When I hear about midlife women struggling with mental health, I want to shout from the rooftops: this is the truth! Protect yourself and others!

Perimenopause is marked by fluctuating levels of estrogen. We have estrogen receptors in our brains, so expecting brain changes in perimenopause is a no brainer.

Recent research using neuroimaging shows these brain changes, and that they largely stabilise post-menopause. Interview – Neurology professor Lisa Mosconi

Going through it?

Like puberty, this too shall pass. You’re not going to stay this way for ever, whether you relish your midlife rage as a force for change, or if you long for it to be over. As much as I’d like to make the case for embracing cronehood, the truth is that perimenopausal mental health can make life unbearable.

Like postnatal depression, menopause depression and anxiety can have both hormonal and environmental drivers.

Hormone changes make you tired – which intensifies emotions.

Other menopause symptoms – night sweats, lethargy, joint and muscle pain – lead to stress and fatigue that make you miserable.

Then there’s the mid-life squeeze: demanding jobs, caring for elderly parents, looking after or saying farewell to children.

Who would cruise through all of this with ease and joy? No woman that I’ve ever met.

Research in Australia in 2015 showed that the highest age-specific suicide rate for females was in the 45–49 age group, and the second highest rate of suicide was in women aged between 50 and 54 years.

What’s more, hormones fluctuate more than ever in the perimenopausal period, so it’s harder to keep track of where you are in your cycle, and you may go for weeks feeling well then sink into a much more challenging place.

In 2023, researchers found that women were more likely to die from suicide attempts at certain phases in their menstrual cycle. Article – Suicide Risk & Menopause – giving us strong evidence to show that the mental health of all women is related to their reproductive hormones.

Symptoms of perimenopausal depression include low energy, paranoid thinking, irritability or hostility, decreased self-esteem, isolation, anxiety, and problems with memory and concentration. Article – Perimenopausal depression – an under-recognised entity

I’m not here to offer an answer, but a plea: if this rings a bell, cut yourself some slack and build strategies for getting the help or space you need. And if you know a woman in her forties or fifties, ask yourself if she’s going through this and if you need to talk to her about it.

TLDNR: menopause is fecking hard and dangerous. Look after yourself and support other women.

Elspeth Alexandra - Women's Health Coach in Edinburgh

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