Lesley Powell had little warning of the catastrophic mental health crisis that was about to envelop her when she was 48.
Life was busy. Passionately in love, she was engaged to be married to her partner, who had recently moved in with her.
She had five children, three of whom were still in school, a PhD on brain function and a successful career in academic research.
"Life was wonderful," she said.
Until suddenly it wasn't.
"I went nuts," she says simply.
'I couldn't look after myself at all'
The change was as shocking as it was bewildering in a woman who had never previously suffered any mental illness, and it rendered her utterly helpless.
"I could not get up in the morning. I didn't know how you had a shower, I didn't know how to get dressed," she said.
"There was no warning that this was going to happen at all.
"And within two days, I couldn't look after myself at all."
Lesley began having suicidal thoughts.
With the help of her worried fiance and mother, she was admitted to Joondalup Health Campus where she ultimately found herself in the mental health ward.
"I can't remember a lot of it ... but I went completely insane," she said.
Lesley had suffered a menopause-related mental breakdown.
Anxiety, fatigue, brain fog
Psychiatrist and menopause expert Jayashri Kulkarni has spent decades researching the condition and its effects on mental health, and says Lesley's experience is not uncommon.
She said up to 50 per cent of menopausal and perimenopausal women will notice a deterioration in their mental health.
"It's not just the condition of the full moribund depression, but it is all of those lesser and fluctuating, but nonetheless incapacitating changes," Professor Kulkarni said.
"Anxiety that increases every now and again, and even full blown panic attacks, brain fog, which is that phenomenon of feeling confused, having memory problems, and not being able to multitask eight things at once, which was normal for her.
"Then there is the tearfulness and the rage, fatigue, and general physical malaise of sort of feeling unwell, and then worrying about that as well."
Dr Powell's breakdown happened more than two decades ago now, and she considers herself fortunate to have been treated by a psychiatrist who quickly recognised what was going on.
Prescribed a tailor-made combination of hormone therapy and antidepressants, over the course of the next 18 months her symptoms gradually began to improve — but the treatment is ongoing.
"If I forget my (antidepressant) tablets, by four o'clock in the afternoon, the world recedes. And I'm in a bubble again," she says.
'Art has been my saviour'
While the drugs have changed her life, Dr Powell also attributes her recovery to the love of painting she rediscovered while in the mental health unit, which also helped when her husband died five years ago.
"I started painting," she said.
"And I think that takes your mind off everything, you can't think of anything else.
"And I painted very heavily during the beginning of grief, because I didn't want to go back to that other stage that I was in with menopause. It's been my saviour."
Risk of suicide
Professor Kulkarni said there was sometimes a tendency for women's menopausal symptoms — especially those relating to mental health — to be downplayed, or for women to want to minimise them for fear of being overlooked for promotion at work.
"So that message has got out to the general female population, that it's just the way things are. So don't make a big deal about it," she said.
However, the reality was that those suffering significant menopausal mental health challenges were at risk of suicide.
"So I would urge people not to just dismiss this as a normal and natural process," she said.
"Yes, it is. But there's a significant proportion of women for whom it is a really severe mental ill health experience."
Professor Kulkarni said declining mental health associated with menopause often hit women in their early to mid-40s, sometimes long before their periods stopped or they experienced more typical menopause symptoms such as hot flushes.
She said this could be one of the first signs of perimenopause, and it typically comes at a particularly challenging time in a woman's life.
"There are many, many pressures on women — in the workplace, in raising adolescent children ... in coping with relationship challenges, ... in being the main carer for aging parents or aging parents in law, a whole range of duties and responsibilities," she said.
"Many women will tell you, I've always juggled all these things... except now I can't. It's too hard."
She said hormonal fluctuations typically affected women's resilience at this time, and some were especially vulnerable, including those who had experienced earlier trauma.
However, hormonal based therapies could make a "dramatic" difference quickly.
"Because hormones will act fast, they act faster than standard antidepressants, or mood stabilizers ... [and] you actually get to see this turnaround in the brain chemistry," she said.
Holistic approach to menopause
Professor Kulkarni said a new understanding of the condition was emerging, which integrated the biological, psychological and environmental aspects and was driving innovative treatments.
"Now, this is not the domain of only the gynaecologist or only the endocrinologist," she said.
"There's some psychiatry, there's a lot of psychologists there, you know, social factors being considered in the workplace.
"There are exercise physiologists, there are dietitians. There's a whole range of primary health care practitioners involved.
"And it's starting to become as it should be — a whole of community issue."
She said men were also becoming interested in the issue, and a Senate committee had been established to look into menopause and perimenopause.
"So the time is really exciting and I hope that the momentum will carry us through to having some significant improvements for midlife women," she said.
Professor Kulkarni and Dr Powell will share their experiences at the Menopause Alliance Women's Life Cycle Summit in Perth on March 16.
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2024-03-10 00:26:10Z
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