There are times when traditional feminist thought does women no favours. In her recent ‘against the stream’ article ‘The Menopause transition, a call for a holistic approach’ Rachel Gibbons quotes from Germaine Greer – a heroine of mine in the 1970s:
‘[There is] a view of menopause as a catastrophe […]. If women on the youthful side of climacteric could glimpse what this state of peaceful potency might be, the difficulty of this transition would be lessened.’
If only it were always so simple, particularly for those of us who have already experienced mental health problems earlier in our lives. In writing Out of Her Mind one of my aims was to try and move beyond the idea that women are somehow lessened by the idea that our hormones might be affecting our minds, ‘driving us crazy’. I wanted to bring feminism up to date with the current science that shows exactly how much our minds and bodies are connected, and it’s essential that psychiatrists and all women understand this – because so many women consulting do not get even asked about their reproductive cycle at all. It cannot be a coincidence that the peak suicide rate for women is between the ages of 50 and 54 – just around the time of the menopause. They want help.
During my career we have moved completely through the cycle from biological theories about depression in older women, through the rise of psychosocial and back again to a clearer understanding about the importance of both. I remember as a young consultant an elderly colleague acting as a locum while I was on leave, diagnosing a woman patient with involutional melancholia. I was horrified. It had been clear that she had numerous life events contributing to how she was feeling and relationship problems. ‘Empty Nest Syndrome,’ was a commonly used term. The relationship issues revealed by the disappearance of children from the nest were less likely to get considered. I wasn’t taught anything about the impact of hormones on mood other than they probably had ‘something’ to do with the onset of post-partum psychosis and depression. The research hadn’t been done. It is being done now. As a second wave feminist in the 80s I was focussed on the psychosocial issues my patients faced and saw those as the primary reason for the problems they had with menopause. Meanwhile I was experiencing my own recurrent episodes of depression.
What puzzles me, in retrospect, in that those people involved in my care during the period leading up to my perimenopause and beyond didn’t consider that my hormonal state might be worsening my mental state, but then I didn’t either did I? I was struggling, not only with persistent hot flushes, and night sweats, along with heavy bleeding that resulted in anaemia but also with some serious interpersonal problems at work. I’ve no doubt now that both hormones and what was happening in my life caused my unbearable state of mind. I know that people found me impossible. I believe that the hormonal changes increased my vulnerability to depression and physically exhausted me. I took early retirement at 58. It took a few years for my mood to stabilise. Antidepressants work less well in post-menopausal women, and I still feel more tired and weaker than I suspect I should do. I don’t feel ‘more authentically me’ because it’s hard to know what that is when you are on multiple pills for your different ills – almost all physical and/or genetically transmitted – although my hair is now authentically grey after lockdown, and I’m very happy with it. I am not mourning the loss of my ‘womanhood’. I’m as engaged as ever – if not more- with life, letters and thought.
I absolutely agree that our approach to menopause should be holistic and biopsychosocial, and that means genuinely so, considering all the recent research into the relationship between moods and hormones. Let’s get it right, especially for the sake of those women who require holistic care, both mental health care and hormonal treatment, to help them recover. That means mental health services and gynaecology/endocrinology working together. No-one should feel ashamed either, if they don’t have a transition that fills you, apparently like Michelle Obama did – with a sense of power! Nor should they feel ashamed to want to try Hormone Replacement Therapy. Menopause is much more significant for some of us than others.
Listen to women and take their concerns seriously.
P.S. I thought I couldn’t have HRT because of my physical health problems, but I can. I’ll let you know whether it helps me to feel any better than I do now.
Out of Her Mind: How we are failing women’s mental health and what must change is available now.
Patching the Soul 