More education needed for better treatment of menopause says Scarborough woman
Mental health services are often prescribing antidepressants rather than hormone replacement therapy
A Scarborough woman going through the menopause says more education is needed for better treatment.
It is because mental health services often prescribe antidepressants, rather than hormone replacement therapy, due to 'low mood' symptoms.
Patient safety investigators say it can have serious consequences for women.
A new report into the suicide of 56-year-old NHS manager Frances Wellburn found staff working in community mental health teams are not trained in this area, and menopause is not routinely considered as a contributing factor among women with low mood who need help.
The report noted that midlife is a point when mental health can deteriorate, leading to an increased risk of suicide.
Plus, women can be at increased risk of developing schizophrenia or other psychotic disorders at or around the menopause.
The Healthcare Safety Investigation Branch (HSIB) report further warned that too many people are taking their own lives while being deemed as at low or moderate risk of suicide.
Despite national guidance telling staff not to rank people as being at low, medium or high risk, too many NHS trusts still use the system, leaving people without the right care, investigators concluded.
Help and support in Scarborough
Louise Cramond works for Age UK North Yorkshire Coast and Moors, which is based in Scarborough. They are going through menopause and is planning to start a free online support service to help educate people.
There is a 'Women's 50+ Walking Football Group' with sessions ran by women, for women that understand Menopause Matters.
If anyone would like a symptoms checker, as well as more information about the above event, email Louise at louise.cramond@ageuknycm.org.uk.
There is also a menopause peer support group, contact Carol Austin at carol.austin@ageuknycm.org.uk or visit 39 Aberdeen Walk in Scarborough or call 01723 379058.
Louise said: "I spent a period of nine months where I struggled to get out of the door and had to be prescribed anti-depressants because of the anxiety but when that lifted I came off it. It doesn't need just a sweeping generalisation of someone coming in saying 'I've got low mood and I'm feeling depressed', you need to look at the whole picture.
"Physical symptoms are hot flushes, your sleep changing, having sleep deprivation and a change in your periods but one of the key things when it comes to mental health is often you'll develop anxiety even if you've never had it before, you can develop low mood and develop mood swings.
"Menopause and perimenopause is a very complex journey of over usually about 10 years. You will go through many different symptoms or not as some women just sail through it. There may be some points where you suffer from absolutely crippling anxiety.
"If a woman understands menopause and perimenopause and feels her mood changing, she can actually go in and say to a GP or specialist 'can you check me out for this? Have you thought about this?' It's not about treating the symptoms, it's about the whole picture.
"We want to lead the way in developing the support for women. We have our own menopause champion, we have support groups available that anybody can join and we're currently developing an online support workshop for women that will be free and available in the next few months."
Frances Wellburn
The report detailed the case of Ms Wellburn, from York, who was in contact with local mental health services between 2019 and 2020.
In a foreword to the study, her sister described her as a "kind, thoughtful, resourceful, funny and caring" woman who "was loved and valued by her family, friends and the people she worked with".
Ms Wellburn had a history of depression, which had been managed by her GP with medication, and had no contact with mental health services until September 2019 when she had suicidal thoughts and was admitted to hospital.
After being discharged, Ms Wellburn was in regular contact with community mental health services run by Tees, Esk and Wear Valleys NHS Foundation Trust.
However, there was then a long gap in care when the country went into a Covid lockdown, with no contact between Ms Wellburn and the trust between February and May 2020.
Ms Wellburn was admitted to hospital again in May after her mental health deteriorated and was then in contact with community teams until her death in August 2020. Doctors noted she had ongoing psychotic depression.
Investigators noted Ms Wellburn was prescribed an oestrogen hormone just before she died to help her with the menopause, but on the whole it was a "potentially unconsidered" factor among those treating her.
This is despite her sister telling the HSIB team that the impact of the menopause on Ms Wellburn was profound, both physically and mentally.
The report warned mental health services are not taking the full effects of the menopause into account when assessing women, and are not looking at its potential impact on more severe mental health symptoms.
It said experts in menopause care had suggested the symptoms of menopause and perimenopause "are often mistaken for depression, resulting in women being prescribed antidepressants rather than HRT".
The report added: "Staff also told the investigation that current mental health assessments do not prompt practitioners to consider menopause as part of the holistic assessment of an individual."
The study also found that, just a few days before she took her own life, Ms Wellburn had been deemed at low risk of suicide.
Investigators warned checklists are sometimes used for suicide risk assessment by NHS trusts even though the National Institute for Health and Care Excellence (Nice) says they should not be used.
The report said evidence suggests they do not accurately predict the risk of suicide 95% of the time "and that suicide deaths in the large 'low-risk' group are often missed".
When it came to Ms Wellburn, while mental health staff realised her suicide risk could increase, her risk status was not reconsidered when more distressing symptoms came to light.
A care plan written in January 2020 was also not updated to reflect relapses in her mental health.
Furthermore, she met the threshold for rapid treatment under the Early Intervention in Psychosis (EIP) NHS programme, but instead it was decided to manage her within the community team.
This is despite trust managers telling the investigation that all patients who are given a "first episode of psychosis" diagnosis should be referred to the EIP.
The report added: "National experts in suicide and self-harm told the investigation that categorising patients as being at high, medium or low risk of suicide can lead to resources being focused on those assessed as high risk."
Clinicians also told the investigation that "risk categorisation is often used as a justification for not providing care".
Recommendations
The HSIB made a series of safety recommendations, including calling on Nice to evaluate the available research "relating to the risks associated with menopause on mental health and if appropriate, updates existing guidance".
The Royal College of Psychiatrists should also form a working group to identify ways in which menopause can be considered during mental health assessments.
The HSIB noted that NHS England has written to all mental health trusts to highlight the importance of taking a person-centred approach and to "move away" from using tools to categorise people's risk of suicide and self-harm.
In the report, her sister said Ms Wellburn had, in the last 10 months of her life, been "thrown into unknown territory as she experienced a first episode of psychosis".
She added: "She became convinced that people close to her were trying to harm her and she lost all trust in everything that had previously given her life meaning.
"This frightening world became her reality and she lost the ability to see what was happening to her as an illness she could recover from.
"Even on her worst days my sister would shower, shop and keep her home clean.
"In her last email she inquired when she may be able to return to her ecological volunteering work and that day's newspaper crossword was left completed.
"She was trying to live normally in a world where her delusions made every moment frightening.
"Our family have shared information about my sister's experience in the hope that others like her can be better supported to stay safe and recover."
A spokeswoman for Tees, Esk and Wear Valleys NHS Foundation Trust said it could not comment on the care of individual patients but added: "We fully support the findings and recommendations in the HSIB report into care delivery within community mental health teams.
"We will keep working closely with our partners in the wider health and social care system to make sure improvements are made."
Experts on what to do if menopause is affecting mental health
"Symptoms go far beyond hot flushes, and include things like 'flat affect', mood changes, withdrawal and exhaustion," says psychologist and author Dr Audrey Tang.
"The problem is, this often affects women when they are established and growing in their careers, or may have young families, and it's often put down to stress, so help isn't sought."
"Menopause symptoms may be confused with other medical conditions, so do get it checked - and ask for a second opinion if you are worried. Endometriosis, adenomyosis and even cancer can share some symptoms."
In perimenopause
"Many women experience anxiety and depression due to the change in hormonal balance in perimenopause," says Dr Shirin Lakhani, intimate women's health expert and menopause specialist.
"Low mood, depressive symptoms and anxiety are often the first symptoms of perimenopause," she explains.
"Many women also experience relationship difficulties due to the perimenopause, and whole family dynamics can change, as partners and family members do not know how to support women."
Body changes may prove challenging, too.
"Women may also feel a loss of self-esteem as their bodies change, and concerns about ageing can develop. Perimenopause can also cause problems with sleeping, and tiredness can make symptoms such as being able to concentrate and anxiety much worse," Lakhani explains.
"A lot of women I speak to have no idea what's going on and feel they are going completely crazy. Even if it's just having someone to listen to and acknowledge something is going on is very helpful. Often, once they are on hormones (HRT), they feel like they have themselves back again."
Women's enjoyment of life often slips
"Women may also experience a loss of interest in activities they previously enjoyed, as well as an increase or decrease in appetite and weight, and even thoughts of suicide. Sadly, we recently heard about the tragic case of Frances Wellburn, who took her own life in 2020. The link between menopause and poor mental health must be reviewed," she states.
"If you already have a pre-existing mental health condition, it is also possible that the symptoms of menopause will cause a relapse or change to your mental health, so people need to be aware of this."
In menopause
"For the menopause itself, which is when you have not had a period for a year, women can experience similar mental health challenges to perimenopause, but things should get better as hormones start to settle down," notes Lakhani.
This can provide some relief, but may continue to pose challenges for many people. Changing hormone levels can still cause mood swings, low mood and anxiety.
"Typically, the mood fluctuations as a result of hormonal changes won't last and will ease. A lot of women are really scared they will need to take antidepressants for the rest of their life, but this isn't the case. It should be temporary."
Lakhani says menopausal women do need to be aware of a link between estrogen and brain functionality.
She says that "as estrogen levels dip in the menopause, many women experience feelings of memory loss and brain fog".
So, if you are struggling, it is still worth getting support, even if your hormones are settling down.
What to do about it
Recognising the symptoms is one thing, but taking the next step can often be tricky. Dr Sohere Roked, GP, functional medicine and hormone doctor, advises taking a holistic approach, to see if any lifestyle changes can improve your situation.
"It may be HRT is recommended to help ease and balance your symptoms, but unless you also address lifestyle factors, it could exaggerate your symptoms, or you may not see all of the benefits. Lifestyle factors include drinking, smoking, high-stress levels in your everyday life, and a lack of exercise."
Try giving up or cutting back on bad habits, take up a fitness class or start walking with a friend, and try to tune in to when you might be feeling stressed and do something about it - whether that's mindfulness, exercise or just talking.
If you've not felt like yourself for a while, feel unwell or are struggling in any way, Roked also suggests speaking to your GP, or seeking a trained mental health or medical professional to guide you,