Don’t blame the menopause for bad behaviour
HOW desperately sad. The fifty-something woman sitting opposite me in my outpatient clinic appeared to have everything in life.
She had a loving husband, two healthy grown-up children, a close circle of friends and a mortgage-free property. And yet she was in floods of tears. She told me she struggled to face each new day. It was a battle to get out of bed in the morning. She no longer found enjoyment in life and was tearful all the time. Clearly, she was deeply depressed. This black cloud had emerged, she explained, when the menopause began.
Of course, it would be easy to blame her predicament on what is called The Change. But the more we talked, the more it became evident that the seeds of her unhappiness had been planted many years ago.
Focused on her family, she had sacrificed a huge amount (including a fulfilling career in law) to bring up her children.
As she reassessed her life, she became highly self-critical — furious because she felt she’d never reached her potential. This brought on a series of negative thoughts such as whether she was trapped in a stale marriage and whether it was justified to resent the myriad life opportunities that her children had in front of them.
This woman’s story is far from uncommon. In fact, in my clinic, I often see women who are like this. Many have never suffered from depression before but, suddenly, just as the menopause starts, they feel as if their world is falling in around them.
So can this turmoil be simply put down to a change in hormones? Can we explain away their deep dissatisfaction, sense of loss and malaise as a chemical reaction? Or is it simply the fact that the menopause tends to set in when so many elements in a woman’s life are changing, too?
I think the truth is complicated, despite the widespread belief hormonal fluctuations in the menopause are responsible for making women feel very down.
Indeed, this jejune interpretation was given credence this week when former tennis champion Chris evert blamed the collapse of her 18-year marriage — triggered by her affair with her husband’s friend, golfer Greg Norman — on ‘menopausal stuff’.
OF COurSe, it is always easy, and tempting, to shift the blame for poor decision- making and bad behaviour onto circumstances out of our control.
But are women really just slaves to their hormones as their ovaries decline? I don’t believe so.
Though evert claims society doesn’t discuss the issue enough, the mental aspects of the menopause are well known. While some women seem to suffer no problems, others complain of erratic mood swings and out-ofcharacter behaviour.
Some quit their job, have affairs or leave their husband. But the medical evidence that this is solely down to hormones is unconvincing.
There is no conclusive proof that falls in the levels of oestrogen and progesterone — the female sex hormones that start to decline in menopause — are responsible.
Instead, I think the menopause suddenly makes women reassess all aspects of their lives.
For many women, their sense of self and identity is intricately bound up with their roles as mother and wife. By their 50s and 60s, they are set in their ways of prioritising their families above their own interests.
But then, often as their children leave home, they look back at their sacrifices and wonder whether they were all worth it.
Often, this leads to feelings of despair and resentment, which are compounded by the effects of the menopause.
Added to all this can be the fact that women in this age group can feel ‘invisible’ — overlooked by the rest of society.
No longer able to have children, no longer needed for day- to- day mothering, they can feel they have not only lost their role in life, but also part of their femininity.
Indeed, I’ve had many menopausal and post-menopausal patients tell me that they no longer feel like a woman. What terrible anguish.
Some also believe they are no longer desired by the opposite sex. This sense of dejection is exacerbated by cruel social attitudes, which judge ageing women on their appearance in a way that doesn’t happen with regard to men.
Nevertheless, men do experience a comparable jolt, though typically it comes some years later. This often happens when they retire and the working role that largely defines them is taken away.
What’s more, because these shifts happen at different times for men and women, couples can become out of sync. This, in turn, can lead to a lack of sympathy when one partner is suffering.
There is no easy solution to coping with this stage of life. But it certainly helps to pinpoint your problems and focus on addressing what is really the matter in a rational way. Blaming hormones is just a cop-out.