Sorry, but midlife horrors aren’t just hormonal
Let NHS psychiatrist Max Pemberton transform your life
Over the years, I’ve lost count of the number of women who have come to my clinic complaining of feeling not quite themselves. They feel down, lost, despairing. Many have been diagnosed with depression, but still their symptoms persist. What’s wrong with them?
In fact, they all have one thing in common: the menopause. This week a number of highprofile women including Penny Lancaster, Mariella Frostrup and Gabby Logan spoke out in an attempt to raise awareness and improve women’s access to medical care during the menopausal years.
But it was something that Davina McCall said about her experience of beginning the menopause that really struck me.
‘I was 44 and I remember it because it was so weird,’ she said. ‘The best way I can describe it is that I just lost something of myself . . . I didn’t feel myself.’
There it was again. A woman talking about the horribly disconcerting experience of losing something fundamental to her sense of self.
WHAT causes this? Can it be put down simply to hormonal changes? Can we explain away women’s dissatisfaction with life and their sense of loss and malaise as a mere chemical reaction?
I don’t think so. I think it’s far more complicated than that.
That’s not to say hormones don’t play an important part — and this is one of the reasons I’m an advocate for HRT.
We know fluctuations in hormones can be directly responsible for low mood, just as the huge hormonal changes after a woman has given birth can lead to postnatal depression.
I’ve seen many women struggling to cope with low mood and anxiety for whom HRT has been a godsend.
But I do think there’s something else going on, too, and it’s the result of complex social and psychological factors rather than just biology.
Changes to the body, disrupted sleep, hot flushes and so on can all make women feel out of control and depressed, but at this time of life they complain of other things too — anger, impatience, and outof-character behaviour, for example. Some have affairs, quit their jobs, or leave their husbands.
I think that the menopause acts like a ticking clock. It suddenly makes women open their eyes and look at the lives they are living. The drama that besets women in the menopause and the emotions they experience aren’t the result of hormones but, instead, down to women taking stock of their lives.
For many, their sense of self and identity is closely bound up with their roles as mother and wife and yet these can change profoundly as they get older, leaving them stripped of purpose and routine. A lot of women in their 50s and 60s have given the best years of their lives to other people — and now they’re not sure why.
They wake up, look around and realise they’re not needed in the way they once were. They look at their children - successful, independent and in their 20s - and see that their job is done.
So now what? For some women that question lays bare the huge sacrifices they have made — to ambition, status, income — in the service of other people. It can be a sudden and brutal reckoning as they weigh up the life they thought they’d lead with the future that now stretches out before them.
It is also a cruel aspect of the inequality between the sexes that women have to contend with a society that pours scorn on their ageing bodies in a way it does not do for men. They feel they are ‘invisible’. I’ve had so many middle-aged women sit in clinics and tell me that they no longer feel like a woman. It’s incredibly sad. The menopause throws all of this into sharp relief — its sudden undeniable nature forces women to confront their changed lives and reassess them in a way that simply doesn’t happen for men.
Men are very much part of this taking stock, however. It’s at this point that a woman often looks at her husband and realises he’s no longer the man she married.
HE’S OVERWEIGHT, boring, and tired all the time. he’d rather sit in and watch boxsets with a lager than go to the theatre or plan a city break. Unlike her, he hasn’t had such a sudden awakening. For men, it’s a far slower, more insidious evaluation that takes place.
The menopause is, of course, a natural phenomenon. It is not something going wrong with the body. It is not an illness in any way.
But for many women it can be physically debilitating and raise deeply unsettling questions about the lives they’ve led.
We should all be aware of the many reasons for women to feel lost and alone in midlife.
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