How does menopause impact our mental health? We’ve all heard that ‘Life begins at forty’ but what does this actually mean? In this article, psychotherapist Kelly Hearn explores how psychology can help.
Mental Health, menopause and midlife
Over the years, I have had a number of perimenopausal clients who have low moods and anxiety and have been medicated with antidepressants. This is in spite of NICE guidelines clearly stating there is no evidence that SSRIs or SNRIs are not effective. Take the example of Maureen* who collapses in tears as we start our initial psychotherapy consultation. ‘The meds aren’t helping.’ It was time to explore the link between mental health, menopause and midlife.
Maureen had been to see her GP six months prior and was prescribed antidepressants to counter her persistently low moods as well as Valium for sporadic overwhelming anxiety. As our discussion continues, her list of complaints lengthens: insomnia, hip pain, flashes of uncontrollable anger, brain fog, even suicidal thoughts had emerged over the last two years. The question of perimenopause lingers in my mind. My clients aren’t an anomaly – a study by women’s health specialist Newson Health showed that two-thirds of women were inappropriately offered antidepressants.
A psychological perspective
Women in mid-life may present with issues that look very much like depression, but there are a number of psychological reasons why low mood and anxiety appear during this significant transition in a woman’s life. In addition to hormonal changes, the forties and fifties almost invariably usher in major life challenges: career rethinks, divorce, illness, ageing parents, angsty teen children…the list goes on. For many, the menopause occurs coincidentally with a ‘mid-life passage.’ When I suggest as much to Maureen, she wryly queries, ‘Okay, but is this a breakdown or breakthrough?’ My work with Maureen continues. Depending on the week, she may consider it to be in ‘breakdown’ or ‘breakthrough’ territory.
The role of psychotherapy
Psychotherapy allows Maureen to acknowledge and explore all of the feelings she has around the many life changes she is experiencing: to become aware of these emotions, to listen and to make sense of them. As is often the case, Maureen is able to see that there is wisdom in even the difficult emotions, information that nudges her more towards generativity, away from stagnation. Outside of our consultations, Maureen has educated herself more fully about the menopause. She sought out a women’s health specialist who took her off the antidepressants and encouraged her to explore hormone replacement therapy (HRT is NICE’s preferred treatment for menopausal symptoms, along with psychotherapy).
A model to understand life
So how can we better understand what was happening to Maureen and what can we learn? Our childhood and ‘first adulthood’ (up to about age 40) incorporate our instinctive need to belong. Humans are social animals who historically survived as part of the wider group. We learn what is expected of us and mould ourselves accordingly with family and cultural beliefs. Acceptance is the name of the game. Daughter, sister, wife, mother, career woman are a few of the many roles women may fill when fostering the relationship between our egos and the outside world.
It can feel like we are climbing a mountain, the summit of which has been clearly described and demarcated. We anticipate ‘arriving’ somewhere near mid-life after which point we can stop and just enjoy the view. And it is beautiful for a while. But then we become aware there is a second mountain to climb. This is a particularly distressing realisation if we are already dealing with sleep deprivation, hot flushes, memory loss and the full menu of menopausal moods. We are at base camp preparing for a second ascent and are already knackered.
There can also be a sinking feeling when we realise there is no map. That the tools and equipment needed for this climb are markedly different from those we’ve relied on thus far. As disheartening as this is to discover, it is also the ‘good news.’ The second adulthood allows – even requires – the development of an inner compass that replaces any externally-supplied GPS. We may not even be aware of our undeveloped instrument as it wasn’t needed in early life when we relied on carefully marked trails. While we can ultimately get to a positive experience of this, we do need to acknowledge that the in-between stage can leave us sitting with a range of difficult emotions.
Change is challenging
Change inevitably includes loss and letting go. A loss of old ways of thinking and living and being – jobs, relationships, aspects of our bodies, health or our very identity – shift to make space for the new. There is grieving involved here – for our childhood, our youth. And it hurts. Sometimes we’re not ready for these losses, we fear what, if anything, will fill their place. We cling to outdated modes of being hoping no one (least of all ourselves) will notice the mismatch. In this case, we feel stagnant and joyless. Our routine – our entire way of being! – can start to feel a bit futile. Or we feel a sadness for the unlived life, unloved or unrealised parts of ourselves that haven’t yet emerged.
Part of the transition from the psychology of the child (and first adulthood) to the psychology of the adult is to become aware; to bring forth these vital aspects of self.
The enormity of these changes cannot be underestimated nor rushed through. We need to honour the endings and feel our way into precarious new beginnings. They certainly need not be medicated – the ‘middle passage’ is a feature of the human experience, not a pathology.
In Erik & Joan Erikson*’s model of psychosocial development the period between ages 40 and 65 presents a conflict between stagnation and generativity. This is a pretty crucial distinction. Will we end up feeling disconnected, uninvolved and marginalised (our worst first adulthood fears about ageing confirmed)? Or will we pursue activities that enliven us and also make the world, a better place?
Because an 8th phase in the Eriksons’ model – the evolution of ego integrity or despair – awaits. Commencing at about age 65, this period considers whether there is a sense of coherence and wholeness to our lives. Simply put, ‘is it okay to have been me?’ Can we look back on our life with a feeling of contentment? Is there a sense of meaning, and so peace? The invitation of midlife to turn inwards is a vital transition for a fulfilled old age.
Read more about how Yoga can support you through Menopause
Kelly Hearn, Psychotherapist and Co-Founder of Examined Life, trained at the Centre for Counselling & Psychotherapy Education (CCPE) in London and is a registered member of the BACP and UKCP. She has wide experience working within the NHS, private practice and at The School of Life. Kelly co-founded Examined Life, a collective of psychotherapists, in 2020. She is also an avid ‘sanity walker’ and yogi; activities which help her balance when her mind is over-active.
* Name changed and permissions granted.
** The couple collaborated extensively to form this model, with Joan even adding a 9th stage after Erik’s death. Erik is commonly the sole name credited, undervaluing his female colleague’s work.
I love this…’The enormity of these changes cannot be underestimated nor rushed through. We need to honour the endings and feel our way into precarious new beginnings. They certainly need not be medicated – the ‘middle passage’ is a feature of the human experience, not a pathology.’
I can relate to the mourning feeling about life opportunities we may have missed, and the demise of the body I used to think was fat, but now realise it was fabulous! Yoga is the thing I always turn to when feeling frazzled and it never fails to get my head in a better place.