DR MAX THE MIND DOCTOR: Don't blame the menopause for bad behaviour How desperately sad. The fifty-something woman sitting opposite me in my outpatient clinic appeared to have everything in life. She had a loving husband, two healthy grown-up children, a close circle of friends and a mortgage-free property. And yet she was in floods of tears. She told me she struggled to face each new day. It was a battle to get out of bed in the morning. She no longer found enjoyment in life and was tearful all the time. Clearly, she was deeply depressed. This black cloud had emerged, she explained, when the menopause began. Love match: Chris Evert and Greg Norman. She blamed their affair on 'menopausal stuff' Of course, it would be easy to blame her predicament on what is called The Change. But the more we talked, the more it became evident that the seeds of her unhappiness had been planted many years ago. Focused on her family, she had sacrificed a huge amount (including a fulfilling career in law) to bring up her children. As she reassessed her life, she became highly self-critical — furious because she felt she’d never reached her potential. This brought on a series of negative thoughts such as whether she was trapped in a stale marriage and whether it was justified to resent the myriad life opportunities that her children had in front of them. This woman’s story is far from uncommon. In fact, in my clinic, I often see women who are like this. Many have never suffered from depression before but, suddenly, just as the menopause starts, they feel as if their world is falling in around them. So can this turmoil be simply put down to a change in hormones? Can we explain away their deep dissatisfaction, sense of loss and malaise as a chemical reaction? Or is it simply the fact that the menopause tends to set in when so many elements in a woman’s life are changing, too? I think the truth is complicated, despite the widespread belief hormonal fluctuations in the menopause are responsible for making women feel very down. Indeed, this jejune interpretation was given credence this week when former tennis champion Chris Evert blamed the collapse of her 18-year marriage — triggered by her affair with her husband’s friend, golfer Greg Norman — on ‘menopausal stuff’. Of course, it is always easy, and tempting, to shift the blame for poor decision-making and bad behaviour onto circumstances out of our control. But are women really just slaves to their hormones as their ovaries decline? I don’t believe so. Though Evert claims society doesn’t discuss the issue enough, the mental aspects of the menopause are well known. While some women seem to suffer no problems, others complain of erratic mood swings and out-of-character behaviour. Some quit their job, have affairs or leave their husband. But the medical evidence that this is solely down to hormones is unconvincing. There is no conclusive proof that falls in the levels of oestrogen and progesterone — the female sex hormones that start to decline in menopause — are responsible. Instead, I think the menopause suddenly makes women reassess all aspects of their lives. For many women, their sense of self and identity is intricately bound up with their roles as mother and wife. By their 50s and 60s, they are set in their ways of prioritising their families above their own interests. But then, often as their children leave home, they look back at their sacrifices and wonder whether they were all worth it. Often, this leads to feelings of despair and resentment, which are compounded by the effects of the menopause. Added to all this can be the fact that women in this age group can feel ‘invisible’ — overlooked by the rest of society. No longer able to have children, no longer needed for day-to-day mothering, they can feel they have not only lost their role in life, but also part of their femininity. Indeed, I’ve had many menopausal and post-menopausal patients tell me that they no longer feel like a woman. What terrible anguish. Some also believe they are no longer desired by the opposite sex. This sense of dejection is exacerbated by cruel social attitudes, which judge ageing women on their appearance in a way that doesn’t happen with regard to men. Nevertheless, men do experience a comparable jolt, though typically it comes some years later. This often happens when they retire and the working role that largely defines them is taken away. What’s more, because these shifts happen at different times for men and women, couples can become out of sync. This, in turn, can lead to a lack of sympathy when one partner is suffering. There is no easy solution to coping with this stage of life. But it certainly helps to pinpoint your problems and focus on addressing what is really the matter in a rational way. Blaming hormones is just a cop-out. Anna Foster, pictured, has undergone the agony of miscarriage twice. She should be applauded for speaking out about the tragedy BBC radio presenter Anna Foster talked this week about the agony of her two miscarriages. The 36-year-old has a genetic condition that was responsible but, despite this, she managed to go on to have two children. Many women, of course, aren’t as fortunate. Miscarriage seems to be one of those taboo subjects that few people are willing to discuss — yet it causes untold grief and distress. It’s also very common. One in six pregnancies where women know they’re expecting ends in miscarriage. From my clinical experience, women tend to suffer in silence — often blaming themselves. They will often torment themselves about why it happened to them. Many don’t know how to feel. Some miscarry at a time in the pregnancy when other women choose, legally, to abort their foetus. As the law sees this as an early stage, those who miscarry may feel that others won’t recognise their need to grieve. Over the years, numerous women who’ve miscarried have told me that they subsequently had become depressed, but felt they couldn’t talk about it because while many are able to sympathise with a woman who has suffered a stillbirth, a miscarriage is considered to be a minor medical problem. Of women who have had a miscarriage, 30 per cent go on to suffer from depression and that percentage is even higher in those who have experienced two or more. It’s thought that because the subject is still taboo, this depression can go on for years before people seek help. And it’s not just the women that this loss can impact on. I’ve seen several men who have also been devastated by a miscarriage and have spiralled into mental illness as a result. For men there can also be a double bind: if they show too much emotion and admit to being distressed, then they can be accused of not being supportive to their partner and being too self-indulgent. If they try to remain ‘strong’ and don’t show an emotional response, then they are branded cold and heartless. The truth is that for men and women, there’s no one right or wrong way to respond. Some will be very upset, others less so. The answer, though, is to start talking openly about this. People like Anna Foster should be applauded for speaking out and starting that urgently needed conversation. Chia seeds (pictured) are one of many super-foods which have been promoted in recent years From extending your life to fending off cancer, super-foods are said to be the answer to a host of problems. Yet again, pomegranate has been hailed as the super-food we should all be eating, after research suggested that it contains a molecule (urolithin A) that can slow down the ageing process. So is there really a group of elite foods that will make us younger, brainier and all round better? I’m afraid not. Coconut water, chia seeds, kale. These so-called super-foods come in and out of fashion. Remember Noni juice? No? The fruit used in folk medicine by Polynesians for millennia was the fad about 15 years ago. Now I never hear about it. The definition of a super-food is fickle and not based on any meaningful science. Yes, fruit and veg have important nutrients and vitamins. But the idea that one is superior to others isn’t true. This obsession with super-foods feeds on our anxiety that we are lacking something in our lives and promises that one (usually very expensive) item will answer our problems. Actually, eating a balanced diet is all that’s needed. You can’t compensate for a bad diet or unhealthy lifestyle by eating endless avocados or handfuls of blueberries. The fact is that behind these foods that are being sold to us as ‘super’ are cynical companies and food manufacturers trying to promote their products. The only difference between a food and a super-food is a good marketing campaign. Source
