We Need to Talk About Midlife Mental Health

I’ll bet my heart wasn’t the only one to break the other week when news filtered around the world that Australian actor Dieter Brummer – Home and Away’s Shane Parrish from 1992 to 1996 – died by suicide on a Saturday morning in his Sydney home at age 45. This blonde, blue-eyed boy was the PC-friendly heartthrob permitted in every teenage girl’s living room in the 1990s, unlike the angst-fuelled, anti-establishment but equally beloved and beleaguered Kurt Cobain.

It’s never not a bombshell to hear that someone has taken their own life. Whether a celebrity or stranger, our guttural reaction is to wonder how everything could have seemed so utterly hopeless. Suicide is an unsettling subject to research and write about, too. It feels macabre and intrusive to maraud misfortunes; to trawl through media reports of tragedies, as you would a TV guide; to interrogate statistics as if they reflect properties bought and sold rather than real lives lived and prematurely lost.

But for Generation X – us – it’s a subject that can’t be tiptoed around or shied away from because the reality is that suicide rates for both men and women are highest between the ages of 45 and 54, according to the National Suicide Research Foundation. In the case of women, between 2016 and 2018 (data provided after 2018 is only provisional), the suicide rate per 100,000 of the female population in Ireland jumped from 3.6 to 4.5. It’s also worth noting that women are most likely to upend their lives and seek a divorce at age 52.

It’s not a reach to suggest there’s a link between the pressures heaped on women in midlife and these stark statistics. In middle age, women juggle multiple responsibilities and face multiple stressors: careers are probably at their peak; children, whether young, teenage or in college, need nurturing and support; elderly parents may require considerable amounts of care; financial commitments are at their greatest, and existential angst pervades as us midlifers realise we’ve hit the halfway point in our lives.

But it isn’t just these lifestyle strains that we need to talk about. After all, women are resilient, multi-taskers, not easily phased by competing demands on their time and emotions. It’s also worth remembering that not every woman in midlife fits this stereotype. I have no children to worry about. Others’ parents have already passed away. Some women are financially secure with the means to pay for as much domestic help and childcare as they may need. Yet still, middle-aged women of any status and in any circumstances can be hit by a horror show of meltdowns, panic attacks, and emotional turmoil – the former 1990s Britpop celebrity Meg Mathews included. In 2020, she told The Guardian that her menopause was “so dark...I was in a really dark place...all of a sudden, I was the worrier…”

From perimenopause through to menopause, a seismic hormonal shift occurs in our bodies, and so women’s wellbeing in their late 40s and early 50s is a far more complex affair than mere external lifestyle strains suggest.

While most of us understand that lower levels of oestrogen, progesterone and oxytocin, which begin during perimenopause, affect our vaginal health, sexual function and reproductive system, I didn’t realise until recently the degree to which they affect our brain function and nervous system too.

Those mood swings, the memory loss, irritability, fatigue, anxiety and depression you may be experiencing (memory loss, fatigue and anxiety are the big ones for me right now) are not because you can’t cope, have taken on too much or are just a bit useless, they’re a direct result, certainly in part, of significant hormonal changes in your body. Psychological symptoms are just as likely as physical ones it turns out. According to Galway-based holistic counsellor and psychotherapist Mary Lynn, many of her clients feel “stuck and as if there’s no way out”. “They are questioning who they are and feel they are without a sense of purpose,” she explains. This can very quickly lead to heightened levels of frustration, anxiety and depression, and the consequence of this existential angst in extreme circumstances is suicidal ideation.

Although I’ve often read that women who have suffered from anxiety and depression in their younger years are more likely to experience either or both during menopause, Lynn says that in her experience, anxiety in midlife can present in anyone regardless of their mental health history – indeed, Mathews admits in the article mentioned that before menopause, she was a person who “got up and went out and didn’t give a shit about anything”. I have always had a propensity for anxiety, so I’m fortunate, I suppose, to understand how it will present itself, and to recognise immediately that it’s not normal and needs to be dealt with, holistically and sometimes medically. It must be terrifying and utterly confusing to wrestle with the inexplicable and continuous feeling of dread and apprehension that can manifest itself in menopause for the first time.

Lynn agrees, telling me it can absolutely overwhelm some women. Her very sound advice is to “feel, understand, talk and connect”. She explains: “If you’re suffering from anxiety, don’t suppress the emotion or try to distract yourself from it. You need to feel your emotions and understand that they are completely normal.” She continues: “Talk to your GP and to your friends. Don’t try and hide what you’re feeling, explain it instead. Finally, connect with other women who are going through the same experiences. You won’t feel so alone this way.”

Lynn advocates taking a 360-degree approach to our menopausal health, so alongside these holistic solutions are others anchored in traditional medicine.“The first thing I ask a client who is experiencing high levels of anxiety or depression is has she had her hormones checked by a GP,” explains Lynn. “Only then can she make an informed decision about her healthcare needs.” She also believes that both HRT and antidepressants have a role to play in menopausal healthcare. “If prescribed correctly, both can offer real benefits. If incorrectly diagnosed, they can do more harm than good,” she explains.

While Lynn is a female midlife specialist, there are too few specialists in the area of women’s midlife and menopausal health (some of the experts doing brilliant work in this country are included in this earlier Heyday article on menopause) and this is one of the major obstacles women face. This isn’t simply the case in Ireland either. In an interview with menopausedoctor.co.uk after her Channel 4 documentary, Sex, Myths and Menopause, Davina McCall made an excellent point: “Half of [a GPs] patients will be women and 100% of these women will go through menopause...but [these professionals] are nervous of talking about the menopause because they just don’t know [enough] about it. There is a failure...in their training. But not all of us will get Alzheimer’s or diabetes...yet these are illnesses they do learn about.”

It appears that, to date, menopausal health has been nothing but a footnote in modern medical training. With so little known and so much scaremongering around, it can be difficult to believe author and anthropologist Margaret Mead’s famous words: “There is no more creative force in the world than the menopausal woman with zest.” Lynn wholeheartedly agrees, explaining to me that the hormone oxytocin is also colloquially known as “the cuddle hormone”. Lower levels in our bodies mean women feel less compelled to nurture others and so can concentrate more on their own needs and desires. “Once you realise what is happening in your body, this can be a time of real creativity,” confirms Lynn. In 2019, Oprah Winfrey used her global platform to reiterate this belief: “So many women I’ve talked to see menopause as a blessing. I’ve discovered that this is your moment to reinvent yourself after years of focusing on the needs of everyone else.”

Since Liveline blew this topic wide open in May, the narrative has very slowly started to change from doom and gloom to hope and optimism. Indeed, Dr Rachel Mackey, of the Women’s Health Clinic, cites the Liveline broadcasts as part of a shift she is seeing in her clinic, where more women are attending in perimenopause (rather than later, in full menopause) and are much more informed and aware of the full spectrum of menopause symptoms. Dr Mackey attributes this, in part, to the increased media conversation on the topic and information sharing and support between friend groups, which may not have been as common in the past.

Anxiety is as normal a part of menopause as hot flashes and loss of libido, and like the latter, it can be treated and triumphed over. But we each need to be as open about what we’re experiencing as possible, because no woman should feel isolated or afraid simply because her body is changing. Menopause is a life transition, not a disease, and nobody should lose their life because of it.

Marie Kelly, August 2021