THE MIDULTS
Annabel Rivkin and Emilie McMeekan
QDear A&E, I am writing to you because I am on the floor. I feel crippled with anxiety, I can hardly sleep and when I do manage to do so, I get night sweats. I went to my GP wondering if it could be the menopause, but he said that because I was 47 it is too early, and gave me antidepressants. They are not working. I don’t know what to do. I don’t feel like myself at all. Please help. Love, Desperate
AOh, brave lady, you are not alone. We hear stories like yours everywhere: of women going into perimenopause in their early- or mid-40s, having strong symptoms (including anxiety, night sweats and insomnia), heading to the GP and hitting a brick wall. Their relative youth and the fact that they are still having periods means that despite being in the transitional phase before menopause (the perimenopause), they are not even considered for HRT and instead are directed towards antidepressants.
It’s no coincidence that studies show that at the age of 46 women’s happiness dips and anxiety peaks. This is often dismissed as part of the rush of our life: juggling caring for youngish children or teenagers, plus perhaps our parents, with our career, and keeping up with hobbies (hah!). Not only that, but the pandemic and the domino global crises since have meant that some symptoms have been normalised. “Of course I’m anxious,” we think, “I was in a pandemic.” “Of course I’m not sleeping, look at the state of the world.” So antidepressants are prescribed, which might shave off a slice of the anxiety, but still leave women floundering and – as you say – desperate. You might not be in full-on menopause, but you are experiencing its crushing effects. Depression doesn’t give you night sweats, after all.
It’s not an easy path to diagnosis and prescription as we contend with an under-resourced NHS and the systemic disregard of women’s health issues. A friend of ours first went to her GP in 2019, deranged with anxiety, but armed with a blood test that showed she was in perimenopause. She was told that, despite this, she didn’t fit the menopause profile. Two years later, after a string of failed protocols (antidepressants and relying on some kind of sleep aid) and even though her periods had stopped, the GP still refused her any hormones. So she went private, was prescribed HRT, and her symptoms were relieved within days. She had been ready to leave her job, but now she is, she tells us, “knocking it out of the park”.
So you are going to have to be the leader in your own menopause initiative, Desperate. As we said, you’re not alone. The menopause debate is swelling, thanks to the work of doctors such as Louise Newson and Naomi Potter, and a chorus of brilliant women, including Mariella Frostrup, Lisa Snowdon and Davina McCall, who refused to accept that it was just our “lot” to suffer or just “suck it and see” as far as treatment and support went. Follow them on social media (Snowdon hosts Menopause Madness Instagram Lives on Wednesdays), buy their books (Frostrup has cowritten a book called Cracking the Menopause), watch their documentaries (McCall’s Sex, Myths and the Menopause is on Channel 4), and join their ranks.
Time for action. We spoke to Dr Kate Stannard, who co-founded Women in Medicine International Network. She said: “This is a common story. On the basis of the symptoms described, it is highly likely you would benefit from HRT rather than antidepressants. For definitive advice, I would point you in the direction of Dr Newson’s free Balance app – it will track your symptoms and you’ll be able to make a record of this, which will be useful when you revisit your GP to request an HRT prescription. If you do not feel you are being listened to, it would be sensible to see a different GP. It is a national disgrace that so many women are still being diagnosed with a primary mental-health issue when they are approaching the menopause and actually need their hormones replacing, not antidepressant medication.”
Because of the cultural representation of menopausal women as brittleboned, angry and withered, maybe we shy away from pushing for diagnosis. Maybe we don’t want to believe that it is “over” for us. Well, Desperate, it’s not over. In fact, it’s just the beginning. You just need to fight your corner – and believe us when we tell you that there are a lot of other women in it.