Anna had a history of OCD (obsessive compulsive disorder) and bouts of depression, but her mental health had been stable for years until, at the age of 45, she fell into a deep depression

Content advisory: this article contains themes of mental health and suicide

I had severe postnatal depression (PND) after the birth of my first child and I was also diagnosed with OCD. I slowly recovered – I was on a medium dose of citalopram and had specialised therapy for OCD. I wouldn’t say my OCD was cured, but it was very low level indeed, and wasn’t interfering with my day-to-day life. I had been stable and happy for 13 or 14 years, and during that time had two more babies – my doctor supported my staying on my medication and I had a completely different experience – I was fine after their births.

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But out of the blue, when I was 45, I was hit with a sudden deterioration in my OCD with no apparent cause. Given my serious history, as soon as I realised I was feeling very low and my OCD had flared up, I asked for an immediate referral to a private psychiatrist. He said my OCD symptoms were most likely due to stress, as I’d been ill with COVID and had been through a court battle with the council to get specialist education for my daughter. So he increased my citalopram dosage – but it didn’t help.

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I began to spiral into worse mental health until, eventually, I was suicidal and on two high-dose antidepressants, an anti-psychotic, clonazepam, propanolol and sleeping pills. I was hospitalised in London, where I gradually improved and was taken off the tranquilizers and sleeping pills. Although the deep depression had lifted, I still felt very flat and anxious – which I’d never had before. I couldn’t remember what it felt like to happy or excited about anything.

In the hospital I had terrible night sweats, and would wake up soaking wet, but I assumed it was a side effect of all the medications. I was often setting the air-con to 17℃, and the nurses would come in every morning and tell me that the room was absolutely freezing. But, at first, no-one connected the dots – myself included. I honestly thought that I didn’t need to be aware of menopause until my late 50s or early 60s, and I had no idea that 45 is actually a fairly average age to start perimenopause.

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When I finally began to suspect that perimenopause could be a factor, I contacted my psychiatrist (who has many decades of experience) on two occasions to ask him if he thought it could be relevant. I was hoping he would want to be involved in treating my perimenopausal symptoms because I was already on so many drugs – and I didn’t really want someone new getting involved in something that could affect my mood and mental health. Unfortunately, it was apparent he wasn’t very interested so I had to seek help elsewhere.

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As soon as I got onto HRT, I felt better almost straight away. The only way to describe it is like my brain had been turned off and someone had just switched it back on. I can’t say for sure that my symptoms were caused by hormonal changes. All I know is that I’ve improved hugely since being on HRT, but I’m also still on the two antidepressants and quetiapine, so it’s possible that it’s a combination of everything that made me feel better. My husband is convinced that my symptoms were linked to hormones – I was doing a lot of crying, but he says his shoulders have finally dried off!

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Now I believe that everyone needs to educate themselves on menopause, and be aware that there are many more symptoms than just hot flushes – and that mental health symptoms are not uncommon. Even though midlife often comes with increased stress, perhaps as a result of raising teenagers, caring for elderly parents, and juggling home life with a high-pressure job, not all anxiety and low mood is directly related to what’s happening in our lives, and there could also be a hormonal element at play.

I desperately wish I had known that previous mental health difficulties, especially PMS and PND, would make me more susceptible to mental health issues during menopause. Of course, not all women who have had PND will struggle, but I think it’s important to be aware and informed, as I could have been much better prepared.

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On a practical note, I’d recommend that any woman who is suffering from mental health issues should talk to their GP and persist if they don’t get appropriate help at first. In addition, psychiatrists need much better education in menopause and mental health, as it’s outrageous that 51% of the population will go through a period of several years where their mental health is much more vulnerable to change, yet this is barely acknowledged or understood by psychiatry and psychotherapy in my experience.

No woman aged 45 should sit in a psychiatric hospital for four weeks without hormones being mentioned once. I think menopause needs to be kept in mind as a possible factor in mental illness in women of any age, but particularly those over 35. It makes me incredibly sad to think that if only the first psychiatrist I saw had tried me on HRT, as well as increasing my antidepressants, then me and my family could have been saved from so much pain and suffering.

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