Losing my wife: was her perimenopause a contributing factor? With Peter Smith

Content warning: suicide

Peter Smith joins Dr Louise Newson this week in a difficult and emotional episode. Peter lost his wife, Victoria, to suicide a year ago after she experienced a sudden change in her mental health in her late 40s. In their quest to understand how things could have got to such a crisis point for Victoria, Peter and his family have learnt more about the menopause and mental health, and they’ve raised the question of whether Victoria’s perimenopause could have been responsible for, or at least contributed to, her sudden mental illness when she had never previously experienced any such difficulties.

Peter describes the series of events that led up to Victoria’s death and how healthcare professionals dismissed the possibility of hormones playing a part in the worsening of her mental health, both at the time and during a recent inquest. Louise explains the work she is now jointly involved in, with Peter’s help, to raise awareness of the link between mood and menopause both in Pete’s local NHS Trust and nationwide.

Peter’s advice for partners if your loved one is struggling:

1. Go with your partner to see a GP, and if needed, find someone that specialises in the menopause.
2. Talk about it with each other. Listen and try and understand what they’re going through, and support them as best you can.
3. Encourage them to talk openly with friends about it too.

Episode Transcript

Dr Louise Newson [00:00:09] Hello. I’m Dr Louise Newson and welcome to my podcast. I’m a GP and menopause specialist and I run the Newson Health Menopause and Wellbeing Centre here in Stratford-Upon-Avon. I’m 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.

Dr Louise Newson [00:00:45] So today, this podcast actually comes with a tissue alert. So for those of you listening and about to listen, have a box of tissues because I certainly will need them and I’m very honoured and privileged to introduce to you someone called Pete who I was introduced to by a hospital Trust actually a few months ago now. And he’s very bravely agreed to join me today in the studio to talk about his experience of perhaps the perimenopause and menopause and what he’s learnt. So I’m very, very grateful for you sharing your time today. So thanks for joining me.

Pete Smith [00:01:22] Oh, thanks for asking me.

Dr Louise Newson [00:01:24] So I was introduced to you by someone called Elizabeth wasn’t I, who works in Norfolk for the hospital, and she reached out following a very sad story, which we’ll talk about in a minute and she told me about you and what a strong person you are and about your amazing family network that you have. And so the story that I heard obviously was very upsetting, and so I picked up the phone and spoke to you. I didn’t quite know what I was going to say to you.

Pete Smith [00:01:53] Well, I was surprised to hear from you.

Dr Louise Newson [00:01:55] Yeah, but I couldn’t listen to a story like the one I had and not speak to you, actually. But it was a bit of an awkward conversation because I was a complete stranger to you and just − I think it was a Friday night, wasn’t it?

Pete Smith [00:02:08] It was. Yes

Dr Louise Newson [00:02:09] I was about to go home and I thought, ‘No I’m not going home until I’ve spoken to this gentleman.’ And I’m so pleased that I did actually. And the reason that we’re talking today is because we want to move things forward and we want to make a real difference and you’ll hear why in a second. So do you want to talk about what’s happened and why we’ve connected Pete?

Pete Smith [00:02:27] Yes. I lost my wife, Victoria, last April. She took her own life after a two-year battle with mental health, really. And through the process of that, we asked many, many, many questions amongst them, menopause and perimenopause, pretty much all of which were dismissed along that journey. After she took her life, the Trust carried out a patient safety investigation incident report, and they then began to realise that opportunities may have been missed. The perimenopause could well have been one of the major factors which they never seriously considered. The Trust then brought you in, and that’s how we came to speak because of your involvement with raising awareness with them. And obviously, since it’s happened, I’ve learnt and read an awful lot more, which is heartbreaking, to be honest.

Dr Louise Newson [00:03:30] Absolutely. And it’s so difficult. And I think before we go any further, for those of you listening and Pete as well, we’re not here to say that every female suicide is due to hormones. And we’re not even saying that your wife’s was due to hormones, but we’re saying there might have been a part to play. And certainly, mental health and the menopause and perimenopause are closely associated because the hormones estrogen and also testosterone are very powerful in the way a female brain works. And we know when the levels reduce, it can affect the way people think, the way they process information and a lot about their mental health as well. Sadly, there’s very little good quality evidence in this area because the studies haven’t been done. But actually, we learn all the time from our patients and from stories and from experiences. And as some of you might know, we do speak to a lot of women who are really in quite a difficult mental situation and really desperate for help. And we know it’s related to their hormones, often because they tell us actually, they know that their periods have changed and so that − I know your wife didn’t have any mental health issues did she before?

Pete Smith [00:04:46] No, none at all. And this is the thing I think really, that you have to look now and you know retrospectively, you look back and you think there was just this enormous change in around early 2019, when she was just turned 49, she just suddenly changed. She said later that maybe in 2018, she felt slightly different. But in early 2019, she was saying, ‘I just don’t feel right.’ And you know, she was such a strong, capable person, the most organised person I knew. And you know, she just fell apart, basically. And when a lady such as Vic, who had no mental health issues whatsoever suddenly changes, I look back now and I think, ‘well why weren’t those questions being asked?’ It was always put down to be in a clinical depression, always treated as such throughout. We saw six psychiatrists over two years privately as well as NHS. And we just couldn’t seem to get anyone to turn around and say, ‘Well, hang on a minute, exactly what is happening here?’ It was just the dramatic change in her personality, really.

Dr Louise Newson [00:06:05] Mm-Hmm. And had her periods changed, were they changing at all do you know?

Pete Smith [00:06:10] Yeah, I mean, certainly she had physical issues during perimenopause. She actually got hospitalised for four months, and during that time she was bleeding heavily. And at the time, they put that down to a side effect of Sertraline, which was one of the antidepressants she was on. And for one reason or another, she didn’t actually get onto any form of HRT until autumn of 2020. So, you know, a good 18 months after she first went to the GP. She was initially signed off with what they thought was work related stress. She’d just had a promotion as an associate in the law firm where she was. And we did think it was that because she couldn’t make decisions, she would ring me up at work about things and things that I would think, ‘Why is she calling me? She’s such… So in control.’ She lost confidence. And then through the ensuing months, when we did get her back home, at times it was like a stranger in the house. She wasn’t herself. She’d felt she’d lost the connection with the children, with me, constantly ask questions like had she been a good mother? And she was such a warm hearted, kind person. She just lost herself.

Dr Louise Newson [00:07:35] So a lot of self-doubt.

Pete Smith [00:07:37] Yeah, huge amount.

Dr Louise Newson [00:07:40] And so you’ve got three children?

Pete Smith [00:07:42] Yes. Yes, we have yeah. Two of them are away at university now, the youngest is still with me at home. They’ve done remarkably well through the period of Vic being unwell. They were taking exams and joining universities, and they seem to be coping miraculously and they just keep me going really.

Dr Louise Newson [00:08:03] Amazing. Yeah. So it must have been very difficult for them experiencing a change in their mother.

Pete Smith [00:08:09] Yeah, because they’d always been so close to their mum. And when she was in hospital, and when she was having better days, I would try and get the children to the family room to see her. But they could see she was − she just changed and she tried so hard. She tried all the time, which is why she often presented really well to the professionals as well. It wasn’t like you’d think of a clinical depression of someone being in a dark hole in the corner. Yeah, there were the odd days like that, but most of the time she could get out of bed, shower, she was immaculately presented, you know, would never sort of give any indication to people generally around her. It was when she was quiet and on her own that it really came across how she was really struggling.

Dr Louise Newson [00:09:01] Yeah. And we see that quite a lot in the clinic, actually, that people look very different if you see what I mean they’ve got a good appearance, they seem fine. And then they tell you that they’re feeling very low and they’ve got very intrusive thoughts and feel very negative. And it can sometimes be quite subtle, but it can be sometimes different to very severe clinical depression where people don’t have eye contact, they don’t get dressed properly they don’t really care, actually. So there is this area that we’re learning more and more that seems to be slightly different. And it’s very hard because if you ask people the questions, you wouldn’t notice a difference. But actually, it’s that physical appearance and the way people hold themselves can sometimes be slightly subtle signs as well. So when she started HRT, did it make any difference to her at all? Can you remember?

Pete Smith [00:09:54] Not massively. I mean, she was diagnosed with a thickened uterus to a hormonal imbalance, and she was fitted with a Mirena coil and started HRT around the same time. And whilst I think that helped with some of the physical conditions, I think she’d just been so blinded by then, almost two years of quite heavy doses of antidepressants, she was on two antidepressants and an antipsychotic at the end because she’d been classed as ‘treatment resistant’ in the experts’ opinions. She was started on a course of Lithium, which just piled the weight on her, which she was distraught, absolutely distraught about. And yeah, and you’re right about the appearance in the week before we lost her. She hadn’t been working, but she decided she was going to try and find a job. She applied for two jobs, went to two job interviews and got both of them so she could present that well. And the following week, we lost her. Yeah. The presentation is… Yeah.

Dr Louise Newson [00:11:01] So and the dose I know she was on HRT was quite a low dose as well, wasn’t it? And I know it was going to be reviewed, wasn’t it? But she was still having some flushes and sweats as well on the type she was on, which suggests that her dose was quite low?

Pete Smith [00:11:16] That’s right. Yeah, although she was on those and we started to think, you know, this is going to help. I don’t think we got to this stage with, as you say, where the doses were right. And I’ve never fully understood one of the things I noticed was there was no joined up thinking between gynae and the mental health team. I don’t think they knew what each other were doing. You know, they never put the two things together, and I believe the antidepressants had just completely blunted her emotions. She was just a hollow version of herself. Of course, I’m saying this with hindsight because I encouraged her to take all these things because I thought it was the right thing to do.

Dr Louise Newson [00:12:03] Absolutely. And when I first spoke to you, we can never go back and actually, I’m sure it was the right thing to do. And certainly, it’s very important to consider antidepressants when people are very low and there’s lots of people that take antidepressants and HRT. And like I said earlier, it’s impossible to prove. But I think what we’re trying to do with talking so openly, and I’m very grateful for you to talk so openly, is think about how we can as healthcare professionals, not work in silo and, like you say, to join the dots, but also listen to people’s stories as well. And one of the things is, you know, Pete, I try very hard is to increase awareness of the perimenopause and menopause. And we know both of us that it might not make any difference to Vic’s, but for future cases, it might make a difference. And it’s about awareness, and I feel very strongly that every woman, whether she sees a psychiatrist or a cardiologist or a urologist or any specialty, should be asked about her periods and asked to monitor her symptoms. But she can do that herself, so it’s not taking more time away from a healthcare professional. And if the person isn’t able to do it, then her partner or advocate or someone else, or a nurse with her could do that. And that’s where it would be amazing. I think for it to go, and I know you agree don’t you that if every time you have a medical encounter, somebody says, ‘Well, have you had your periods or do you think any of these symptoms could be related to hormonal changes?’ And I think we would − it would be amazing if we got to that stage, wouldn’t it?

Pete Smith [00:13:45] Absolutely. I mean, as we’ve exchanged in emails, you know, what you’re doing is fantastic because every time I turn the radio on in the car or the TV, there’s more and more awareness even in the short space, in the 10 months since we’ve lost Vic, it’s becoming more and more.

Dr Louise Newson [00:14:03] Good.

Pete Smith [00:14:04] It really is. I mean, I work in construction, which is hardly a hotbed for guys talking about menopause. But we are − they know what’s happened to me and with Vic and the number of male colleagues, female colleagues I’ve got coming up to me asking me for links to websites talking about you. And I think that’s one of the things that’s going to help. Someone is just talking about it.

Dr Louise Newson [00:14:31] You’re totally right. And you know, if I’d met you six years ago, I actually would probably be like some of the psychiatrists who you’ve met because I didn’t know there was this association. No one taught me at medical school. No one taught me when I did psychiatry training. No one taught me in hospital medicine. No one taught me when I was a GP. I’ve been very good at prescribing antidepressants, and I’ve prescribed them to hundreds, if not thousands of people, appropriately for what I thought was clinical depression. But no one had ever taught me that there was a mental health component and also some of the drugs that people are on, certainly for long times and longer period times and the ones Vic was on can suppress hormones as well. So even if people don’t have any menopausal or perimenopausal symptoms initially after the years go on, then often their ovaries will switch off. And so I actually very strongly feel that every psychiatrist, every psychologist, every mental health worker should be switched on with hormones the same way that any healthcare professional that sees an adult person should be. But like I say, if someone had told me that six or seven years ago, I would have said, ‘Well, that’s silly. It doesn’t affect psychiatry, doesn’t affect cardiology because no one taught me.’ And it was only really because I see and speak to so many women who are perimenopausal and menopausal and a lot of them do have these other symptoms, and I know they’re related because they often get better, and I’m not saying that every low mood is due to hormones like not every headache or every palpitations is due to low hormones. But we have to think about them, and we have to have the right training, otherwise we can’t ask the right questions. But also, women have to have the right training so they can think about it as well, don’t they? So it’s a joined up approach.

Pete Smith [00:16:23] Yeah, absolutely. Yeah. You know, we were talking earlier about the inquest and the psychiatrists who were called as witnesses. You know, and we questioned them. And one of them, outright, said he thought the question of perimenopause in Vic’s case was a red herring and that the argument for it was baseless. And another one quoted the World Health Organisation, which I don’t know, you probably know this, but he said there was no differentiation between clinical and hormonal depression and there were no different treatment plans, which again is against the reading that I know you’ve been sending through.

Dr Louise Newson [00:17:05] And it’s very hard. I find with a lot of the work it’s very hard changing people’s attitudes. And sadly, the older we get, the more resistant we are to learning new things and being challenged. And, you know, challenge is a good thing. You’ve got children, I’ve got children. They challenge us all the time with either their behaviour or their beliefs and sometimes their beliefs that actually are completely unfounded. But you’ve got to challenge them because that’s the only way of learning. And I feel like every day we have to learn, and you know, one of the things I certainly learn from is patients and stories, and it’s a great privilege being a doctor. But I’m doing some work with someone called Professor Kulkarni, who you might know is a psychiatrist in Melbourne. She’s a professor of psychiatry, and she talks a lot about perimenopausal depression and how you diagnose it and how you pick it up and how it can be different to clinical depression. And what’s very interesting is that she’s been trying to work with some very eminent gynaecologists, but they don’t believe there’s a mental health component. And then she’s also been trying to work with some other psychiatric colleagues, but they don’t believe there’s a hormonal component. And she’s been doing this for far longer than me, but this frustration is very apparent when you talk to her.

Pete Smith [00:18:16] Yeah, I don’t, you know, I’m just the husband who’s lost his wife and trying to understand if there was any way we could have done anything differently to help her. And the answer appears to be there may have been and that’s just heartbreaking that, you know, we could have potentially saved her life. We will never know. But I’m no expert Louise.

Dr Louise Newson [00:18:41] Course you’re not. And like I say, it might not have made any difference at all. But what we want to do is to make changes going forward from here for other people as well. And we do know that the risk of suicide or the rates of suicide increase by a factor of seven between the age of 40 and 50. And we do know that hormones are related. So we’ve already done some really good work, haven’t we, with the Trust and we’ve got some good things planned. So last week, I did some training for some of the crisis team and one of the psychiatrists was there, and I just had an hour with them and I gave a presentation and then they had some really amazing questions and answers and they’re going to − we recorded the session. And that’s going to be fed back to a lot of their team. And that was amazing, actually, because they all started thinking about it in ways that they hadn’t because no one had taught them before. They learnt a lot about the perimenopause and the menopause, they learnt a lot about the power of hormones in the brain. And also, they learnt a lot about the safety of HRT and how to signpost other healthcare professionals to information, but more importantly, their patients. And so that was actually a really enlightening session, which is very supportive of the Trust. And then we’re also going to do another session where you’re going to be involved, aren’t we?

Pete Smith [00:20:01] Yes, I believe we’re doing a webcast − a live one, which is quite frightening. But, yeah.

Dr Louise Newson [00:20:07] Yeah. So we’re going to do that in March this year. So 2022, and we’re going to make it available to anyone aren’t we. And so you, all being well, are going to be there at the start and you’re going to be talking at the start, I should say, you’ll hopefully be there for all of it. And we just really want to open the conversation to talk more about the whole perimenopausal, menopausal depression, the mood changes that occur and how people can again be signposted to information. There’s information on my website about mental health. There’s information through the society we’ve just launched for healthcare professionals and how we can expand on that knowledge and share experiences, and I think that’s going to be really powerful to start this conversation going, and I think there’s so much more we can do, but we can’t do these things on our own. And so to work together, it’s going to really start the conversation. And the more work I do in the media, the more we can talk about mental health as well, because there’s a lot of people out there that don’t have a supportive partner or family who maybe haven’t got English as their first language, who are really struggling to get any sort of help. And that’s got to change as a matter of urgency, hasn’t it?

Pete Smith [00:21:30] It certainly has. You know, it’s finding a way. We as a family we were supportive of Vic. We all took time off work when she was troubled and there are families out there with much less support around them. You know, it’s frightening to think there are people on their own out there. That really is the thing. You know, ultimately, we couldn’t − Vic seemed to fall through all the holes in the net as she went down. You know, we didn’t get that opportunity to turn things around. And as you were saying earlier, you think about your very first point of contact with a medical professional is your GP. And if they get you off on the right track, I think you’re in a much better place. So that really needs to be the starting point, I think, because once we we’re in the system and we got shut down, the mental health route was very hard to sort of turn it around and go in a different direction.

Dr Louise Newson [00:22:30] Yeah. And I think that’s so important with any aspect of medicine that we don’t work in isolation so that we see patients as a whole and we appreciate other symptoms because, you know, sometimes people might have a headache, but they might also have a fever and they might also have a chest infection. And it’s very important that we look at everything. And mental health obviously covers so much and it’s so much more relevant, even more than it used to be, especially with COVID. We know mental health has had a big effect on that. But I think it is also trying to review things very regularly as well is really important as well. So as things change, we always look and think, ‘is there any other reason or is there something else that might be contributing?’ And keeping a really open mind is really important. But I think the other thing we want to do is try and educate partners and families as well, because for that person, when they’re going through any changes with their hormones can be very hard to actually see the wood for the trees, actually. And so we’ve already developed a partners section on the balance menopause website, and we’re going to expand that even further. And now we’re actually writing some literature, some information for families as well, because I really feel that every child should know about the menopause, not just because it’s going to come to them, but also ways they can maybe pick it up, not just in their families, but maybe their teachers or a carer or something else. Because that way, then you’ve got more people looking out for you if you’re a perimenopausal or menopausal women. And I think that will make a difference too, don’t you?

Pete Smith [00:24:09] Absolutely. I mean, to my to my shame, if I go back, you know, a few years, I knew absolutely nothing about menopause. Like most men, the conversations you would have with your friends in the pub, you know, I mean, one of my mates, he complained that his wife constantly had a fan on because and it was, you know, quite dismissive some of the conversations. But I think things are changing. Things really are changing as I said the conversations online with people. And literally every man I speak to has a story about his wife and sort of says, you know, this is happening to her, do you think that could be and I’d say ‘try and get some help’, you know, find the right people.

Dr Louise Newson [00:24:53] Yeah, which is amazing because you are going to help people in a way that you would have never been able to or even considered. And I know it’s not going to replace what’s happened, but the amount that you’re going to be able to give to people is just phenomenal. And this legacy that we’re going to be able to leave and that you already are leaving is huge. And I think it’s incredibly brave what you’re doing, but I know that Vic would be very proud of everything that you’re doing as well. And I really look forward actually to seeing what we can do going forward to make this even bigger and bolder and louder than it is already. And so I’m very grateful for you to spend some time talking because I know it’s not easy, but I know it’s going to resonate with people and make them think and anything to improve awareness has got to be a good thing. So before we leave, Pete, I’m going to put you on this spot and ask you for three take home messages, and there’s lots that I’d like to ask, but if it could just be three things that you think would be useful for people to know if they were either struggling themselves with mental health or someone around them was struggling. What are the three tips that you would give to those people?

Pete Smith [00:26:19] Blimey, I think what I mentioned earlier about your own GP is the person who should know you the best and they’re your first point of contact. So I would say to anyone who’s, you know, a guy whose wife or partner is going to a GP, you know, go with them, ask the questions. If that GP hasn’t got an interest to specialise in menopause, ask for someone in the practice who does. And if there isn’t one, find a menopause expert. I think that’s really important. The − I don’t know if I’ve got three points. They’re all also muddled up. But it’s just the talking, I think, is just talk. Vic and I talked all the time, she was trying desperately to understand what was happening to her, but we weren’t getting − we were asking all the questions, but not getting the answers coming back. But yeah, just talk. Understand and support them as much as you can.

Dr Louise Newson [00:27:18] Yeah.

Pete Smith [00:27:18] And just encourage them to talk with friends as well, I think. I don’t know. I can’t say, but I always got the impression that Vic never really talked details with female friends too much. I don’t know if it’s a sort of kind of secret thing. Almost, you know, maybe it was just her that. But yes, speak to your friends because I just know from what guys are telling me that all their wives are going through the same things, you know, to various degrees.

Dr Louise Newson [00:27:47] Absolutely. Really good advice. Sharing with each other is so important and trying to seek help. And actually, if you don’t get the right help, or there’s help that you think is right the first time, then keep asking and keep challenging. And I look forward to seeing what we can do going forward. I feel this is only the start, so there’s a lot we’re doing. We’re also funding a PhD student actually who’s going to be a suicide prevention, looking at suicide prevention. We’re working with Liverpool University and UCL, and that’s going to start soon. So that’s a three-year programme for a PhD student that I’ve committed to funding through my not-for-profit, so I’m going to be really keen to share with you how that goes as well. So I’m very grateful actually for you that we’ve met and I’m very grateful that you’re spearheading this and giving me even more energy and strength to use this as an absolute priority so we can make a difference. So I apologise also to the listeners that this is probably the most depressing podcast that we’ve done.

Pete Smith [00:28:55] Sorry.

Dr Louise Newson [00:28:55] But no, don’t apologise because it’s going to make a difference. And you know, I’ve already founded The Menopause Charity, we’re really going to try and fundraise so that we can get a help line. So it’s another area that people can go to to get help. So we’re really going to − this is a big move this year. So if any of you have gotten a hand in your pocket, if it’s not round the tissue, then contact The Menopause Charity so we can really get this going because between us all, we’re going to make a difference. And I’m very grateful again for your time today. So thank you for joining me.

Pete Smith [00:29:31] Not at all. Not at all. No. Thank you.

Dr Louise Newson [00:29:36] 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