Journeys in Mental Health: Quo Vadis (peri)menopause? – Shining a light on women`s health

In the latest blog of PLOS Mental Health’s ‘Journeys in Mental Health’ series, our contributor, Dr Anna Schueth, has chosen to waiver anonymity. She shares a raw account of her thoughts as she has navigates perimenopause alongside number of major life transitions and events that woman around the world often feel pressure to hold in silence…

***Trigger Warning – this blog discusses topics that some may find uncomfortable***

It is clear that the female body, while transitioning to menopause, undergoes drastic changes and that the end of the menstrual cycle comes with many symptoms. However, in this time period, which can usually start somewhere in the late thirties and can last up to the age of approx. 52, a lot is happening in our fast-paced life. Women will have a lot of pressure and responsibility, whether that comes from their job, their families and children, or a whole variety of minor and major life-altering circumstances. This is also often the stage of life, in which, for example, parents pass away, the kids start their own life, career changes happen and possibly a divorce takes place. All of this individually, and especially as a sum, can take quite a toll on the (peri)menopausal woman’s physical and mental health. I think for some women this could even be the most stressful time in her life and is sadly oftentimes accompanied by the emergence of age-related disease.

There are a lot of (published) health issues and co-morbidities starting in perimenopause, which can last up to post-menopause during old age. I am aware of a whole host of literature on osteoporosis, autoimmune diseases, cardiovascular disease, incontinence, uterine fibroids, insomnia, diabetes, metabolic syndrome, liver disease and especially obesity, breast/ovarian cancer and hormonal imbalance during perimenopause. Additionally, I see many publications about perimenopausal women with anxiety disorders, depression, eating disorders, suicidal ideation, and general effects on mood.

When reading all of this I could not help, but wonder: What`s first? The chicken or the egg? What is the kick starter for all these (co) morbidities of both the physical and mental health of (peri)menopausal women? In general there is a massive global care taker burden on women, including care duties surrounding children and elderly parents, while often working full-time and being responsible for the household. Furthermore, around the age of 50 the annual screening of breast cancer starts in many countries and subsequently we see an increase in the number of women diagnosed with breast cancer during this stage of life. Changes in hormones can lead to weight changes, which in turn can promote fatty liver disease and that can potentially increase the risk of liver cancer. We also know that (fatty) liver disease in women, often diagnosed around 50-65 years old, is a risk factor for breast cancer. So, taken together, one can observe that there are many potential connections between the different diseases occurring from perimenopause onwards, which can have detrimental consequences on the women`s health. I would personally advocate for investigating more in women`s health in the second chapter of her life (e.g. after the age 40), as we realise that there is a growing elderly population, including an increasing health and economy burden with a number of co-morbidities.

In a few months’ time I will turn 44 and all of sudden I also find myself in this transitionary phase, the so-called perimenopause. Seemingly overnight a variety of symptoms appeared, which at first did not make sense to me at all. As women we are not always told in our 30ies or 40ies that we are about to enter a completely new phase of our life or what that might look like. I felt left alone with figuring the whole peri(menopause) thing out on my own, until I found more and more resources online. At first, I tried to get more insight into hormonal changes, but more and more symptoms appeared, that I wonder: Quo Vadis (peri) menopause? During puberty, when we experience our first period, that seems like such a milestone and the conversations with mothers and grandmothers feel a lot more accessible and commonplace. Additionally, we often discuss pregnancy with close friends and family. Yet, the topic menopause is rarely ever discussed and if at all, a female family member mentions hot flushes and it does not go beyond that.

However, I still see a large knowledge gap and hope that researchers worldwide will focus on perimenopause, menopause and post-menopause to help millions of women globally. More insights should be accessible for and shared with women, so that they find support and understand what is going on with their body and mind on the journey towards and during menopause. Personally, I am rooting for all women during perimenopause, menopause and post-menopause and hope to see more women sharing and normalising their experience, and being an inspiration for a younger generation.

More insights should be accessible for and shared with women, so that they find support and understand what is going on with their body and mind on the journey towards and during menopause…

Nowadays people can live up to 100 years old and there is so much excellent knowledge about nutrition, exercise and overall lifestyle interventions, which can improve our quality of life tremendously. There are women who say that they are more happy at the ages of 45 or 50 than in their 20ies.

Personally, I have overcome a lot of adversity in my life, such as suicidality, and I am excited for this next chapter of my life. Almost two years ago I quit alcohol, switched to a fully plant-based diet, ran my first marathon and could gain strength with weight training. This was not easy, and I take one step at the time and appreciate that it may not be an option for all. But I truly believe that a healthy mind lives in a healthy body, regardless of our age, and that nutrition and exercise are the key cornerstones of living a long and healthy life.

Lastly, I hope that not only the knowledge of (peri) menopause increases, but also the acceptance and gratitude for age. Aging is a privilege and we as a society should be able to recognize it as such.  

About the Author:

Dr. Anna Schueth is an Assistant Professor at the Faculty of Health, Medicine, and Life Sciences at Maastricht University in the Netherlands. At the medical campus, her research work focuses on microscopy with a strong expertise of over 15 years. As a female scientist in the STEM field, she works on the assessment of cancer tissue samples and the development of new imaging technology, together with colleagues from industry and clinical settings. A few years ago she also became vocal about academic mental health at her university and beyond, with her blog annaschueth.com and through setting up the support group “Flourish Maastricht” to increase awareness and mental health literacy. She is passionate about the link between research, outreach, and education. Currently, she is setting up her own research group as a young PI with a strong interest in women`s health.

** Disclaimer: This blog represents the perspective of Dr Anna Schueth and does not necessarily reflect the perspectives of PLOS or PLOS Mental Health or any of its affiliated Editors. It does not replace any professional medical or mental health advice. If you are affected by any of the issues discussed in the blog, please seek advice from your physician and/or mental health professional.