Royal Pharmaceutical Society

Menopause and mental health

By Kathryn Murray, Lead Clinical Trials Pharmacist at Cardiff and Vale University Health Board

The adverse effects of menopause on mental health and wellbeing were not spoken much about in the past.

I was 38 when I had my first episode of severe depression, which coincided with some gynaecological problems I was having. I sought help and started taking citalopram, an antidepressant. I had two months off work and gradually recovered.

I met and married my husband when I was 42. I was happy, we started building a life together and I loved being a weekend Mum to his teenagers. But I started having drenching night sweats. Hormonal blood tests were inconclusive, and I was told that it was just something I’d have to get used to. No-one ever mentioned the menopause.

Symptoms

The sweats deprived me of sleep and I felt exhausted. Things that I would normally cope with made me anxious. I spiralled downwards into depression again and was unable to work. I restarted citalopram and counselling. It was around this time I discovered the charity Pharmacist Support and I became a charity ambassador and fundraiser, sharing my journey as a pharmacist with mental illness at various conferences.

At 46 I started becoming anxious again. I found it difficult to concentrate, my memory was appalling, and I had brain fog. I still had night sweats and suffered from insomnia, as well as joint pain, recurrent urinary tract infections and vaginal thrush.

I went to the GP who repeated hormonal blood tests. I will never forget her bleeping me at work while I was on a ward, telling me that I was postmenopausal and asking if I wanted to start HRT. I immediately said yes and started using oestrogen patches in summer 2016. Outwardly I looked OK and continued to work, but internally I was struggling and hit my 3rd episode of depression and started mirtazapine in addition to citalopram and HRT.

Coping mechanisms

All the healthcare professionals I saw recommended that I tried to exercise to help my recovery. I decided to use a couch to 5k app to see if I could start to run. This gave me a focus for each day and I started to look forwards to going running. I went from a depressed non-runner to completing a half marathon nine months after starting running.

I saw a clinical psychologist, who was incredible, and learnt skills in prioritisation, acceptance and self care.

I also started baking bread and cakes and knitted as a way of passing time. The satisfaction of creating something made me happy.

Workplace adjustments

My employer was very helpful. They agreed I would focus on my clinical trials role but maintain my commitments in the dispensary. This role change has worked extremely well for me. Previously I had felt pulled between two busy roles (ward based clinical pharmacy and clinical trials) and never felt that I achieved anything during the day.  

One of the side effects of mirtazapine is weight gain. I put on 20 kg. Despite running, cycling and eating reasonably healthily I couldn’t lose the weight. Two years after starting HRT, my GP and I decided to gradually reduce and stop my antidepressants and the weight fell off. I am happier and healthier than I have been for a long time.

Finding solutions

Although I had many years of counselling, I never totally understood why I suffered from severe recurrent depression and anxiety, until I discovered the Menopause Café. I met lots of women who suffered from anxiety and depression while they were perimenopausal or following a surgical menopause.

Realising that my experience with mental illness through my late 30’s and 40’s could have been due to undiagnosed menopause has felt like finding the missing piece in a jigsaw and has finally allowed me to heal. I’m now 51 and have been on HRT for five years. I am astounded that so many women are offered antidepressants in preference to HRT. There’s such a lack of knowledge out there amongst health professionals as well as women. Despite guidance from NICE on menopause, many GPs are still reluctant to prescribe HRT. I know colleagues with typical menopausal symptoms who are unable to convince their GP to prescribe HRT and they are left to suffer. This is shocking.

Hopefully the increasing number of women in the public eye speaking up about their menopause will make a difference, alongside public awareness campaigns like Pausitivity’s #KnowYourMenopause. More women and health professionals need to understand the symptoms of the menopause, and its impact on mental health, so fewer women suffer and can get the treatment they need.  

Also see: Balance - Homepage (balance-menopause.com).

We want to encourage voices that express the diversity of lived experiences in the profession as part of our inclusion and diversity work. If you’d like to share your story, contact [email protected] or get involved through our ABCD group.

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