not provided the most supportive environment for women through their menopause experience. Sadly, many women decide to duck out early, because it’s all just too much to manage. It’s an example of women being told that they are the problem, rather than society figuring out ways of supporting her. Women can begin to view their bodies as somehow failing them, once menopause symptoms kick in.’

The influence of hormones

During perimenopause, levels of the hormones oestradiol, progesterone and testosterone fluctuate, before lowering in menopause and staying low after. The correlation between oestradiol levels and serotonin, which is commonly known as the “feel-good hormone”, is well established [3]. Serotonin helps to regulate mood – when serotonin levels are balanced, you are more emotionally stable, focused and calm. So, when oestradiol and serotonin levels are reduced, you can feel more irritable (or down).

Research has also shown that serotonin levels affect the brain’s response to anger. A study found that fluctuations of serotonin levels affect brain regions that enable you to regulate anger [4].

The amygdala is the emotion centre of your brain – it processes fear, identifies threats, and motivates you to respond to any threat and anger can be a response to a perceived threat. The prefrontal cortex is responsible for executive brain functions such as decision making, judgment and impulse control. The study showed low levels of serotonin made communications between these regions weaker than normal. The hormones oestradiol, progesterone and testosterone all have important roles in the amygdala as well as other areas of the brain.

The amygdala is rich in hormone receptors. Lisa Mosconi, a neuroscientist and author of The Menopause Brain, has described perimenopause – when oestradiol levels fluctuate – as a time when mixed messages are sent to the brain, a sort of misfiring. This can prompt mood changes, including rage, irritability and tearfulness.

RELATED: The menopause brain: why it might be feeling strange and what you can do about it

The effect of cortisol

Cortisol, often referred to as the “stress hormone”, can fluctuate during perimenopause and menopause and can be linked to anger.  These fluctuations in cortisol levels can lead to various emotional changes, including increased irritability and anger. Low hormone levels, especially progesterone, can lead to higher levels of cortisol in the body.

Studies have looked at what happens to cortisol during menopause, and findings include:

• Cortisol levels increase 20 minutes after vasomotor symptoms (hot flushes and night sweats) [5]
• Cortisol levels rise among some women during the late stage of the menopausal transition [6]
• Cortisol levels increase overnight as women through perimenopause and menopause. [7]

Our hormones are closely linked, the fall in oestradiol, progesterone and testosterone levels during menopause can lead to higher cortisol levels, which may exacerbate stress and mood swings. Lack of sleep, poor diet, chronic stress and certain medical conditions can also cause cortisol imbalances, which then further exacerbate feelings of anger and aggression [8].

RELATED: Why is the menopause so stressful?

What about GABA?

Gamma-aminobutyric acid (GABA) is a neurotransmitter (a chemical messenger) that soothes the nervous system. It has a calming effect and promotes the release of endorphins. Progesterone’s interaction with GABA receptors play a significant role in mood regulation.

What can I do about my anger?

Realising that your hormonal fluctuations can have such a disruptive effect on your brain can be reassuring. HRT, often with testosterone, the first-line treatment for menopausal symptoms, can help to even out these big fluctuations by replacing the missing hormones and improve mood symptoms.

Jennifer says it’s important to take your feelings seriously – to explore them rather than internalising and burying them. ‘There are several ways of doing this. You can begin with the absolute basics: Are you tired? Hungry? Did you say yes when you meant no? Do you have any time for just yourself? What do you enjoy doing anyway (at this point in our lives, we’ve often forgotten)?

Practice self-compassion and look after your wellbeing. Take time to discover what relaxation techniques work best for you – some women find mindfulness helpful, or you might prefer yoga or Pilates.

Jennifer recommends walking: ‘It’s great for processing and working through your feelings, and you can probably factor it into your day more easily than other forms of exercise. Get used to saying, ‘I’m going for a walk to clear my head.’ Ringfence your walking time as the space you allow yourself – whether something’s just happened to anger you, or whether you need to think about a wider area of your life which might need to change.’

A healthy, well balanced diet, regular exercise and getting enough rest can all help to manage your physical and mental health.

Jennifer Cox is a psychotherapist and author of Women Are Angry, available now (Lagom).

References

1. Experiences of the perimenopause and menopause, December 2022
2. Born L., Koren G., Lin E., Steiner M. (2008), ‘A new, female-specific irritability rating scale’, J Psychiatry Neurosci, 33(4) pp344-54.
3. Bendis P.C., Zimmerman S., Onisiforou A., Zanos P., Georgiou P. (2024), ‘The impact of estradiol on serotonin, glutamate, and dopamine systems’, Front. Neurosci., 18, https://doi.org/10.3389/fnins.2024.1348551
4. Passamonti L., Crockett M.J., Apergis-Schoute A.M., Clark L., Rowe J.B., Calder A.J., Robbins T.W.. (2012), ‘Effects of Acute Tryptophan Depletion on Prefrontal-Amygdala Connectivity While Viewing Facial Signals of Aggression, Biological Psychiatry, 71 (1) pp36-43, https://doi.org/10.1016/j.biopsych.2011.07.033
5. Meldrum DR, Defazio JD, Erlik Y, Lu JK, Wolfsen AF, Carlson HE, et al.. Pituitary hormones during the menopausal hot flash. Obstet Gynecol. (1984) 64:752–6.
6. Woods NF, Mitchell ES, Smith-Dijulio K. Cortisol levels during the menopausal transition and early postmenopause: observations from the Seattle Midlife Women’s Health Study. Menopause. 2009 Jul-Aug;16(4):708-18. doi: 10.1097/gme.0b013e318198d6b2.
7. Woods N, Carr MC, Tao EY, Taylor HJ, Mitchell ES. Increased urinary cortisol levels during the menopausal transition. Menopause. 2006;13:212–221. DOI: 10.1097/01.gme.0000198490.57242.2e
8. Kajantie, E., & Phillips, D. I. (2006). The effects of sex and hormonal status on the physiological response to acute psychosocial stress. Psychoneuroendocrinology, 31(2), 151-178. https://doi.org/10.1016/j.psyneuen.2005.07.002

The post Why menopause can make you angry appeared first on Balance Menopause & Hormones.

Content advisory: this podcast contains themes of mental health and suicide

Joining Dr Louise on the podcast this week is Linda Gask, retired psychiatrist and author of new book Out of Her Mind: How We Are Failing Women’s Mental Health and What Must Change.

In her book, Linda draws on the lived experiences of women, alongside expert commentators, recent history, current events, and her own personal and professional experience to look at women’s mental healthcare today.

Dr Louise and Linda discuss the challenges women face in accessing mental health treatment, the importance of understanding the impact of hormones on women’s mental health, and the need for women to be listened to.

Find out more about Linda’s book here.

For more information on Newson Health, click here.

Dr Louise Newson’s first-ever live theatre tour, Hormones and Menopause – The Great Debate, runs until 12 November. For more information and tickets, click here.

Contact the Samaritans for 24-hour, confidential support by calling 116 123 or email jo@samaritans.org.

Transcript

Dr Louise Newson: [00:00:11] Hello. I’m Dr louise Newson. I’m a GP and menopause specialist, and I’m also the founder of the Newson Health Menopause and Wellbeing Centre here in Stratford-upon-Avon. I’m also the founder of the free balance app. Each week on my podcast, join me and my special guests where we discuss all things perimenopause and menopause. We talk about the latest research, bust myths on menopause symptoms and treatments and often share moving and always inspirational personal stories. This podcast is brought to you by the Newson Health Group, which has clinics across the UK dedicated to providing individualised perimenopause and menopause care for all women. So many of you know, I’m really interested in the brain. I’m very interested in mental health. And it wasn’t until I started to do as much work as I do with hormonal health, I realised the association between hormones and the brain and also just how many women are affected with different mental health conditions and often find it really difficult to get treatment. So I’m very privileged and honoured to have with me today a psychiatrist who actually is from Manchester, which is where I trained, so another coincidence. And so Linda is someone I reached out to on Twitter, I think. So Linda Gask was a consultant psychiatrist, NHS consultant, academic, and has written a book, which is incredible. Everyone needs to have a read, but be quite shocked when you read as well. So really honoured that you’re here on the podcast. So thanks for joining me today, Linda. [00:01:55][104.7]

Linda Gask: [00:01:56] Thanks for asking me. [00:01:57][0.8]

Dr Louise Newson: [00:01:58] So I read something on Twitter about your work and then I saw that you had a book coming out, and I think I just messaged you on Twitter. And then we had a great conversation, didn’t we? [00:02:06][8.9]

Linda Gask: [00:02:07] We did. Yeah. [00:02:08][0.7]

Dr Louise Newson: [00:02:09] So your book that’s just come out is called, it’s quite a long title, but every word is really important. So I’m going to read it out. It’s entitled Out of Her Mind: How We Are Failing Women’s Mental Health and What Must Change. Really powerful. So tell me a bit about why this is so important and what led you to write this book? [00:02:36][27.1]

Linda Gask: [00:02:37] Well, I’ve had my own mental health problems over the years, and I’ve written about those, and I’ve spent most of my career actually caring for women because my particular interest was in common mental health problems, anxiety and depression. And so I’ve very much worked with women and done quite a bit of psychotherapy with women as well. And when I was younger, I was really very determined that we were going to do something to really change things for women’s mental health. It was the 1980s when I started training as a psychiatrist, and now towards the end of my career when I retired, I looked back and I thought, Do you know, things haven’t really changed very much for women in that time. In fact, in some ways they’ve actually gone backwards. And it was quite shocking to start researching this book and realise that young women are going through, I think, worse things than I went through when I was growing up. Women’s mental health remains a kind of hidden problem because the whole kind of narrative about mental health at the moment is about suicide, which is very, very important. But that’s something which is much more common in men. And women get very depressed, suffer and take their own lives. And a lot of their problems are related to relationships and the families and the struggles that we have in life. And yet we don’t get the same attention and concern. I think because we survive. Many women, far more women than men, harm themselves. But very often our problems are just not taken very seriously. We’re viewed as though we’re overreacting or making a big fuss or not asking for help in the right kind of way. And so… [00:04:42][125.3]

Dr Louise Newson: [00:04:43] And that’s gone on for centuries thought, hasn’t it? [00:04:45][1.4]

Linda Gask: [00:04:46] Yes, it has. I mean, you know, this was happening in the 19th century in Vienna when women were presenting with hysteria and no-one was really asking or considering even the things like abuse might be happening to them. But they were. So many women, women have far more problems with anxiety, depression, post-traumatic stress disorder, many more of those kind of problems. And a lot of that is related to the difficulties that we have in our lives right from childhood through having far more exposure to abuse than boys and men. The struggle… women are the people who hold families together. Women are subject to a lot more comments about our appearance. We have to behave in a certain way. Talking to young women, it was quite shocking to find out how much they’re still expected to conform when, you know, in the 70s, when I was growing up, I was determined that we were not going to conform. You know, we were going to be able to do woodwork just like the boys. Okay, we can do the woodwork now, but we still have to wear the right clothes and we still have to look the right way. And it’s even worse because if we don’t do the right things, people on social media are talking about us and bullying us. And those are the kind of problems that young women are still facing. [00:06:10][84.7]

Dr Louise Newson: [00:06:12] Which they didn’t have before, did they? [00:06:13][1.4]

Linda Gask: [00:06:17] No,exactly. And I’ve always been a feminist, but there was some aspects of feminism. I think feminism kind of hasn’t moved on in the way it views women’s mental health problems. I don’t think it’s taken sufficient account of biology very much in the way that, you know, your work around menopause. Traditional feminist approaches were around hormones were that, women were hormonal, we were written off for being hormonal. But actually hormones matter and our bodies matter. And it isn’t just… I think too often our suffering is written off and not only by men, but by women, too. So I set about writing the book and interviewing a lot of women who were kind enough to share their stories with me. And I checked out whether they were happy with what I’ve written. And so there’s a lot of real women’s stories in the book. [00:07:14][57.4]

Dr Louise Newson: [00:07:15] Which is so powerful because I think as a healthcare professional, I still see every day that I work as a privilege to have women, men, but mainly women in my work now who come from all walks of life. And they often tell you things that they’ve never told anyone before and they have complete confidence in us. But you hear things that you’ll never hear anywhere else, and it’s quite revealing, but also quite shocking as well. And I was very lucky. I trained in psychiatry in in Manchester and I trained in North Manchester. So in Crumpsall. So it was a very deprived area. But we had this extended case that we had to write. And I remember the lady so well and I’ve still got the project that I wrote up. So she had an eating disorder, she had bulimia, she had really bad teeth. And she came because she had anxiety, she had depression. And so the consultant said she’d be a really good person. And we had like an hour to take a history, which is such a long time compared to hospital medicine. So I could really talk to her but after half an hour, she’d told me about her bulimia, she’s told me about her teeth. She told me that she was anxious and I thought, I don’t know what else to ask. I’ve got an hour. So I said, Is there anything else that’s ever happened to you or anything else you want to talk to me about? She said, Well, there is actually. She said, I was abused as a child by my stepfather and I’ve never told anyone about it since that time. And then it all came out. So then my project was actually about eating disorders and abuse and association. But what taught me then really young as a young medical student was that it’s the unexpected that you get from people. It’s giving them time, making them feel safe. And then what you hear is not what you expect. And I use these techniques quite a lot still in my clinical practice because it’s very easy to get the top line, isn’t it? But it’s what’s underneath and what’s associated. And actually I could just watch her shoulders go down a few inches because she’d shared her story… because I couldn’t treat her. I wasn’t able to prescribe. I was only a medical student. But what I could then do is talk to her. She gave me permission, of course, I could speak to the consultant and her whole treatment was very different. I thought, Gosh, this is incredible that we can make such a difference, that the only thing I regret about that history taking though Linda is that I didn’t ask her about her periods or hormones or whether she had any change in how she felt throughout her menstrual cycle. And I didn’t know to ask then. And I can’t change the past, but I do it a lot now. And you really notice there’s a hormonal change, often with women… [00:09:53][158.4]

Linda Gask: [00:09:56] Yes. I mean, I, I wasn’t taught as a psychiatrist very much about the impact of hormones. I learned, I think, from my patients. I heard what they told me about the impact of their periods on their mood. And I saw, in my practice I saw several women over the years. I didn’t specialise in perinatal problems, but I saw the impacts of hormonal changes at childbirth and the impact that that could have on women’s mental health. And then I saw what happened around the menopause, and I could see and I could hear from listening to my patient’s stories, but I was taught very little, very little. And we were told, I think, that it really it wasn’t important, as you say. And it’s really shocking, though, when you look back to that period, how little education and until relatively recently, how little education psychiatrists have had about hormones. [00:10:59][63.7]

Dr Louise Newson: [00:11:00] Yes. And you might know we wrote a course about mental health and hormones for the Royal College of Psychiatrists. And I was up in Edinburgh recently accepting a certificate because it was the most downloaded course, which was great because it shows this need. But I didn’t know and and I was recently reading my old psychiatry textbook and it actually said there is no link with hormones and mental health. And so that’s what I grew up. I didn’t think about it even as a hospital doctor, as a GP for many years, didn’t think about this association. But also, as for the tour that I’m on at the minute, I’ve done a lot of reading, and I was reading a book by Edward Tilt from 1870, and he talks about this crisis time before menopause, which obviously now we know is more perimenopause, and how those women still can have regular bleeding, he was saying, regular periods, but their mental health can be in real turmoil, really affected, all the barbaric treatments they were often giving to people, including locking up in asylum. But the more I see women, it’s this havoc that occurs in hormones in the perimenopause that often is far worse than in menopause. When hormones are low and just stay low, they plateau, which makes sense, really, doesn’t it? How our brain works and reacts to changes. [00:12:19][78.4]

Linda Gask: [00:12:20] It does. And I think obviously the difficult thing is that there are so many other changes going on in a woman’s life at that time as well. So that the hormonal changes sensitise you to everything else and are not coping in the same way with everything else. And I think it… When I talk about when I mentioned suicide early, I think, you know, the commonest age that women take their own lives in this country is in the late 40s and early 50s. And no one knows why that is. I can only think, I don’t know, but that is a time when women are not only going through major changes in life, but they’re also going through menopause and perimenopause. [00:13:05][45.1]

Dr Louise Newson: [00:13:06] Yeah, I mean, every day in the clinic we see women and speak to women who have suicidal thoughts. And the reason that I know it’s their hormones often Linda is because they’ve been under psychiatrists. I saw someone recently who has been on three different antidepressants, didn’t help, just made to feel numb. She was given quetiapine then she was given lithium, then she was given ECT. They were thinking about giving her ketamine, but she wasn’t any better. And it was her partner that said, Look, you’ve always been a bit down just before your periods. This is really different. Why don’t you go and speak to this, you know, doctor. But then when I spoke to her, she said, you know, she’d planned what she wanted to do. She couldn’t carry on the way she was. She had very dark, very intrusive thoughts. But when I said, did you have them every day? She said no, when my period comes, which is quite scanty, I feel fine. But she also had great insight. And a lot of these women really have a lot of insight, very different to other people that I’ve seen who have been very clinically depressed and very flat. And we’ve, you might know, we’re funding a PhD students looking at suicide prevention with Liverpool John Moores University, and we do a PHQ-9, which is a depression screening questionnaire and all our patients that come, but what we’re finding is about 25% of women who come to our clinic have very negative thoughts, have thoughts of harming themselves, which they wouldn’t tell us. But on the questionnaire, we can see it, but it’s very high proportion, actually higher than you would think in a menopause clinic where people traditionally menopause is about hot flushes, isn’t it? Of course it’s not. It’s more about the brain. [00:14:50][103.8]

Linda Gask: [00:14:51] It’s about mind and body. [00:14:52][1.2]

Dr Louise Newson: [00:14:52] Of course it is. And there’s so many women say, I know it’s related to my hormones, but no one’s listening. And I think we sometimes, I don’t know what you feel but I’m sure you agree is that women aren’t believed and they’re not listened to enough. And as a doctor, I might not have the solutions, but my job is really to listen and understand. And when women say, I think it’s due to my hormones or I think it’s due to some trauma or I think it’s a combination, in my experience, they’re usually right. [00:15:21][29.3]

Linda Gask: [00:15:22] I think your point about women not being listened to and not actually being heard is crucial. Women do not feel listened to by many doctors. And your example as a medical student, I just think you gave someone time, you gave them attention, you listened. And that is very often something that women don’t experience in medical settings. I’ve experienced that myself, you know, and I’m a I’m a doctor, but I’ve experienced that in my own care. When I went at the time that I was going through the menopause and my menopause was late, I was quite severely depressed. And that was one of the reasons why I gave up work early. And at no point did anyone ask about my menopause, except when I went to the gynaecologist. And I didn’t make the connection either because I’d had mood problems all my life. But those mood problems were worse at that point. And then I have physical symptoms as well. And I’ve spent quite a lot of my career trying to help people with unexplained symptoms. And then I found myself with unexplained symptoms and really understood what it was like for women not to be believed. It was really very, very upsetting. And in the end, things resolved. But it gave me a lot of insight into knowing how understanding how people are just not, well women are just not taken seriously. [00:16:52][90.2]

Dr Louise Newson: [00:16:54] Yeah. And I’ve been doing quite a lot in prisons recently and a lot of women have hormonal changes in prisons because they’re older, you know, they’re in for life when they come 40s, 50s. But also lots of younger women who have abused drugs, they might be alcoholics. They… might just be the trauma or whatever but their ovaries have switched off, their periods stopped and they get worsening symptoms. But also lots of them have PMS and PMDD. But what’s interesting is a lot of them have these physical symptoms, so they’re getting dry, itchy skin, they’re getting cystitis, urinary tract infections, palpitations. Because when I speak to some of the medical staff, they say, no, it’s because they’ve had trauma. It’s because they have difficult lives, because they’re in prison. Of course they need antidepressants, antipsychotics, pregabalin, whatever else. But when I say, well, what about hormones? And it’s almost like, oh hormones, a bit of a lifestyle drug, now it’s all in their heads. They don’t need they’re not taking these other drugs. So why would they take hormones? But I think it’s that thing about taking a complete history, because if someone’s got dry, itchy skin without any other reason, that’s come on with their mental health symptoms, for me, it’s like a bit of a ok, you can’t make up something physical. You could try as a doctor if you really don’t believe patients but it’s very hard to make something that is physical. [00:18:14][79.9]

Linda Gask: [00:18:15] I think one of the… you mentioned trauma, and I think that there’s been a real move to say that everything is down to trauma. And in another way, that’s another way that I think women can be gaslit sometimes because they’re told that what they’re experiencing is due to trauma. And they say, well, I don’t know of any trauma, I don’t remember any trauma. And I think there’s sometimes a denial of the reality of the severity of women’s mental health problems, that depression really does exist. And it’s not just unhappiness. And I see that a lot, that there’s an assumption about trauma. I think that both are important. You know, women experience really adverse things happening in their lives, and that triggers off in those of us who are perhaps vulnerable because of our life history or because of earlier experiences, sometimes because of our genes, some of us, that triggers off something much more severe and they need to be listened to and they need to get the best help. And I see that not happening. I see an assumption that half a dozen sessions of talking to someone, talking to a therapist is going to solve those problems. And and it doesn’t know at all. And I also met many women who’d been told that they had personality disorder when actually they were being misdiagnosed. Some of them had had chronic traumatic experiences, but some of them are young women with PMDD, premenstrual dysphoric disorder, which is very severe and not uncommon. Some of them were women who had undiagnosed autism or ADHD because all of the screening tools for them were designed on boys. Because it doesn’t get picked up and some of them have something more serious like bipolar disorder, which just doesn’t get recognised in young women. They’re just assumed to be young women with personality disorder who are just being difficult. And so there’s so many ways that we are not listened to and don’t get a proper assessment, a full history, a proper assessment. And sadly, that happens in psychiatry as well, particularly at the present time. [00:20:41][145.8]

Dr Louise Newson: [00:20:41] Yeah and even since I qualified in 94, so many years ago now, medicine has become more siloed. I think, you know, it’s quite hard to find a traditional clinician who’s trained in all specialities. And that means that we do then focus too much on one organ, which can be very difficult, because then that sometimes means that we’re making maybe the wrong diagnosis, but also we’re focusing just the treatment on that individual organ as well. And often in medicine there are many treatments. So even though I give hormones a lot to women, there’s no point not looking at their diet and their lifestyle and what else is going on. And, you know, I can’t change their job. I can’t change their partner. But changing how we think about things is really important as well. But doing a sort of multi-pronged 360 degree approach and individualising care in my mind it’s really important. But I think that Individualisation has reduced in medicine because we’re very conveyor belt thinking about the guidelines, doing the same one size fits all. And then I think that gives people less of a good service because they’re not treated as individuals and that often leads to not being listened to as well. And then the frustration can make things worse. Also, so many women say to me, I’m just not going back to see that doctor or clinician because I didn’t feel I was listened to. They don’t say I don’t feel that I got the wrong treatment, because as a doctor we can all give wrong treatments and make a wrong diagnosis, but we can be open about this. I’m sorry that didn’t work. Let me think about X, Y, Z, or let me refer you to a doctor or whatever. And I think patients know that we’re human. But when there’s this closed, no that it, I’ve made the diagnosis, you’re not better. Therefore it’s in your head, is awful, isn’t it? [00:22:38][116.6]

Linda Gask: [00:22:38] It is. It is. And a lot of the work I did over the years in my career was seeing people who they had been told there was nothing wrong with them because doctors couldn’t find any reason for their symptoms. And the first thing it was really important to do was to say, I understand that you really are experiencing this and this is real. And okay, maybe we can’t find a cause for it now. But that doesn’t mean that we won’t find a cause. And it also doesn’t mean that it’s all in your head, which is just a terrible thing that has been said to more women than men. And some of the women that I interviewed for the book were suffering from things like fibromyalgia, which can’t be explained in traditional medical terms, but a very real and really limiting people’s lives. And more common in women. [00:23:33][54.8]

Dr Louise Newson: [00:23:33] Yes. And we see a lot of people with fibromyalgia and they do improve with hormones often, but no one’s thought about hormones because…especially testosterone adding in testosterone, because we know also our hormones affect our perception of pain. They affect our pain receptors as well. But it’s that whole thing that it’s not real pain because we don’t know what’s causing it. [00:23:56][22.3]

Linda Gask: [00:23:56] Absolutely. [00:23:56][0.0]

Dr Louise Newson: [00:23:57] I find really upsetting for these people because they are feeling it. [00:24:00][3.2]

Linda Gask: [00:24:01] Yeah. And women are supposed to have a higher pain threshold than men, which I always find amusing. But I was taught that, I think, as a medical student, which… [00:24:09][8.6]

Dr Louise Newson: [00:24:10] If women and men. There’s studies that show that if women and men have the same pain subjected to, then women are more likely to be given antidepressants and men are more likely to be given painkillers, which is just wrong, isn’t it? [00:24:23][13.7]

Linda Gask: [00:24:24] Yes. [00:24:24][0.0]

Dr Louise Newson: [00:24:25] So before we finish, what’s going to change? You’re saying it must change in your book title? So how are things going to change to improve future generations? I’ve got three daughters. I want them to have a good experience. [00:24:35][10.7]

Linda Gask: [00:24:37] Well, the first thing I think is that women, we mustn’t allow ourselves to be written off and not be taken seriously. We’re taught throughout our lives, that we’re supposed to behave and just do as we’re told and just shut up and not complain. And I think that one of the things I’ve tried to help women with in my career is helping them to rediscover that self, that self that doesn’t mind complaining and shouting out and saying, hey, this is just not good enough. I’m just not putting up with that. And some of the women I met in my interviewing were able to do that and kind of rediscovered that power. I think the second thing is that we have to get away from this idea that things are either all mental illness or all caused by trauma. Both matter. Women get depressed, but they’re also oppressed. And if you just treat the depression, you ignore what’s going on in their lives. That doesn’t work. But if you just treat what’s going on in their lives, if they’re severely depressed, they can’t actually get enough energy together to make changes. And too often we’re all in silos. The people who do the helping and the people who do the treating of mental health problems need to talk to each other. And need… I spent a lot of my life trying to connect women with resources in the community that could actually provide them with practical help. And I think the last thing is we need an awful lot more concern about the problems that are common in women are just not getting enough research and enough money spent on them. When you look at the amounts of time doctors get taught about eating disorders, it’s about two hours in our career. And because they’re more common in women, they don’t get the same attention. Similarly with fibromyalgia, you know, it’s a similar kind of problem, More common in women. Less research. Less investment. So I think we have to support each other. I think women have to support each other in this. We have to listen to each other and take each other seriously. But we also have to really try and campaign to get people to listen to us. And I think we, one of the things that we did do in the past was we got grassroots organisations going that were founded by women and got things going for women in the community. And I think we have to go back to doing that. I don’t think we can rely on men to do these things for us. We have to do it. And it’s a whole new generation that we have to take this forward and actually do the kind of thing that you’ve done, Louise, and actually say, I’m going to make a change here, and we have to do that for each other. And the first thing is to take each other seriously. [00:27:33][175.7]

Dr Louise Newson: [00:27:33] Totally agree. I couldn’t agree more. And I think we’re very lucky actually the way things have changed. Technology has changed. The work I do is on behalf of women I hear from every single day, which when I was sitting in that consultation room many years ago, there was no social media, there was no internet. I kept that story to myself in a project. But now I can share anonymously and you hear others saying the same. And that’s where you learn, from experiences and work together. Women work in mysterious ways, which I love. And connecting with women can make a difference. So I do feel most not all the time, but I do feel positive because I think change is happening. I don’t think we can go back anymore. We can just keep going forward. So I’m really grateful for you coming on the podcast and very grateful for you writing such a fantastic work as well. So I look forward to hopefully meeting you in person sometime too. So thanks ever so much, Linda. Thank you. [00:28:29][55.6]

Linda Gask: [00:28:29] Thank you for asking me, and I look forward to that. [00:28:31][1.7]

Dr Louise Newson: [00:28:36] You can find out more about Newson Health Group by visiting www.newsonhealth.co.uk and you can download the free balance app on the App Store or Google Play. [00:28:36][0.0]

ENDS

The post Women’s mental health: what must change, with Linda Gask appeared first on Balance Menopause & Hormones.