Home

Bluesky · LinkedIn

Tag: womens health

  • Putting up with the Perimenopause

    Peters et al., 2025 – “Just Put Up With It: Women’s Experiences of Perimenopause and Menopause” (J Adv Nurs)

    Back in 2021, myself and my brilliant colleague, Kate King, undertook some research looking at the experiences of servicewomen who were suffering from symptoms of the perimenopause. Although this was a cross-sectional survey, with all its limitations, what really hit home were some of the challenging experiences our servicewomen were having, from the Chain of Command and Healthcare Professionals, as well as in their working environment.

    With my educator hat on, I then looked at how confident our GPs were in offering advice in the perimenopause. While most were up to date with their knowledge and familiarity with guidance, the lack of regular experiential practice and limited patient contact meant that confidence in applying guidelines was a real issue. In other words, knowledge wasn’t the barrier — experience was.

    Fast-forward to this year, and a paper by Peters and colleagues in the Journal of Advanced Nursing has captured, through a mixed-methods approach, what many of us already recognise in our clinics and conversations: that women are still being told, in one form or another, to “just put up with it.” Their study of over 400 women in Australia uncovered three familiar themes — the unexpected sequelae on daily life, stigma and shame, and feeling dismissed and devalued.

    The accounts are powerful. Women spoke about the intensity of symptoms — heavy bleeding, insomnia, brain fog, hot flushes so severe they avoided social events. They described the shame of not talking about menopause, even with friends or family, and the frustration of health-care encounters where symptoms were minimised or met with antidepressants. The words “shouting into the void” stand out.

    What strikes me most is how transferable these experiences are to our own setting in Defence Primary Care. We know that stigma, silence, and gendered assumptions still shape the care women receive. The same structural issues — limited appointment time, inconsistent access to specialist advice, and discomfort in talking about reproductive health — all play their part.

    Peters et al. end with a clear call to action: better education for all clinicians, nurse-led multidisciplinary care, and workplace policies that recognise the real impact menopause can have on performance and wellbeing. For me, that aligns perfectly with where we need to go in Defence — normalising the conversation, building confidence among clinicians, and creating an environment where women feel supported rather than sidelined.

    Menopause shouldn’t be something our patients have to endure. It’s a phase of life that deserves understanding, compassion, and competence — and that starts with us being willing to talk, listen, and learn.

  • Supporting Women Before, During and After Pregnancy: Helpful Resources for Professionals and Families

    I’ve updated some of the perinatal resources I’ve been collecting to include the following (look under the ‘resources’ tab in the menu). The aim is to have these in one location for sharing to patients or to healthcare professional colleagues for onward dissemination. I hope all the links work but please let me know if there are any issues.

    Preconception and Early Support

    Preconception Care Partnership Toolkit A comprehensive toolkit designed to help healthcare professionals support individuals and couples in optimising health before pregnancy.

    Make Birth Better – Free Resources Resources for improving experiences of pregnancy and birth, with a strong focus on psychological wellbeing.

    Postnatal Care and Guidance

    NHS England – GP 6–8 Week Maternal Postnatal Consultation: What Good Looks Like National guidance for clinicians on delivering meaningful and effective maternal postnatal checks.

    Mending Milk – Perinatal Booklet A downloadable leaflet with clear, accessible information on perinatal wellbeing and mental health. Hearts & Minds – Perinatal Mental Health Support Map An interactive map of perinatal mental health services across the UK, helping families and professionals connect with local support.

    Physical Activity in Pregnancy and Postpartum

    Active Pregnancy Foundation – Professionals’ Hub Evidence-based advice and guidance for healthcare professionals supporting physical activity during pregnancy and after birth.

    This Mum Moves A fantastic initiative with resources and campaigns to promote safe and supportive activity for mums at all stages.

    Moving Medicine – Patient Resources Practical infographics, activity diaries, and patient-facing resources to support conversations around physical activity.

    Moving Medicine – Postnatal Return to Exercise Timeline A helpful timeline outlining safe return to physical activity in the postpartum period.

    Active Together A local partnership supporting active pregnancy and postpartum initiatives. Many areas can provide flyers, posters, or signposting to local activity groups (e.g. Active Mums clubs).

    Active Partnerships A nationwide network of regional organisations that connect communities with physical activity opportunities—including postnatal support.

    Peer Support and Community Networks

    Breastfeeding Together An example of a third sector organisation providing peer support on wards and after discharge. Local equivalents may exist in your area, or there may be opportunities to help establish one. Some regions have excellent peer support teams for new parents, often linked to maternity services or third sector organisations. It’s worth checking what’s available in your area.

  • Decoding Depression: How Hormones Shape Mental Health Through Menopause

    Chirinos DA, Yin Z, Schreiner PJ, Appiah D, Wellons MF, Lewis CE, et al. Trajectories of depressive symptoms in a population-based cohort of Black and White women from late reproductive age through the menopause transition: a 30-year analysis. Menopause. 2024;31(12).

    https://journals.lww.com/menopausejournal/abstract/2024/12000/trajectories_of_depressive_symptoms_in_a.3.aspx?context=latestarticles

    The menopause transition, or perimenopause (PMP) is often framed as an important period for women’s mental health, with fluctuating hormones blamed for mood swings and depressive symptoms. A recent study published in Menopause: The Journal of The Menopause Society tried to shed more light on this, by examining the long-term trajectories of depressive symptoms across a 30-year period in women. The findings offered some further insights into the role of oestrogen and hormonal contraception in shaping mental health outcomes during midlife.

    The study used data from the Coronary Artery Risk Development in Young Adults (CARDIA) project, a large population-based cohort that tracked 2,160 women aged 23–60. The researchers assessed depressive symptoms every five years using the Center for Epidemiologic Studies Depression Scale (CES-D), a validated tool for measuring depressive symptoms. The participants were classified into three distinct trajectories:

    1. Minimal Symptoms (61%): Most women showed consistently low levels of depressive symptoms.

    2. Intermediate Symptoms (31%): This group experienced moderate depressive symptoms over time.

    3.Persistent Symptoms (7%): A small but significant proportion faced ongoing, high levels of depressive symptoms.

    By identifying these patterns, the study demonstrated that depressive symptoms are not random but follow stable trajectories influenced by sociodemographic, behavioural, and hormonal factors.

    The Role of Hormones: Oestrogen and Contraception

    Hormonal changes during menopause are often implicated in mood disturbances, but the findings challenge the oversimplified view of hormones as mere culprits of midlife depression. Women who used oestrogen therapy to manage vasomotor symptoms (VMS) like hot flushes were more likely to experience persistent depressive symptoms. The odds ratio (OR) of 1.71 indicates a higher likelihood of depressive symptoms among oestrogen users compared to non-users. While this might suggest a negative impact of oestrogen, the researchers proposed a different explanation that women with severe VMS—often treated with oestrogen—may have been more prone to depressive symptoms in the first place. Conversely, hormonal contraceptive use was linked to a protective effect, with lower odds (OR 0.69) of persistent depressive symptoms. This finding is similar to previous research showing that hormonal contraception can stabilise mood by maintaining consistent hormone levels. These results reiterate the complexity of hormone therapy, suggesting that its effects on mental health may depend on individual circumstances, including the presence of VMS and pre-existing mood disorders.

    Sociodemographic and Behavioural Factors

    Beyond hormones, the study highlights the influence of sociodemographic and lifestyle factors on mental health. Women in the persistent depressive symptoms group were more likely to be black, have lower income and education levels, and engage in unhealthy behaviours, like smoking and excessive alcohol consumption. Body mass index (BMI) also emerged as a significant predictor, with higher BMI associated with persistent depressive symptoms. This reinforces the interconnectedness of physical and mental health, suggesting that obesity and depression are linked, possibly through shared biological pathways. This is probably somewhat generalisable to the UK population although the number of black women was proportionally much higher in this cohort. There is also no mention of other ethnic groups which again limits how the results might apply to a UK population.

    Menopause: A Myth-Busting Moment

    One of the study’s most intriguing findings is that the menopause transition itself did not appear to exacerbate depressive symptoms. Depressive trajectories remained stable before, during, and after menopause, suggesting that midlife mental health is shaped by other factors, such as early-life influences, than by the hormonal fluctuations of menopause. This challenges the narrative that menopause is inherently a time of heightened vulnerability to mood disorders. Instead, the study calls for a broader view of women’s mental health, one that considers lifelong influences rather than focusing solely on menopause. I would argue this may represent a limitation of the study. While the 30 year timeframe is a good period for a longitudinal study, it is observational and relied on self-reporting measures every 5 years (with a 71% response rate). I had not come across the CES-D before. It seems to be a reliable tool, but the 20 items are depression related, with no questions about anxiety. These 2 areas, self-reporting and not asking about anxiety, would suggest the study may have under reported some of the cognitive issues women I see with perimenopausal symptoms really struggle with, but may not volunteer freely. Additionally, the use of the CES-D at five-year intervals may have missed shorter-term fluctuations in depressive symptoms, particularly around menopause.

    Implications for Practice

    This had some interesting findings, but for me, the take home is (once again) having a holistic approach to women presenting with cognitive symptoms during the PMP. Lower socioeconomic status or higher deprivation are perhaps beyond the scope of primary care, but addressing lifestyle factors (high BMI, lifestyle, strength training versus extreme cardiovascular exercise) can help alongside any pharmacological intervention. Enquiring about previous mental health presentations is also important. Is this the first time or is this an exacerbation of an underlying common mental health disorder? I have also had a few women questioning undiagnosed neurodiversity which has been made worse by the PMP. I think offering a pragmatic approach to medication can be helpful. Hormone Replacement Therapy is recommended as first line treatment for VMS of the PMP but crippling anxiety can be helped by anti-depressant medication, especially when there are few other symptoms. And while this study is interesting, it won’t really change my practice in this area. One area that I might raise in a consultation is the effect of combined contraception on mood. This does provide some evidence of a positive impact, and could be discussed where a woman has a concern about this effect.

     

  • PBSGL Oct 14 – Post Menopausal Symptoms

    An excellent discussion. Lots of areas where there was learning and confirmation of practice. There was also discussion about our role as patient advocate in 2 of the cases. Should we stop the HRT in the 74 yr old lady suddenly? What about if it was contra-indicated. Also the role of alternative medicine – if we advise it as an option & the patient is harmed, where do we stand?

    Unaswered questions were:

    1. Circulate a Menopause Rating Scale (ASW to do)
    2. Should we ask opportunistcally about peri-menopausal symptoms?
    3. When using topical E3 gel as a systemic therapy (as opposed to vaginal gel), what are the options for providing progesterone? The IUS was discussed as an excellent option but what about if it was contra-indicated or if the patient declined? Are progesterones actually required if use of E3 gel is intermittent and on a PRN basis? (JCS to find out).
    4. Which is the best primary care tool for memory/dementia screening (TW to find out).
    5. What are the absolute contra-indications for HRT and smoking? (ASW will investigate).

    Two new members (both young males) expressed concern about the limitations of their knowledge in this area. Whilst we all expressed this (we do not have many patients with peri-menopausal symptoms), it is something that needs to be raised on the PQO/PGMO course. The curriculum should cover common urogenital problems in middle aged women at least so GDMOs are confident in raising the subject. Women are known not to volunteer conditions such as loss of libido and stress incontinence.

    Areas of learning we discussed:

    1. The use of a topical E3 gel as a systemic therapy.
    2. Use of self help web sites – Amarant Menopause Trust.
    3. One of the scenarios involved a concern about dementia. We moved on to scoring systems in primary care – 6 question CIT, MMS.
    4. We all agreed the time constraints in a single consultation would rule out a comprehensive history, examination and investigation. Another option was to spread over 2-3 consults with the patient doing some research in the interim.

    There shouldn’t be too many barriers to change. ASW will raise the issue of the curriculum change with the GP Dean next week on the Tri-Service Trainers Course.

    Most of what we discussed had mutual agreement. Some guidelines were discussed and we agreed that a single sheet of pros/cons of the long term risks & benefits might be a useful tool in the surgery.