[Podcast] Menopause and your mental health

Speaker 1: Abbey Stanford, Specialist Health Editor

Hello and welcome to another episode of the Bupa Healthy Me podcast. My name is Abby Stanford and I'm a specialist health editor on Bupa's Health Content Team.

Today, we're going to be talking about the menopause, and I'm joined by Doctor Sam Wilde, a GP and also two women with experience of the menopause, Elaine and Amanda. We'd like to start Elaine and Amanda with you both briefly talking about your experiences of the menopause

Speaker 2: Elaine

Thank you. My name is Elaine. I'm 52. I don't know really when I started the menopause, but earlier on this year, maybe during the start of lockdown started having a lot of symptoms that I'd never had before. My period had been intermittent at best for quite a long time. I'm not sure when I really stopped having my periods. I was struggling to sleep, was very moody, very snappy with the husband.

Really, really struggling to sleep. I put that down to COVID really and being stuck inside and all the issues that were going on in the world on there and plodded on for a few months. Eventually I just really couldn't sleep due to the amount of hot flushes. I was literally waking up several times a night. Was getting an hour or two couple of hours a night at some point due to the just waking up wet through basically from hot flashes.

So I rang my GP, had a good discussion about all my symptoms and everything and he asked me to go down for a blood test, which I did and then not too much long later, a week or so later he gave me a call to say that I'm in the throws of menopause basically and things I wanted to discuss about options going forward, HRT and things like that.

I've been taking multivitamins for a while, recommended by friends who've also going through the menopause and things that didn't seem to help. It was the hot flushes that was causing my major issues because there was no point in the day where I wasn't having a hot flush. My mood swings, I can only describe PMT tenfold and my husband would agree with that on there.

I had good support at work. My manager was understanding and on there some days the brain fog was just a bit too much. On that again, I personally I put it down to a mixture of things going on in the world.

Eventually I rang back to my GP. Who and agreed to go on HRT on there, which they prescribed for me I have been on HRT now about 3 weeks. Maybe coming up to week four and I can honestly say I haven't had a hot flush now in over a week. I'm sleeping better at night. Mood swings are still a little bit there. I'm there still a little bit, but nowhere near as much on there. At one point a month or so ago, I was so feeling so down with just bursting out into tears for no apparent reason, which is not my personality.

Anybody would know me knows I'm quite a strong person. But I was just literally wanting to cry at a drop of a hat. So we have some good support at work. So I gave one of our help lines a call and had a had a discussion about that, about my mental health and about my physical symptoms, which I found a great help on there. And I've tried to now get ways around to help me deal with it, gain plenty of fresh air, speaking to friends, making sure I'm keeping in touch with people. We're in stage 3, lockdown here where I live. We're very restricted. I can't see my family, my friends and things, but keeping in touch online is a is a great way to go.

So, far for me, the HRT's worked, so I'll keep it going for now, I'll trial it. They gave me 3 month’s worth. At work my manager is so supportive, he is very understanding. I can talk to him at any point. And we have a mental health first aider on our team as well, who's also a good support for me. So far that's my experience. I don't have any pre-existing medical conditions. I am textbook. I always have been textbook with my periods and everything before this and hopefully fingers crossed life's gonna get a little bit better. So thank you for listening and I'll hand you over to Amanda

Speaker 3: Amanda

Hi everybody. My name is Amanda. My menopause story is quite a bit different from the norm because in 2010 aged 47, I was perimenopausal. So my periods have become irregular and that was about the only thing I noticed. But then I was diagnosed with breast cancer. So, I had a lumpectomy and six months of chemotherapy and then 20 sessions of radiotherapy. So my cancer treatment came to an end. That was only the start of my menopause journey.

So my oncologists have said that my menopause would be brought on artificially by the treatment I’ve had and the drugs that I was still taking. So in effect it would be like a double whammy. And I didn't realise how that would affect my everyday life. So the drugs I'm on caused hot flashes sleepless nights, restless legs, weight gain, emotional turmoil and that is pretty much what the menopause causes as well. So I got it in duplicate, so twice as bad. My main symptoms have been hot flushes which initially I found very difficult to deal with and also the sleeplessness. And it was quite debilitating.

The night sweats were so severe at the start that even changing the bedding in the middle of the night, I sometimes found that sleeping on a towel would help. Standing against the cold wall was good, and I've even tried standing in front of an open freezer to help cool down, and nowadays I've learned to cope with them better. Although I still suffer with them at night. But I have a low tug duvet. I don't have a a memory foam mattress because they keep you warm. So I've got rid of that. But it's it's difficult to sleep when you keep having all these hot moments.

So when I started working at Bupa about 4 1/2 years ago, my main worry was experiencing hot flashes when I was in a meeting. And I don't just mean getting hot and red, I mean actually sweating and feeling very unfeminine. It's not so bad when you're at home in your own space because it doesn't matter who sees you in in that hot spell. But I've managed to get through those embarrassing moments by always carrying a fan or a piece of card to fan myself with when I have those hot moments And cold water obviously helped, cold water on the wrist And I also at home have a cool place I can go to. I always have a fan by the bed for those really hot moments. But the sleeplessness can be quite draining and I'd fall asleep and then like, half an hour later I'd be awake. For no reason or it would be a hot flush that would wake me up. So on a really bad night, it could be about 3 or 4 hours sleep I'd have and I'd feel like a zombie. But my manager really helped let me adjust my working hours to sleep so I I could get better sleep. So I wasn't frightened to ask for that help because I was struggling emotionally.

I'd feel like I was on a rollercoaster some days on a really high, and then other days an extreme low and I wasn't very good at dealing with this. I'm quite a sociable and outgoing person and to have those low spells were really alien to me. But thanks to friends and colleagues it's now easier. It's 10 years down the line for me. I'm hopefully coming off my medication in January. So I'm hoping that those menopausal symptoms will lessen, but watch this space, we'll wait and see. Thank you.

So now we're gonna hand it over to, Doctor Sam Wild who’s our Bupa GP.

Speaker 4: Dr Samantha Wild

Hi. So I think both Elaine and Amanda have given a very good description of a lot of the symptoms that that can occur with the menopause.

We find that about 70% of women do suffer with hot flushes and night sweats, and they tend to be the symptoms that we commonly think of when we discuss the menopause. But there are dozens and dozens of different symptoms that women can experience. So things such as achy joints is something that women don't quite so often talk about. Also, the fact that some women get palpitations. Another common one that that women often are suffering with but don't actually have the sort of the nerve to speak to the GP about because they might feel embarrassed, is vaginal dryness or recurrent urinary infections. And so they start to find that sex can become uncomfortable, or they may avoid having smear tests because of that as well.

And so, yeah, I mean, Elaine and Amanda were both brilliant at talking to us about sort of the mental health aspect to it and the hot flashes. But I wonder if they've had you know some of those other symptoms too.

We know that with regards to mental health, that a lot of women do find that they suffer with low mood and those moods can be up and down as their hormones tend to fluctuate. And so I see women in clinic that are complaining that they started to suffer with panic attacks or little things that they know in the past wouldn't have bothered them really started to become sort of a mountain and they what we call catastrophize situations. They may find that they're unable to drive on the motorway anymore, or they might fear flying when in the past it wasn't a problem at all. And we do tend to see a peak in suicide rates in this age group as well.

So between the ages of 45 and 55, and I'm assuming that there's a an association with the hormones there, so sleep can be disturbed because of the hot flushes, but some women just find that their sleep quality just isn't as good as it once was anyway, and obviously that with feeling low and then finding the that your concentration may not be as good as it once was, and your memory wasn't good as it once was. All these things can have a knock on your self esteem and your self-confidence and then affect your performance at work as well as you know relationships too. So it can be a really difficult time for women and that's why we're really encouraging you know women to speak up, speak up to their friends and family, speak up to their GP to get help. Speak up at work as well and hopefully get that support there that they need.

And as Elaine said and Amanda said, you know, the things that can be done at work to help you know, we can put fans near desks. We can let people have as many toilet trips as they need and we can give them access to cold water. You know, there are things that can be done in the work environment we can hopefully with working from home maybe change working hours a little bit more now if people haven't slept well they could maybe start a bit later in the day. There's, a lot of things that can be done to make life a little bit easier when it needs to be really to support.

Elaine talked about HRT as well, and we know that's absolutely fantastic for treating symptoms and also has other benefits of keeping our bones nice and strong as they can start to suffer through the menopause too we can be at a greater risk of osteoporosis and there is some evidence that it will help reduce your risk of heart disease too.

But if you can't have HRT then there are other treatments that you can have that may be beneficial. We can use antidepressants, not necessarily for the low mood. There's no evidence that that will work for low mood caused by changing hormones. Although we do know that if a woman becomes clinically depressed, and antidepressants will work, but we can use antidepressants for hot flashes and night sweats for women that can't take HRT because they have had breast cancer for example,

And there are other medications we can use as well. There's one called Clonidine, which it's old fashioned now. We used to use it as a blood pressure medication, but it is there and you know, a lot of women won't tolerate it. It's not the best medication ever, but there's options that can be tried. So I always say, you know, please don't suffer in silence. Go and see your GP. Find out what other treatments are available.

We can use topical oestrogen cream for the vaginal dryness that doesn't have to be taken orally or used as transdermal sort of rubbing through the skin treatment to be used throughout the body. It can just be used locally where it's needed. You can also buy things over the counter, vaginal, lubricants, vaginal moisturisers which will also help with any dryness down below and can help with the current urine infections and the sexual discomfort. So, there's lots and lots of other sort of treatment options that you can get from your GP as well as trying all those self-help measures.

We haven't talked too much about diet. We know that diet can be very beneficial, so trying to have a healthy diet as possible. Trying to maintain a healthy weight. Making sure that you don't drink too much alcohol because alcohol has a few effects, one it will stop you sleeping as well. It is also a depressant, so it's not going to help with your mood. We also know that it can aggravate hot flashes. As can caffeine for some women too, as can spicy foods, sometimes it's a little bit of trial and error with your diet to see if it can make a difference. Exercise is also very beneficial. We know that it helps with our mental health. It also again helps keep our bones nice and strong. It helps keep the strength in our muscles. So all these things should be considered also.

I always advise women to take a vitamin D so it was good to hear that Elaine's taking a multivitamin. We know that we need vitamin D to keep our bones nice and strong. And our main source is from the sun.

And unfortunately, in this country we don't get enough sunlight. So I tell all women to take vitamin D, especially through the winter months. But you know, it's no harm to take it throughout the whole year and to take 10 micrograms a day of that. And to ensure that they're getting enough calcium in their diet too, because that also helps with the bones. So I think if you can try and do as much as you can to help yourself, but also please, you know, speak to your GP if you're suffering. Get the help that you need from them too, then that's really going to help you through this difficult time.

Elaine:

Sam, can I ask, I've never mentioned it, but can low libido be one of the symptoms of menopause?

Dr Sam Wild:

It is yes. Thank you for highlighting that. And again it's something that women don't want to talk about.

Elaine:

How can we? How can how can we stop that?

Dr Sam Wild:

So again we yeah, we want to break that taboo. We want to make women aware that there's something that can be done. So the HRT can help you with that. Also, ensuring as I said before that it isn’t uncomfortable down below, so that you are using vaginal lubricants or vaginal moisturisers or a topical oestrogen to try and help the tissue down there. And the reason that it does get uncomfortable down below is that oestrogen affects so many different parts of our body that it does affect the collagen and the tissue. So the tissue starts to get thinner as we get older and so you know by treating locally and by treating systemically with the HRT, that can help. Some women may also need testosterone. So women in particular that have gone through a premature menopause or have had a surgical menopause where they've had their ovaries removed, they will really lack testosterone.

Because, believe it or not, we need a lot of testosterone as women and 50% of it comes from our ovaries and our adrenal glands. So if our ovaries have gone, then we're going to suddenly lack that testosterone.

And so a menopause specialist will prescribe testosterone to help women with that too. It is unlicensed in this country, so it doesn't tend to be available on the NHS. But it can be given privately and used as a cream, and that's just rubbed on and doesn't tend to have any side effects to it, so you know, there's options there. Some women will find that psychosexual counselling may help as well. You know, looking at the relationship and ensuring that you know they're doing everything appropriate as they should be to try and help in any way that they can.

Elaine:

Thank you. It's useful though, when I was put on HRT we they discussed lots of different variations. The patches they wanted me to do originally, but I have quite a few allergies, so I have an allergy to like the stickiness in plasters and things like that. So there's no way I could risk wearing a patch thing and things like that. For me, so this is why they put me on what I'm on now. So fingers crossed it's going well, but who knows? We'll wait and see.

Dr Sam Wild:

Yeah. Yeah. So, there's lots of different options. So tablets tended to be used first line for many years and often still are in the NHS because they are cheaper. But actually, if you use the oestrogen topically, so either sort of what we call transdermally. So, either in the form of a gel or a patch to rub in, that does get rid of the sight of the risk of taking it orally is there was a risk of blood clots with it. So actually if you use it transdermally that risk goes. So it's just a safer way of using the oestrogen, but that risk is small, so it doesn't mean that you can't take oestrogen orally at all. You just have to be aware that there is that slight increased risk with that taking it that way.

Elaine:

Yeah, they she did mention that my GP. I just. I'm just would be worried that I'd be allergic to something in the patch.

Amanda:

Hi, Sam, just talking about oestrogen levels cause the cancer I had was oestrogen receptive. So the medication I'm on keeps my oestrogen levels down. But I've noticed like the changes in skin, my skin is a lot thinner. I bruise very easily and as you mentioned about aching joints, I do get that I've forgotten. I do get that. So what do you think? Is there anything that I could take when I've finished my medication to help or I just got plough through it as I have been doing?

Dr Sam Wild:

Yeah. So, this is a very specialist area. So any sort of HRT treatment would need to be discussed with the menopause specialist and an oncologist. As you know, after you've had breast cancer, then on the whole HRT is not usually routinely recommend it, but that doesn't mean that you can't necessarily have it and some women are so debilitated with symptoms of the menopause, that after discussion with the menopause specialist and their oncologist, they sometimes do choose to take HRT anyway, understanding that that risk obviously is there with regards to the cancer recurrence. But their life is so debilitated that you know they want the quality of life in the interim and so it's weighing up those risks and those benefits.

But there are other things that you can do so, as I said, you know you can use antidepressants. There are certain ones that will interfere with tamoxifen. So again, this has to be sort of carefully looked at. But they can help with the hot flashes and the night sweats. Some women are still able to use the topical oestrogen for the vaginal dryness to help them there because actually using that for a year is only equivalent to taking one oral HRT tablet. And so for a lot of women, again, you know they would have to be in conjunction with their oncologist, but it is actually, you know, safe for them even if they have had a history of breast cancer to use it topically.

So I think they're sort of the main things, the rest of it would really be more sort of diet and exercise related to try and you know manage the rest of those symptoms.

Abby Stanford:

And I know we've briefly touched on it there, but it'd be really great to get everyone's input on how other people can support someone in their life going through the menopause. Because I think there might be some people listening who maybe aren't going through it themselves. Maybe their partner or a colleague or a friend, so it'd be really nice to hear what you all think about the best ways that you can support somebody?

Elaine:

From my perspective, patience is a virtue on there, so if you if you know somebody is going through it, your mum, your sister, whoever's on there, just be patient. And if especially if that person's a little bit snappy. I've just, I've been very snappy with my friends and family and things. But my husband's as patient as the most patient man in the world, so he will just agree to disagree and just leaves me alone. Basically, I think that's giving people space is another thing. And also asking if there's anything you need or you want to talk about something. It's just talking about my day at work. Maybe I just need to vent when I finish work.

And it's not something I would normally do. But since going through this I just find myself a little bit more on edge. So just having a conversation helps me. So if you know somebody's going through just talk to them as if they're, you know, normally that's what I would say.

Amanda:

I think as well from me, I live on my own, so there's nobody sort of directly gets my mood swings, but I find that relaxing music helps you know it just helps calm me down. Also, I've tried acupuncture for the hot flushes, which has helped for a little time and I have also tried reflexology. So, there are alternative things if you can't have HRT that you could try, you know natural remedies. That type of thing.

But relaxing music, I've tried playing that at night, and these podcasts that you get on for helping you sleep, but they didn't work brilliantly for me because I'd dozed off as soon as the music had finished, so it didn't quite work, but there are things out there for everybody.

Dr Sam Wild:

I think leading on from that Amanda as well, what I hadn't mentioned also is cognitive behavioural therapy. There is evidence that, you know, that can work not just from the mood aspects, but also for the hot flushes as well. So that's sort of another option leading on from the mindfulness and the acupuncture and things like yoga as well, which we do know are very beneficial for some women.

Amanda:

I think as well just exercise as well does help. OK, we can't do much in lockdown at the moment, but because, I'm in Tier 3 at the moment. But you know, just going out for a walk and you know, I've taken up cycling, which I never thought I'd ever do. Don't get me wrong, I'm not doing mountain biking or anything, just little canal path drives, but I'm finding I'm getting a buzz out of that and it's using up your energy and perhaps can make you feel that a little bit tired at the end of the day, so it will help you have a better sleep?

Dr Sam Wild:

Yes, I think definitely, I think there's some evidence that shows that that that will help. Trying to exercise sort of earlier on in the day, so you're not sort of raising the endorphins too much in the evening, but yeah, it does make a difference.

Abby Stanford:

That's great. And I think just before we sort of end things and round things up, it would really be great if everyone could share their one top tip for and the thing that has helped them get them through the most. And maybe for somebody listening who's just starting the menopause or is going through it, that that feels a little bit lost. What would be everybody's top tip for getting through?

Elaine:

My top tip would be, if available is talk to people, so I have a best friend who's going through the same as me. Started a bit before me and so we talk regularly about it and we haven't seen each other for a few weeks cause we're in Tier 3 lockdown. But we'll talk on the phone or over Zoom or whatever it may be and that helps me no end. So for me, just having somebody there to talk to is a is a bonus. So if you can, if you have somebody close to you, that would be a good help.

Amanda:

I think for me my top tip would be always wear layers so you can take a layer off. I think when we've been in the office during the winter and I’m the one walking around in a T-shirt typed top, you know, short sleeves and everyone else has got woolly jumpers on. I don't wear jumpers because I get too hot. But yeah, wearing layers. So if you get too hot, you can take a layer off. And always carry a fan. And just remember that the menopause isn't a taboo subject anymore. At one time it was, there's always people out there going through the same thing as you and help is there if you need it.

Dr Sam Wild:

Yeah, yes. And I would completely agree with that. Just don't suffer in silence. There is plenty of help available. We are going through a good time at the moment when that that taboo really seems to be being broken and more and more it's getting talked about in the media and with us doing events like this and hopefully that information is there and readily available for women to really educate themselves and ensure that they get the best help, really that they should be getting.

Abby:

That's great. Thank you so much, everyone. And that's been so so interesting and thank you, Elaine and Amanda as well for sharing your personal stories.

I know with you know, the menopause is no longer taboo, but I still think it's a really brave thing to do, to come and share with a large group of people. And so thank you everyone for sharing your experience and your advice. And I think we got to round things up and that's all we've got time for. But you can get lots more advice and information on the menopause by visiting the Bupa Health Information pages.

And also please do subscribe to the Healthy Me podcast so that you don't miss an episode.