Perimenopause symptoms: the impact on nurses’ mental health
Low mood, lack of confidence, anxiety and depression can have devastating effects. Learn more about the perimenopause at Nursing Live, RCNi's unique event
- Perimenopause can cause severe emotional issues and even lead to suicide. With nursing being predominantly female, support for staff experiencing difficulties is essential
- Nurses have a higher risk of suicide than women in other occupations and the perimenopause can exacerbate stress, burnout and a loss of confidence
- Emotional symptoms; what it’s like to work during perimenopause; how to get support; possible treatments and menopause clinics for NHS staff
This article was updated on 11 October 2023
Victoria Smith, a solicitor who had three children, died by suicide in April 2021 after a dramatic deterioration in her mental health two years earlier, at age 49.
Her husband Pete shared her story to raise awareness of what he – and Victoria – believed to be the hormonal cause of her depression and anxiety: perimenopause. ‘I still know so little about perimenopause, but it appears a large proportion of mental health professionals also know very little,’ Mr Smith wrote in an article for the Balance menopause website.
Potential impact of perimenopause on mental health
Ms Smith’s is one of a number of distressing cases that have recently pushed further into the spotlight the potential impact of perimenopause on women’s mental health.
Perimenopause is the time when a woman’s periods change as they transition to menopause, which is when periods have stopped for 12 months. Perimenopause most commonly occurs during a woman’s forties, and on average lasts four years before menopause, although it can last longer. Around 80% of women will experience menopausal symptoms at this time of life.
At the beginning of this year, police conducted a high-profile three-week search for missing woman Nicola Bulley, a mortgage adviser and mother who it was later revealed had experienced ‘significant issues’ with alcohol that were related to the menopause. In a tragedy closely followed by the media, her body was found in the River Wyre and an inquest later ruled her death was an accident.
In March, a report into the suicide of another woman, who was under the care of community mental health services, found that ‘menopause is not routinely considered as a contributing factor in women with low mood’.
The Healthcare Safety Investigation Branch (HSIB), which carried out the report, has recommended that the National Institute for Health and Care Excellence evaluate available research relating to the risks associated with menopause and mental health and, if appropriate, update existing guidance.
HSIB also recommends that the Royal College of Psychiatrists form a working group with relevant stakeholders to identify ways in which menopause can be considered during mental health assessments.
Perimenopause in nursing, a predominantly female workforce
These tragic cases have placed some belated focus on the impact that going through the perimenopause and menopause can have on mental well-being.
As nine out of ten nurses are women and more than a third (36%) of registrants are aged 41-55, a significant proportion of the overall nursing workforce is likely to be going through the perimenopause, with possible consequences for their mental and emotional well-being.
Director of menopause clinic FluxState, Katharine Gale, a consultant nurse in women’s health and menopause, says nurses frequently tell her about the significant impact that the perimenopause is having on their levels of anxiety, self-confidence and depression. These can affect home and work life, she says.
There is a whole spectrum of impact the perimenopause can have on women’s mental health, she says, from no symptoms at all through to severe, sometimes with tragic consequences.
Nursing Standard podcast: Perimenopause – advice for nurses going through it, and bosses tooWhat is the perimenopause?
The perimenopause is the phase running up to menopause, when a woman experiences changes and symptoms before her periods stop.
This transition phase can last for 4-8 years, and generally begins with changes in the length of time between periods, according to the North American Menopause Society.
It is prompted by change and decline in female hormones, particularly oestrogen and progesterone, which control the menstrual cycle. While for some women, the perimenopause and menopause will bring few, if any, symptoms, for others it can bring a wide range of challenges including anxiety, mood swings, brain fog, hot flushes and irregular, or heavy and painful, periods.
In a survey of 4,014 women who had current or past experience of being in the perimenopause or the menopause by the Fawcett Society, a UK charity that campaigns for gender equality and women’s rights. Respondents were most likely to report difficulties with sleeping (84%), brain fog (73%), or anxiety or depression (69%), highlighting how powerful the psychological and emotional symptoms of the transition can be.
Risk related to menopausal symptoms
Women’s Health Concern, which provides information from the British Menopause Society, says that menopause increases a woman’s risk of developing depression, and if emotional and cognitive symptoms of menopause are ignored, they can develop into more serious depression.
The exact relationship between the perimenopause and severe mental ill health and suicide risk remains under-researched. But it is known that nurses’ risk of suicide is 23% higher than that of women in other occupations, although more research is needed into the reasons why, according to the University of Manchester.
Nearly half of nurses who die by suicide were older, and specifically more likely to be aged 45-54 years, compared to women in other occupations.
Nursing Live – focus on the menopause
Brought to you by RCNi, Nursing Live is the first event of its kind in the UK, featuring more than 100 presentations, demonstrations and masterclasses.
Included in the Learning self-care programme on Saturday 11 November at 1.05pm is Focus on the menopause: top tips for managing symptoms in the workplace presented by Kathie Cooke, nurse consultant for menopause at Liverpool Women’s Hospital. The event takes place in learning lab 4.
Free event: Sign up here for Nursing Live
Cognitive and mood-related symptoms can have a big impact on work life
Ms Gale recently carried out what she believes to be one of the first studies on the impact of menopausal symptoms on NHS staff.
The findings that came back from just over 800 women employed by North Bristol NHS Trust suggest a huge number of nurses and their colleagues are struggling. Just over half (51%) said their symptoms greatly affected them at work, and 43% said they had severe physical and mental exhaustion.
Only a third (32.9%) reported no anxiety, while more than one in five (22.1%) said their anxiety was severe or extremely severe. A similar proportion reported depressive mood and irritability.
A survey of 1,000 healthcare staff carried out by Newson Health Menopause Society last year suggested that the cognitive and emotional impact of the menopause can be a particularly heavy burden.
Those with predominantly cognitive or mood-related symptoms were 63% more likely to report a significant negative impact on their working lives, compared with women whose symptoms were exclusively physical.
Emotional and cognitive symptoms related to menopause
- Anxiety
- Low mood
- Difficulty concentrating
- Anger
- Brain fog
- Crying spells
- Depression
- Irritability
- Loss of confidence and self-esteem
- Loss of joy
- Mood swings
- Panic attacks
- Poor motivation
Source: Women’s Health Concerns: Emotional wellness in menopause
Emotional symptoms can be severe enough to push nurses to quit
Ms Gale has often spoken to nurses worried about the impact of their new emotional and cognitive symptoms on their work.
‘Often women find their confidence and self-esteem is affected during perimenopause, possibly due to the anxiety and low mood,’ she says. ‘Unfortunately, I hear from nurses who are quitting because they feel they made a mistake or they are not good at their job anymore.’
‘Many nurses are leaving silently, like I did. These are the nurses who feel overwhelmed or may feel they have made a mistake, but not realise they are perimenopausal and feel unable to ask for help’
Katharine Gale, consultant nurse in women’s health and menopause
Ms Gale understands this, as she quit her NHS job in her forties after feeling overwhelmed at work while not realising she was experiencing perimenopausal symptoms.
While exact figures on the numbers of nurses who may be leaving due to perimenopause or menopause-related issues are not available, research has found that one in ten female workers overall leave their jobs due to menopausal symptoms.
And for nurses leaving the register, the second highest reason given, after retirement, is their physical and mental health, according to the 2023 Nursing and Midwifery Council survey of leavers.
‘It is hard to talk about perimenopause symptoms’
Shiona Martin, a social care nurse who works in a nursing home in Scotland, has been experiencing perimenopausal symptoms including brain fog, fatigue and poor sleep, since 2020.
‘I will be talking to someone about something to do with work, something very familiar, and then the totally wrong word can come out and I feel like an idiot,’ she says.
At age 43, she finds her 12-hour shifts more draining than she used to and worries this affects the energy she has to spend with her two children. ‘It is hard to talk about the perimenopause symptoms and the impact they are having when I’m at work; it is not really discussed,’ she says. ‘It would help if we could be more open about how we are feeling.’
Recently, Ms Martin made a medications error, which could have been serious but fortunately caused no harm.
‘This is not an error I would normally make and I’ve thought a lot about why it happened,’ she says. ‘That was a day my brain fog was bad. Sometimes I take longer to do things at the moment, because I am worried about making mistakes.’
Menopause, emotional exhaustion and the link to burnout
A survey of Italian nurses published in 2019 found menopausal symptoms are associated significantly with emotional exhaustion, which is seen as a core element of burnout.
‘We need to be caring for these experienced nurses so that we can retain them for the profession,’ says Ms Gale. ‘They have so much to offer. But many nurses are leaving silently, like I did. These are the nurses who feel overwhelmed or may feel they have made a mistake, but not realise they are perimenopausal and feel unable to ask for help.’
Nurses are often working under a lot of pressure in services that are understaffed and overstretched. Guy’s and St Thomas’ NHS Foundation Trust nurse consultant in gynaecology Debby Holloway says these pressures can exacerbate psychological symptoms of the perimenopause, such as anxiety and loss of confidence.
Work pressures may also contribute to further disruption to sleep, which has a knock-on effect on other symptoms, she says.
‘If you’re having a lot of psychological symptoms, it can definitely lead women to thinking “this is too difficult, I’m just going to step down”, says Ms Holloway. ‘But talk to your manager first and look into treatment and cognitive behavioural therapy. I would say don’t do anything rash at this point, try and get support first.’
Treatments for the emotional symptoms of perimenopause
There is no ‘one-size-fits-all’ for women when it comes to managing physical or psychological symptoms of menopause, Women’s Health Concern says.
- Anti-depressants can help, but unless you have been diagnosed with depression, there are other treatments that may be more helpful and appropriate
- Hormone replacement therapy (HRT) can help with many cognitive and emotional symptoms of menopause. HRT can also help improve quality of sleep
- Cognitive behavioural therapy (CBT) and other talking therapies can be hugely beneficial in dealing with some of the emotional symptoms of menopause
- Mindfulness and meditation are popular techniques to help relax and clear the mind – and can aid with managing some of the emotional and cognitive symptoms of menopause
Source: Women’s Health Concerns: Emotional wellness in menopause
Some women more likely to experience mental health difficulties in perimenopause
Some nurses may be at higher risk of experiencing more intense mental health symptoms while going through the perimenopause and menopause. This includes those who have previously experienced anxiety, premenstrual syndrome or the more severe form, called premenstrual dysphoric disorder, says Ms Gale.
Research from the US has found that black women tend to go through menopause slightly earlier than white women and have worse symptoms.
NHS England guidance says it is important to be aware that transgender, non-binary and intersex staff may experience menopause symptoms, either due to age-related hormonal changes or hormone treatments and surgeries.
Ms Gale encourages managers to be open to having conversations about the perimenopause and its effects on their staff.
Nurses should visit their GP or their occupational health services if they need more support, and seek out menopause policies and services as work. Many employers run education sessions and menopause cafes, where staff can talk about their own experiences, and some even run menopause clinics.
Menopause clinic for NHS staff: helping to maintain a healthy workforce
A self-referral menopause clinic for NHS staff is helping nurses at Guy’s and St Thomas’ NHS Foundation Trust access the care and support they need.
It was set up after growing demand for information about the menopause and hormone replacement therapy (HRT) during staff education events, says nurse consultant in gynaecology Debby Holloway.
After starting with a successful pilot, it is now an established service with one or two telephone clinics a week seeing up to 12 women.
The team do not prescribe in these sessions, but they do make recommendations for the women they see.
‘Sometimes we will recommend HRT and we write up these recommendations for women to take to their GP. This can be particularly useful for women who have been having difficulty accessing treatment in primary care,’ Ms Holloway says. ‘Or we may suggest women try cognitive behavioural therapy.’
Helping women access the treatment that is right for them
The service has been consistently well received by staff at the large trust. ‘It is a popular clinic and the feedback has been good,’ Ms Holloway says. ‘Women say it helps to have someone to talk to, someone to listen and just to check out their symptoms, ask if they are due to the menopause and get some clinical direction.
‘It is helping to make sure we have a healthy workforce and people get the care they need.’
How managers can help: listen, understand and offer reasonable adjustments
‘A lot of women struggle to talk to their managers about the menopause, due to embarrassment, stigma and shame,’ Ms Gale says.
‘For women to feel confident to speak up about their challenges, we have to make sure that managers are equipped to listen, to understand, to offer reasonable adjustments, and to know what other resources there are to signpost people to.
‘Managers don’t need all the answers but being allies for their colleagues going through the perimenopause makes a big difference.’
Do you need mental health support?
- For those in mental health crisis or experiencing suicidal thoughts, the NHS recommends calling a GP or dialling 111 or 999
- The Samaritans helpline is free and open 24 hours a day. Call 116 123
Further information
- FluxState
- University of Manchester: Suicide by female nurses: a brief report
- NHS England: Supporting our NHS people through menopause: guidance for line managers and colleagues
- North American Menopause Society: Menopause 101: A primer for the perimenopausal
- Fawcett Society: Menopause and the Workplace
