Finding hope with hormones after 20 years of struggling with my mental health

Content warning: This episode contains discussion of suicide

Vanessa had always suffered with PMS and struggled with her mood and emotions after the birth of each of her children. After her fourth child was born, Vanessa’s mental health took a severe turn and she became suicidal. When her husband intervened and insisted she received specialist care, a psychiatrist realised how unwell Vanessa was and this was the beginning of an eighteen year journey of taking medication and receiving mental health support, including spells of inpatient care. It was all Vanessa could do to wake up every day and look after her children. Vanessa had wondered whether her mood was linked to her hormones as she would have 2 good weeks in every month before two bad weeks would inevitably creep in. In more recent years, friends persuaded her to see a menopause specialist and begin topping up her declining hormones and, as Vanessa explains, this has been lifechanging.

Vanessa’s advice:

1. You may not be well enough to go and ask for help yourself, allow family and friends to support you with this.
2. Don’t always accept everything you’re told by healthcare professionals, challenge thoughts and negative attitudes towards mental health and the link with hormones.
3. We develop lots of coping strategies to mask how we are really feeling. Don’t carry on hiding how you really are, speak to someone.

Help is available if you are struggling. Please contact the Samaritans by phone on 116 123, download the Samaritans Self-Help app or email jo@samaritans.org

Episode Transcript:

Dr Louise Newson [00:00:01] Hello, I’m Dr Louise Newson and welcome to my podcast. I am a GP and menopause specialist and I run the Newson Health Menopause and Wellbeing Centre here in Stratford upon Avon. I am also the founder of The Menopause Charity and the menopause support app called balance. On the podcast, I will be joined each week by an exciting guest to help provide evidence based information and advice about both the perimenopause and the menopause.

[00:00:46] So today on the podcast, I’m really excited and encouraged actually that I’ve managed to persuade someone called Vanessa to come on the podcast today to talk about her experience. So thanks very much, Vanessa, for coming today.

Vanessa [00:01:01] Not at all. As I said to you before, if there’s somebody listening that I can help, I’m absolutely delighted.

Dr Louise Newson [00:01:06] Yes. So. Well, this podcast probably comes with a tissue alert but I’m sure you will help people. And as many of you who listen to my podcast or listen to some of my work before know that I’m very keen and very committed to helping as many women as possible. But when it comes to mental health and the perimenopause, the menopause is really key. And it’s very high up in my agenda because I’m very struck with the stories of how women’s mental health can often deteriorate when hormone levels reduce. And that can start quite early actually, after the birth of a baby, when hormone levels decline very quickly, when women have PMS and then perimenopause and the menopause and some of us term it as ‘reproductive depression’. So it’s just the way our brains respond to changing hormone levels. And we have receptors for estrogen and testosterone and progesterone in our brains. And there’s a reason that they’re there because they help with the way the nerves work, the way our brain works, the way even our brain metabolises and thinks and does all the amazing thing our brains do. And for some women, not all, some women really struggle without their hormones. And I see a lot of women in my clinic who have been given antidepressants – sometimes because they’re clinically depressed – but often no one’s really thought about hormones as well. And we know that mental health can deteriorate. We know that incidents of depression increase in the forties. We also know that suicide rates increase in the forties as well. And we’re funding a PhD student with Liverpool University to look into this more. But some of the stories are very harrowing. And so I’ve known Vanessa for a while and her story has been harrowing, but it has a happy ending. Otherwise we wouldn’t be talking here today. But it’s quite a long story, Vanessa. So I don’t know if you mind just going back to this and talking about what’s been happening to you before we met.

Vanessa [00:02:58] Oh, yes. Okay, I’ll try. Yes, I obviously suffered with PMS a long time ago. And then after my third child, I found I was struggling even more. I then went on to have my fourth child and after the birth had the most incredible drop and I wasn’t quite sure what was happening. I thought it was just having a baby. I just thought it was normal. Anyway, I deteriorated further. I just couldn’t go out of my room. I could care for my baby, but I was just completely lost myself. So I went to my GP. I was really basically told that I was making a fuss. You know, ‘everyone copes with having a baby. It’s just completely normal’. Basically, just pull yourself together. I then came away from there and I think I believed her for a while because we look up to our doctors and, you know, rely on them. And then I just went further down and down and I then had my first suicide attempt. Thankfully, my husband realised something wasn’t right and came to find me. He then took me to the doctor the next day and was quite insistent something was wrong. I was then referred to a psychiatrist that day. We have private medical care through my husband’s work, so I was able to see a doctor within a few days. So I went along and I could see from his face that he thought I was very bad. He then spoke to my husband separately and explained to him what was happening and I think it was about the 23rd December. It’s just before Christmas. And then I went off, came home, went to bed and just was completely blank. So I then started medication and I’ve tried so many different medications over the years. But it’s been a long time that was – well, my son’s going to be 18 next week – so it’s 18 years that I’ve had medication. It’s the side effects. I’ve had treatment at the hospital. I’ve been in hospital for a period of time, and I just tried to look after my children and just could not do anything else. So, you know, I’ve obviously got that tendency to have depression. And I eventually read a report saying I had severe depression. And through my history with my GP, I would have thought it was quite obvious that this was hormone related, but at the time I was quite sick so I didn’t realise what was happening.

Dr Louise Newson [00:05:46] And did any of the psychologists talk to you about potential of hormones at all?

Vanessa [00:05:51] No, no, not at all. And over a period of time, I’ve told you that I did see a professor at a leading hospital but still never got anywhere. And I did talk to him about, the only thing I remember asking him was, ‘is it hormones? Could it be related to the trouble I’ve had in the past?’ And it was just a blank ‘No’.

Dr Louise Newson [00:06:15] Does he give any reason why not? Or is it just…

Vanessa [00:06:18] No just seemed to think it was depression. You know it’s genetic. It’s the way at the time I was probably…. you just take what they think.

Dr Louise Newson [00:06:27] Well of course you do. And I think it’s just very different. And I’m absolutely not being rude about psychiatrists on this podcast at all, because they have such an important role with mental health. Of course they do. And, you know, you, I’m sure, were clinically depressed, but it’s about what’s causing the clinical depression and what might be contributing to it. And this is where we need to do more research, because there are certainly women who are feeling a bit low and they’re menopausal, or there are people who are severely clinically depressed, but they’re also menopausal or perimenopausal or have hormonal changes. And, you know, the treatment is – absolutely antidepressants can be very, very useful. But we do know that antidepressants work better in an estrogenised woman. That means a woman who’s menstruating when they’re producing good levels of estrogen from her ovaries, or a woman who takes HRT. And this is something that’s been well documented in papers, but it’s something that’s not really spoken about. And certainly, the work we’re doing with the Royal College of Psychiatrists, psychiatrists often don’t know about it. So if you didn’t know it, obviously you haven’t got that understanding. But actually it does have this effect in our brain. And the estrogen can improve serotonin and can work synergistically with the antidepressants. And you know it’s very interesting that your, almost your senses were saying to you, could this be my hormones? And I hear that a lot from women. There’s a whole narrative about women not being heard about, not just menopause, any of their symptoms if they don’t fit into a box. But often the diagnosis is in the history. 90% of it – just listen to your patients. And when I trained in the eighties, we didn’t have the luxury of doing as many scans and MRI scans, CT scans. They were so expensive and so scarce, we had to use our diagnostic skills so much more than we do now. And so just listening to patients is number one for being a healthcare professional. So often women know when it’s their hormones. I think some of us are quite tuned into our hormones and we often have this, it’s very hard to explain, isn’t it? But I think you do know and I think, you know, you’ve had four pregnancies in your pregnancies, you would have had very high levels of hormones. And I presume you felt better in your pregnancies than postpartum?

Vanessa [00:08:48] Oh, yes, absolutely. Because I think as women, as you say, we’re so aware of our cycle and hormones is very much in our minds. But at the time, I was obviously very sick and despite asking, there just didn’t seem to be a link between the doctors I was seeing and the menopause or, you know, any sort of hormonal health. And as I went on, it just seemed more and more obvious. And then in my forties, when I dropped even further and then many, many years, I just didn’t want to be here, you know, I just wanted to die.

Dr Louise Newson [00:09:27] Which is very scary for you, but also your family as well.

Vanessa [00:09:31] Yes, my husband is amazing. Amazing. And he’s kept a very close eye on me. And we’ve just tried to look after our children. But, I don’t mean to sound sexist anyway, but with being a woman, we’re all so aware. And I think it might be it’s difficult for men to understand. We feel it in our bodies and maybe you know, me too, I don’t want to criticise psychiatrists in any way. I think what I would like to do, if anyone’s listening today is that, you know, keep asking questions and also just almost see, it’s terrible to say, but if you could see a female psychiatrist, it may be something that might be helpful. But I think it’s education. I just think if the psychiatrists are a bit more aware of this possible link, it may be helpful.

Dr Louise Newson [00:10:29] I totally to agree education is really, really important and some of you might know we’ve actually just written an education module. It’s the first one on the menopause for the Royal College of Psychiatrists and they’ve actually agreed it’s going to be free. So they’re putting the funding for it to be enabled that any psychiatrist can access it for free without paying for it, which is phenomenal. And actually, we’re going to do a part two as well. And we’re working very closely with psychiatrists as well to help with their education, empowerment and do this sort of cross-referral. And we’re going to have a psychiatrist working with us in the clinic, which will be really useful as well, because it has to be a joined up thinking. There’s not just the menopause on its own and it’s just not psychiatry on its own. And I know actually when we first met, it was somebody who we both know had reached out and was very worried about you actually, wasn’t she? And we first met and I was worried about your mental health. I mean, I’m a GP, I’ve got a lot of psychiatric experience just with my psychiatry training. And I remember speaking to your psychiatrist who is amazing, very good, but said he was keen to know how you’re your menopause would last for in case there was some hormone involvement. I said, well it would last as long as she’s alive because it’s the low hormones will last forever. And I think that was a concept he’d not really thought about before. And I remember saying to him and I know I said to you when we first met, I have no idea whether hormones are related to your mental health at all. But we do know that there is future benefits for HRT, for your bones and your heart, for example. So it’s no harm trying and seeing. So you obviously took HRT, but you didn’t have this miracle effect after a day of taking it, did you? It’s been a slow and steady winning the race, would you say?

Vanessa [00:12:14] Yes. I was so fortunate that somebody I knew for a long time did advise me to get in touch. And if it hadn’t been for her, I wouldn’t be speaking to you now. And I was so fortunate. I can’t, you know, it’s absolutely changed my life. And, you know, that’s something that, you know, I’m so grateful for. And what you’re doing is just extraordinary… really is.

Dr Louise Newson [00:12:39] Yeah, but it’s so sad because you’re just one person. We were talking earlier, you know, how many other people are suffering. And some of you might have heard the very emotional but very brave podcast that I did with someone called Pete, whose wife Vic sadly did commit suicide. And she tried to get help and she was really, really struggling and knew that it might be her hormones. And we want to prevent as many suicides as possible. And, you know, I think a lot about disease prevention for the menopause. And obviously, we want to reduce osteoporosis, we want to reduce heart disease. And all these have got mortality associated with them, but the mortality from suicide is 100%, isn’t it? So we really got to look at this in a lot –I think it’s a real urgent priority, actually, because we have to allow, not just psychiatrists, but anyone who works in mental health, whether it’s, you know, nurses or allied healthcare professionals. We see a lot of people who come from Crisis or from Relate or they’ve had psychotherapy or counselling or CBT, and no one’s really been thinking about could it be a hormonal effect. So the power of estrogen and often testosterone, which again we urgently need to do research on because all the studies have just looked at libido. And, no disrespect to you, but I’m sure your libido wasn’t your number one priority when you’re thinking about how to kill yourself.

Vanessa [00:14:06] You know, as anyone experiences those thoughts, you know, it’s just, you don’t care about anything. You’re just… that’s all you can think of. It’s just the only way you can get out, really. You know, you get to the end and you’ve tried and tried. But as you say, once I started seeing you and taking the gels, it’s been quite a long time, but I can honestly say I never expected to be here. I never had any plans for my life because that’s what happens. And now I wake up and I think I’m alive and there’s things I want to do today. And I think I just enjoy things that my psychiatrist noticed, he’d say time and time again, ‘Do you enjoy anything?’ No, literally, no. I think the point in that for other women is that if they can, if they get the message about HRT, they could at least try it, try and learn about it.

Dr Louise Newson [00:15:12] I think that’s very important. You know, I’m not here saying HRT is a cure for depression. Of course I’m not. And I’m not here saying everyone has to have HRT. But I am here saying that it is a hormone or it’s a combination of hormones, and they can be tailored, the dose, to each individual and it can be used in conjunction with other treatments, as in psychiatric medication, lifestyle, you know, exercise, nutrition, everything else as well. It’s a very holistic thing, but often it is the missing piece of the jigsaw that people have lost that piece of the jigsaw. They’re ignoring it. They’re in denial about it. And it’s almost like it’s a shame to consider HRT and it’s a failure to think about it. Whereas if someone, I often think about an underactive thyroid gland, you know, if someone had an underactive thyroid gland, they’re going to feel slow, they’re going to feel sluggish. They might be okay. But actually, why are we doing this? Why are we denying our body of a hormone that metabolically is very active and important in our bodies and evolutionary we were not designed to work without our hormones. And so it’s really important that we think more about why are women not having HRT as opposed to ‘Oh should we really give it because we’re so worried about it’. And I think the whole conversation is starting to change. But I do think mental health is something that often isn’t thought about enough. And it’s only because I’ve seen the volume of people that I have and heard the harrowing stories that I do – and see the improvement actually with HRT. And I know it’s not a placebo effect because I don’t give it to people who are mentally unwell telling them that I’m going to cure you, because that would be so wrong of me. Absolutely wrong. And it often is a gradual thing. It doesn’t work overnight, but the body has to learn how to adjust and the brain has to learn to adjust with hormones that haven’t had for quite a long time. But we see a lot of women who aren’t clinically depressed. They just say things like, ‘My zest for life has gone. I feel joyless, I feel lifeless, I have no joy in my life, I just no spring in my step’. And, you know, even a few people have said very little things like, ‘I found myself singing in the shower the other morning and I didn’t, you know, I had a voice’ or one patient a few years ago said to me that ‘my children said, I can see your teeth, mummy. I didn’t know you had teeth because you never normally smile’ and it’s very little things. But actually, you know, I think a lot about marginalised communities, I think a lot about minority groups. And then there is some studies say that domestic violence increases during the perimenopause and menopause and domestic violence isn’t just about beating someone up. There’s this low level of emotional sort of neglect that can occur. And I do think a lot about children growing up in families of women who are menopausal. And, you know, you had your adoring husband, if you were a single mum. I don’t even want to think about it. You know, I’ve got three children, you’ve got four. It is hard, even if you’re feeling mentally brilliant, you’ve got the best support network and everything else. But it doesn’t take much for us to just think, ‘Oh, I can’t do it’. And some of my children, my older two children have persuaded their friends, mothers or stepmothers to take HRT and a few of them have come round to the house and said, ‘Louise, I just want to thank you because I’ve dreaded going to my stepmother’s house every other weekend because she was so vile and it’s gone on for years and suddenly she’s happy. She’s taking me out, we’re going shopping together, we’ve bonded’. And then she said, ‘Oh, you know, I’ve read a book. This book by Doctor Newson or I’ve asked my GP and I’ve got some HRT’ and they’re just thanking me and I think, wow, this is amazing, actually. So these are teenagers who are scared to go to their stepmother’s houses.

Vanessa [00:19:39] That’s awful.

Dr Louise Newson [00:19:39] It is awful, isn’t it? And you can’t measure that on research. You can’t write a paper about it. But day to day, this is happening a lot. And I do often wonder what women would be like if they all had their hormones back that they needed, because I think the world would be a different place. And, you know, when I was a junior doctor, one of the treatments for heart attacks was to give aspirin and tuck people in bed, you know. We would just started giving the blood thinners, kinases, and now obviously they do the angioplasties and it’s amazing you know how – and stroke as well we never used to admit some patients who’d had a stroke and now it’s a medical emergency. And isn’t that fantastic that we’ve got these advances in medicine and, you know, obviously sepsis is massive, so important. But we seem to neglect, very basic medicine. And I don’t know whether it’s because it’s women and I don’t know whether it’s because it’s all women. So therefore, any treatment is going to be expensive because it’s multiplied by 13 million menopausal women that we have in the UK. I’m not quite sure why there’s so much neglect for us, because surely, as women, aren’t we quite productive when we’re well? Aren’t we able to give back to society more when we’re well and, you know, not draining the resources of healthcare? I know you said you’ve got private health insurance, but if you were on the NHS, how much would your hospital admissions and your various appointments have cost and your lost productivity to society?

Vanessa [00:21:11] Yes, I think we hear about it so much now, which is fantastic. But I think, you know, I think we compare ourselves as mothers to other mothers around us. And, you know, we’re all trying to do our best. But, you know, we do compare and think, you know, I’m just not good enough. I’m not good enough as a mother. And I’m sure as it’s, you know, people at work, they’re almost more capable people think, why is this happening to me? I’ve just got to get on. But as you say, if we had had that help, we would be more effective.

Dr Louise Newson [00:21:48] Yes.

Vanessa [00:21:49] At home or at work and almost it wouldn’t get to the stage that, you know, I think I’ve been surprised by some of my friends who maybe don’t understand or just think the whole talk of periods and menopause is too much. And, you know, I think you have to look at everybody in their situation and just be kind and just see, you know, if there’s anything possibly we could do. But for a long time, I’ve suffered. And now that I can speak properly and speak up, all I want to do really is… well, I worry, worry every day, probably about, you know, women who maybe can’t afford and there’s millions probably or who can’t afford the care that I’ve had and I feel guilty, you know, that I, I sit here and I feel well.

Dr Louise Newson [00:22:45] I totally agree and, you know, I have – there’s a lot of misconceptions about my work because it’s a private clinic and I feel very embarrassed, it being a private clinic. But I can’t get a job in the NHS, I can’t set up an NHS menopause clinic, there’s no funding for it. So what I’ve decided to do is be very philanthropic with my work and give as much as we can to education and research. And we’re doing a lot of work to try and help reach other groups and try and get our prices down. Trying to educate more nurses, pharmacists, trying to give back a lot to the NHS because it’s really, really important that we reach as many people as possible and there’s not as many women as possible know that it’s an option. And I think this is really important. What you were saying is about – and I often do it in the clinic – have a trial of HRT, you know, it’s not a wonder drug. It’s not a sort of fancy new drug. It’s just hormones, but it’s completely reversible. So if anyone decides they don’t want to take it, they just stop it. I’m not giving anyone an injection or an implant or something. I’m not giving them an operation. So it’s very easy as a woman to be in control. And I think that’s what’s really important as well. And that then women feel really empowered with what they’re doing and they’re also sharing that decision making. But it’s very difficult when people are mentally ill, you know, to actually be able to know and understand all the information. And so often that’s really important that women and their partners, their families, their loved one, other people are involved as well as much as possible. But knowing that decisions are reversible is really important. But the other thing is we’re doing a lot of work looking at the sort of polypharmacy that’s going on. The lots of people we see and we know certainly from disadvantaged groups, a lot of low socioeconomic classes, they’re on more medications and we see a lot of people who are on antidepressants, they’re on painkillers, they’ve had urinary tract infections so they’re on antibiotics. They’re on painkillers for their muscle and joint pains and sometimes on heart drugs for their palpitations or blood pressure drugs. They’re on statins as well to lower cholesterol. And a lot of these drugs have side effects, especially some of the stronger painkillers. And some of the antidepressants, which are hormones in the brain as well so if you’re not menopausal before, you will be after some of the heavy duty antidepressants and then no one’s thinking about the hormones. And we often find when we give people HRT one by one, they can reduce their medication, which is just liberating. And it’s really important as a doctor, we’re not just layering on more and more drugs, which is sadly what is happening. And so having someone – and I think this is why I’m selling myself, I suppose as a GP and a physician – that we do have skills to be able to look very holistically at people, whether it’s they’ve got a mental health issue or a cardiac issue or something else going on and we can work out which medication they really do and more importantly, don’t need. And I think that’s really important as we age. We don’t want to be rattling around do we? We want to have as few medications as possible, but we want our health to be optimal as well so we can reduce future disease and future drain on health services as well, of course.

Vanessa [00:26:03] Yes, absolutely. I remember trying packets and packets of paracetamol, sleeping tablets just to try and get away. And I remember that when I was with the two good weeks I had during my periods and the two bad weeks before. And I know it’s a long time and my psychiatrist could see that so clearly, but he’s interested in this link and he, you know, he finds it difficult to understand it, too. But as you said, if somebody around you can guide you to some sort of care and, you know, as you say, if a doctor has, I suppose it’s the time in the NHS, to actually look at what might be the underlying problem rather than just prescribing all sorts of other things that may not actually be the main problem. It’s very easy, I think, for doctors to maybe want to do something, a quick fix,  and dish out and the cost of all that on the NHS, as you say, the cost of people being in hospital, you know, it must be extraordinary. I’ve no idea, I’m just a normal person, but…

Dr Louise Newson [00:27:18] You’re not normal. You’re very special, but you’re absolutely right. It’s the financial cost and the personal cost and the society cost as well, actually from losing key individuals. So there’s a huge amount that we need to do. But having this conversation is really good and I’m sure it’s very helpful for a lot of people. And, you know, for me, it’s wonderful to hear and see you so much better. And, you know, just for you to be able to look forward to your life and, you know, have interest is just wonderful. So but before we end, Vanessa, I would really like, I always do these three take home tips. So I’m putting you on the spot, but just if you wouldn’t mind, just three tips to women who might have listened and think, Oh, yeah, what do I do? How can I get heard really? It’s about being listened to. So how would you suggest women really try and get the most out of the healthcare system to be listened to.

Vanessa [00:28:11] That’s difficult, it’s difficult. I think the main thing that I would say is you may not be well enough mentally to go and ask for help, but if you can talk to your GP. And now I would mention your name and suggest… there’s so much information that you’re providing, I don’t know how you have the energy to do everything that you do. So I think that’s the message I’d really like to get across and just look at all the things that you’re doing, other medication that you may be taking, and not just accepting that. And I suppose maybe, you know, I’m surrounded by very well-educated people and between my friends there’s very mixed feelings about it. And I think we have to sort of challenge those thoughts and maybe negative attitudes that go along with certainly mental health and also hormones that, you know, I think if you are depressed, you develop so many ways of coping and then all sorts of strategies to hide yourself and, you know, appear normal. And I think we do this as women, we compare ourselves and that’s very sad.

Dr Louise Newson [00:29:30] Yes. So I think being focused on yourself, which is quite hard actually when we’re all sort of busy and giving and just allowing ourselves to have the information that’s right for us and the treatment that feels right for us as well and it might take a little while and involve others as well is really important too, isn’t it? So thank you so much. I know it’s been difficult, but it’s been really lovely sharing a very sad but happy ending story. So thanks so much Vanessa.

Vanessa [00:30:01] Not at all. Thank you.

Dr Louise Newson [00:30:03] For more information about the perimenopause and menopause, please visit my website balance-menopause.com. Or you can download the free balance app which is available to download from the App Store or from Google Play.

END.