High bridges and low mood: the unheard voices of menopause

Rose GeorgeFirst Published October 20, 2019 Research Article https://doi.org/10.1177/2053369119875387

In 1936, an editorial was published in the Lancet. It was strangely apologetic, and urged its readers to forgive the editorial board, because it had decided to publish an article by a layman. This, the editors wrote, did not call for “a lifting of the eyebrows.” They were right. Because the layman was Percy Oliver, who had identified a huge need that medical men had not seen, of mass blood donation by volunteers, and who had created the basis of the modern National Health Service Blood and Transplant. Why do I begin with this? Because I anticipate eyebrow-lifting too. I am not a scientist by training. I have no medical background or expertise. Although the brief for this section of this journal requires me to cite at least five references, I’m not going to do that. The reason for this obduracy is a principle underpinned by considerable anger: that the experiences of women undergoing menopause have been unheard, under-researched, undertreated, and they still are. Women’s subjective experience is still undervalued, routinely and endemically.

What do I base this on? A year ago I wrote a long piece for the New York Review of Books on the depression that I sometimes feel now that I am menopausal. The piece took me many months to write, because when I was well, I didn’t want to remember that I had been unwell, and when I was unwell, I could not write. Language is important here. Notice that I use the vague phrase “unwell,” most commonly used in what is considered the “physical” body. Yet I am talking about mental illness, which for reasons I have yet to understand, is still considered somehow separate from the physical body, as if the brain were a cloud or an idea floating serenely outside our bodily selves. I wrote that I have seen many medical professionals about how difficult my menopause has been, and that I objected to being diminished by the phrase “low mood.” This is trotted out whenever women present to clinicians. Have they felt like jumping off a bridge? That is “low mood”. Have they sat in their cars at lunchbreaks at their place of work, sobbing and not understanding why? That is “low mood.” The person who felt like jumping off a bridge was me. The person sitting in a car sobbing was me. The person who got up and ran ten miles and stopped halfway to cry then carried on running was me. I endured these emotions for a couple of years. I had all the usual menopausal manifestations too: flushes, broken sleep, wrecked libido. I had more unusual ones too: a problematic posterior tibial tendon; tinnitus; dry eyes; peeling skin. But they were mostly fixed by HRT with a low dose of oestrogen. My depression wasn’t. Again, the language matters. What I experienced does not qualify as depression. It came and went. I could want to jump from a bridge one day and feel like I could lift it with one finger the next. I could not predict which days I would wake up dysfunctional to the point where I could not bear to leave my house or interact, where I felt a physical pressure on my chest. (The last one of those was yesterday.)

I had already spent a year researching an article on the menopause for the Guardian. I am a journalist and author, so I did what I knew how to do. I researched. I wrote to the Society of Endocrinologists and asked for an expert who knew about oestrogen’s role and importance in the brain. They could not help. I researched (this was several years ago) and found very little. The reduction of menopausal “symptoms” (this is in quotation marks because the menopause is not an illness, despite the powerful effects it has on the body and mind) to hot flushes and broken sleep was baffling. I knew how I felt, and I knew I had not felt that way before being peri-menopausal and menopausal. I knew the danger and force of the depression that would arrive, unexpected, and ruin my worklife, stop me being able to write or communicate or do much beyond lie in a darkened room with no external stimuli. I began to think I understood what autism must feel like, with life being an overloading of sensation, noise and stimulus, unbearable in its relentlessness.

I saw a menopause specialist who told me this depression, and my “brain fog” – another reductive phrase for the real cognitive changes the menopause can bring, so unsettling that many women are convinced they have dementia – was simply due to aging. I suppose she was right. But she could also have said, we are slowly understanding that oestrogen plays a fundamental part in the brain. We are learning that it can shift mood, that it acts on neural pathways, that anti-depressants probably won’t affect this depression. She didn’t say that. She gave me no comfort or treatment. (I eventually sought help privately, was given a much higher dose of oestrogen, less progesterone and a kind reception.)

After my articles on the menopause were published, the response was both warming and chilling. For days, I had constant tweets and emails. I still get emails from women thanking me for being so frank (I thought I had nothing to be ashamed of, so why not) and saying that they recognised their own experience in mine. But I was chilled, too, by how many were going through similar mental torment, and being dismissed by medical professionals, employers, colleagues and family. They were still being given anti-depressants. They had no idea that oestrogen had any role in the brain. They thought the menopause brought only hot flushes and poor sleep. They had no idea that other women felt like they did, that they were normal. They had been dismissed, as I had been dismissed.

I am more stable now, but not entirely. My last bad day was yesterday. I woke up with my heart in my boots, tears in my throat, panic in my chest. For no obvious reason, except I know now to blame my changing body and my hormones, to wait it out. But this lesson has been too hard-won, and I shouldn’t have had to learn it.

Declaration of conflicting interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) received no financial support for the research, authorship, and/or publication of this article.