Hormonal changes and mental health: maternal mental health awareness
Advisory: this podcast contains themes of mental health and suicide.
Earlier this month Maternal Mental Health Awareness Week was marked across the UK. In this week’s episode Emma Hammond, an employment lawyer specialising in advising women who have experienced discrimination due to the menopause, generously shares her own story.
After a traumatic birth with her first child, Emma developed serious symptoms, including psychosis and not sleeping or eating, that ultimately led to medication and hospitalisation. While she wanted a second child, her periods stopped and she was told she was perimenopausal – but an unexpected development took place soon after she was admitted to a mental health hospital.
Here she and Dr Louise talk about the powerful role of hormones in women during pregnancy, birth and perimenopause, and how hormones can be overlooked by healthcare professionals caring for women struggling with their mental health.
This podcast follows an earlier episode with Emma where she talked about her career, and offered advice on menopause in the workplace.
Emma’s three tips:
- See your GP promptly if you are struggling with your mental health and don’t think you can fix everything yourself
- Be honest and open with your family and friends about what you are going through so that they can support you
- Think about life changes and holistic approaches as well as hormonal treatments or medication.
Read more about Emma here.
Contact the Samaritans for 24-hour, confidential support by calling 116 123.
Dr Louise Newson [00:00:09] Hello, I’m Dr. Louise Newson and welcome to my podcast. I’m a GP and menopause specialist and I run the Newson Health Menopause and Wellbeing Centre here in Stratford upon Avon. I’m also the founder of the Menopause Charity and the menopause support app called balance.
On the podcast, I will be joined each week by an exciting guest to help provide evidence-based information and advice about both the perimenopause and the menopause.
So today on the podcast, I’ve got somebody who’s already been on the podcast. So this is her number two experience and she’s called Emma Hammond and she’s a lawyer who’s doing some incredible work on helping women in the workplace who are menopausal, which hopefully many of you have already listened to.
Today she’s been very kind and generous with her time to talk about her own experience, actually, and what really has empowered her to do the work that she’s doing. And most of us learn from our experiences. I wouldn’t be doing the work that I’m doing if I hadn’t had such a bad perimenopause and realised the injustice and suffering to women. So, Emma, thank you so much for your time today.
Emma Hammond: [00:01:25] It’s a pleasure, Louise. Thanks for having me.
Dr Louise Newson: [00:01:27] So tell me a bit about you and what happened, if you don’t mind.
Emma Hammond [00:01:31] I’ve been working as an employment lawyer for 25 years now, and my interest in mental health within the employment arena really kind of came to a head following my own personal experience. And that was linked back to the very traumatic birth of my first child when I was 36.
And it’s interesting, isn’t it? Because when things happen to you, often you look back and you start to put pieces of the jigsaw together. And that’s very much what happened to me.
I’ve always been a coper, an optimist, always really prided myself on being very resilient and dealing with the challenges that been thrown at me through, whether that’s work, personal life etc.
But when I had my son, I thought that the symptoms that I was experiencing, which were actually psychosis, were simply baby blues, lack of sleep, that kind of thing. And I have a very graphic image that still stays with me that I didn’t talk to anybody about because I thought it was normal, which was that my son was asleep on the floor, because obviously when babies can’t move, we tend to put them in the blankets on the floor and do jobs around them and that somebody had come around to visit. And they hadn’t seen him and they put a chair leg through his head. And I thought that was me just being a typical normal mother, worrying about the safety of my boy.
Obviously, looking back, I realised that wasn’t that at all. And there was another image where he was falling through – we were in a flat – and he was falling through the banister, the barriers, at the top of the corridor. But the chair leg one, I mean he is 16 and that image still stays with me, because it was repetitive and it was only later, when I read about how psychosis can present itself, and how dangerous it can be, that it all sort of pieced together.
It was only when my son was then three that things started to unravel. I lived with not being myself for a long time and I had a miscarriage when he was three. And then a few other things happened. I had a very bad back and it was one of those things where it was a kind of a tsunami of other symptoms. Suddenly I was presented with this position where I wasn’t working because of my back anyway and I was met with a myriad of physical symptoms such as…because I couldn’t swallow. So I lost nearly four stone. I couldn’t sleep. The pills that the doctor gave me, they said, would have knocked out a horse and I still couldn’t sleep, and my periods stopped, which is one of the key things. So I was told I was going through perimenopause because I sought advice from all sorts of areas.
I refused to believe I was mentally ill and was convinced that I had some sort of awful disease, that something was happening internally. So I was going to private people, I was going to my GP. I was just convinced I needed a diagnosis to get some help. Interestingly, around that time, one of my sisters, who is a GP, said, ‘I think you are clinically depressed.’ And I absolutely would not believe that, at all. That can’t be happening to me. I’m a coper, I know I’ve had a bad back and a miscarriage, but no surely not. And it got to a place where there was then suicidal ideation because I couldn’t see a way out. I couldn’t work, I couldn’t sleep, I couldn’t eat. All the things I enjoyed doing fell away. And my poor family were really struggling to understand how to cope with this. I couldn’t look after my son properly and so the crisis team were visiting. My friends and family were fantastic, but nobody could really find a way through for me.
Dr Louise Newson [00:05:16] And did anyone talk about your hormones at that stage, Emma? I know personally you’ve been told you’re perimenopausal, but did anyone say that? No. So you weren’t given any hormones or anything at all to try?
Emma Hammond: [00:05:28] So nothing was given or prescribed as such other than this conversation that because my periods had stopped, surely that meant that I was perimenopausal. Now, one of the things that I was just absolutely, well the thing that I wanted to happen more than anything else at that point, was to have another baby. I had a wonderful stepson and my son, but I wanted to kind of complete the family.
And obviously having had a miscarriage, that really sent me into a bit of a spin, thinking as I was 39 and a half by then so time, in my view, was clearly running out. And so I convinced myself I was perimenopausal as well, and I thought that’s it, it is the end of the road and it’s not going to happen. And I did go onto citalopram, so the GP did give me some meds to help with the low mood, etc. I was on really strong sleeping pills, but nothing touched the sides and things were getting worse. I was struggling to even shower. I was struggling to look after myself in any way, therefore couldn’t look after anyone else.
And I think the people who knew me very well and were close to me could see that this was absolutely not how they’d ever seen me live or function before. They were quite desperate for some assistance and it got to a stage where I needed to be hospitalised because there was no other option. And in fact that was the best thing, ironically, that happened.
Because then it was almost like I finally accepted I was really poorly and I’d lived with those symptoms, and those worsening symptoms, in fact, probably by then for about four years, although on a trickle basis until it really hit in about the spring of 2010.
And then looking back, of course, after I recovered, I was making all of these jigsaw puzzle together thinking, wow, of course the traumatic birth was the starting point. And then I didn’t get help because I didn’t think I needed it, because I didn’t think I was ill, etc. And so whilst in hospital, again, no one talked about hormones, and nobody at that point asked me about things like Joe’s birth or anything. It was too far removed, I think, from the event.
Dr Lousie Newson: [00:07:41] The crisis that was going on now?
Emma Hammond: [00:07:44] Exactly. And so I was given some antipsychotic drugs, including lithium. And again, this was all very new to me, you know, being on so much medication.
Dr Louise Newson: [00:07:53] You’ve not taken lithium before or you’ve not been offered it before?
Emma Hammond: [00:07:56] No. Because I didn’t know the earlier issues with psychosis, I never sought any help for that, so this was the first time. And I was asked the question when I arrived, could you possibly be pregnant? And I almost scoffed at it. I can remember thinking, well, of course I can’t be pregnant. My periods have been stopped for five, six months. It’s not possible. I’ve been told I’m perimenopausal, I can’t have any more children. And so they gave me the lithium and some of the drugs I can’t remember the name of. And that was that. And then I remember one, maybe two days later, quite a young doctor coming to see me, looking rather worried and saying, oh, I need to sit down with you and your nurse. And no idea what that was about. And he said, well, your test pregnancy test has come back positive. I said it can’t have done. And he said, no, genuinely, you are pregnant.
Dr Louise Newson: [00:08:46] Just to interrupt, they do the pregnancy test before lithium because you can’t be on lithium if you’re pregnant. So that was the reason. So you hadn’t thought you were pregnant and they hadn’t thought you were pregnant. And there are some medications we give in medicine where we just do a pregnancy test routinely beforehand. So, yes, so carry on. So you had this positive pregnancy test, which is not what you’re expecting?
Emma Hammond: [00:09:09] That’s not what I was expecting. I’ve probably been on lithium a few days, in fact, by then, because that was one of the issues then that flowed through. So you can imagine I’m just immediately being escorted to the scanning unit, the ultrasound section with my nurse who was assigned to me, ready for a scan, knowing that there must be a pregnancy in there, having no idea how long I was pregnant or what I was going to find out.
Bearing in mind that with pregnancy one, I’d had migraine aura every single day for 12 weeks. And with this now new pregnancy, I had no symptoms. I had no sickness and I had terrible sickness with pregnancy one as well. No sickness, no migraine, no nothing. I’m thinking this must be a false positive. This can’t be right, because I’m not presenting physically the way I was before and I had started eating again in hospital. And so I put on some weight anyway, so I couldn’t make that connection with it being pregnancy. I was taken down to the ultrasound room and yes, absolutely, there was clearly a pregnancy in there and I was 12 weeks pregnant. So a well-established, past first stage, pregnancy. I’m now married to my husband, but at the time he was my partner. You can imagine, I’m being escorted then to a private room to say, well, I need to ring him. And I’m ringing him to say by the way, it’s not what we would expect and not ever to expect ringing, obviously, from hospital.
But this was the news and it was basically what saved me on so many levels because it was what I’d absolutely hoped for, but thought would never happen because I was told it would never happen. And then, as you know, my age and everything else were working against me. And then the rush of just suddenly wanting to look after the baby and therefore the shift in mindset of needing to look after myself and recognising that that was the most important thing was amazing. And of course, as you said before, to me, the hormone changes. The positive hormonal changes around all of that as well were phenomenal. I was probably in hospital four to five weeks, but within a week or two of the pregnancy test I was discharged and I’m sure that I wouldn’t have been if it hadn’t been for that.
Dr Louise Newson: [00:11:32] And that’s really it’s very powerful, Emma, Because I remember when you told me this story, a little while ago, and I thought, my goodness me, it’s not just because you thought, Oh, I’ve got to change my mental state because I’ve got this baby and I’m going to be a nurturing mother.I’m absolutely convinced, and I know you are as well, that your hormones actually probably saved your life. And I think for some people, it might be quite a new thing to think about. You’re listening to this, and I never thought about the mental health aspect of the perimenopause and menopause until I opened my clinic, because in general practice, I would look after mental health patients, I would look after menopausal women, and I actually wouldn’t really think about them both being a big overlap. Because I did quite a lot of psychiatry in Manchester, I really enjoyed psychiatry, but no one ever told me that estrogen and testosterone worked in the brain. I never, ever knew that.
And even there’s some research now that estrogen is produced in the brain as well. But we know it’s a really important neurotransmitter, really important chemical. But I didn’t know that at the time. And seeing in the clinic, we see a lot of women who obviously they know they are perimenopausal and menopausal because they come for treatment. And I have seen hundreds of women who have been like you, sadly, on lots of psychiatric drugs. Many of them have been sectioned. Many of them have had ECT or lithium or other very heavy-duty drugs.
And I’ve actually now seen quite a few that have been given ketamine, which seems to be the new treatment for resistant depression. But the psychiatrists haven’t been thinking about hormones as well. So I sit there and I know it’s not a psychiatric illness that there’s treatment for because these women have tried all the treatments. But I also know these women, like you were at the time, perimenopausal, and I know there are benefits for women for their future health, for giving them HRT.
So I often say to women, and I’ve said to many, many women, I have no idea whether your mental health is associated or not with your hormones. But what I do know is that we know there are benefits to your heart, to your bones, to your symptoms, other symptoms, for having hormones. Let’s try. And when I first started, the lady I saw actually she had written her suicide note. And this was her last stop. I didn’t know at the time she’d written her suicide note. She was absolutely desperate to feel better. But she had vasomotor symptoms. She had joint pain, she had other symptoms. Her periods had stopped about eight months before. So I gave her hormones thinking, Oh gosh, I don’t know. I got in touch with her mental health team, the crisis team, said, look, you know about this lady. I’m worried about her, but I am also giving her hormones.
And she then emailed me two weeks later and said, I just don’t know how to thank you. It’s the first time I’ve slept for many years. I can feel my brain starting to come back. I know I have a long journey. And it’s taken her about, I would say, three and a half years to really feel better. But she said, I just want to thank you for saving my life. And I thought, goodness, wow. We always learn from our patients. But this is a patient who will always stay in my mind and haunt me, actually, in the way that I feel scared for other women who aren’t able to access hormones. So you had your own internal hormones, you didn’t have HRT then at all, of course. And we know that hormone levels are so high in pregnancy. And so in the clinic we spend a lot of time individualising treatment and some women need higher doses of estrogen. And that’s often because maybe the patches don’t stick on well, or the gel doesn’t get absorbed, but there are some people that their brain needs higher levels of estrogen to really respond and there’s some evidence to show that as well.
But when we give higher doses, it’s still very low, the levels we achieve, compared to in pregnancy. Just to put into perspective, levels can reach up to about 17,000 to be estradiol mostly in the clinic, we go up to about 1,000 occasionally, sometimes we have 2,000. So it’s so different that say suddenly after 12 weeks your brain is being flooded with estrogen, progesterone, maybe a bit more testosterone. And you’re starting to feel better.
Emma Hammond: [00:15:48] Yeah. And, I mean, it’s opened my eyes significantly to how mental health can present itself, the physical and mental and how they are so intertwined. Because I had such dire physical symptoms, I was absolutely convinced I must have had a terrible illness. I mean, the amount of research I did, which drove everybody nuts. But that’s because as a lawyer, I’m looking for evidence because you are looking for a reason as to why I feel so terrible. I’ve never felt like this before. There must be something happening because of it. And of course there was. But the learning for me as well around suicide and how I did so much reading afterwards when I was feeling better to try and understand why. Of course, I never wanted to leave. I never wanted to die. What I did want to do was escape the horror that I was living through, and I understood then that suicidal ideation is to clinical depression what a temperature is to the flu, in that it is simply a symptom and it’s your brain or your body wanting to escape what you’re living through or trying to exist through because it’s not the life that you want to stay in.
And that kind of made more sense to me afterwards. And it’s something that then, you know, my partner was absolutely fabulous at the time, he held everything together, even though it was so difficult to watch me go through that. And it’s made us closer as a family because I talk to my boys about it. They know what I struggled with. Mental health has removed all its taboos in the family, and I think that’s also really powerful for them to understand.
Dr Louise Newson: [00:17:21] Totally is and I feel, you know, with mental health, it’s so difficult. You know, if I went to work and I burnt my arm and I had a big sore down my arm, I could show people, I would get sympathy. If I feel just a little bit anxious or a bit fed up, I can’t show people, it’s hard. And then when people are psychotic or they have suicidal thoughts, how can they tell that to people? How can they be taken seriously? And then when you say, oh, it’s related to my hormones, there’s no way. And that’s so wrong, because mental health affects all of us, every single one of us. If we’ve got a brain, our brains will change. And, you know, there might be just a day where you’re just feeling awful.
But mental illness is different to having poor mental health. But we should all be talking because there are always things we can do to improve our mental health. And sometimes it starts very small with teenagers. We know mental health is such a big issue, but it’s still almost they’ve all say, you know, and one of my children for a while wanted a diagnosis and she was having a stressful time. She was hormonal, she was adolescent and trying to work itself out. I didn’t want to give her a big diagnosis because I knew a lot of it she had to work out herself. And, you know, I think it is important and I’m all for getting diagnosis for the right reasons, but I think we need to work internally. You know, what else are we doing? But I know for you could have had the best diet, you had loads of drugs, you could have done as much mindfulness or whatever, but without your hormones, your brain actually couldn’t function properly. But then so you were in your second pregnancy, but you’d had a very scary time with your first boy. You must have been thinking when you were pregnant what’s going to happen when the baby’s born.
Emma Hammond [00:19:06] Well, yeah, I mean, that was a frightening next step as to how I was going to cope. And in fact, I had great care because I stayed with the community nurse right until after the birth. So I had somebody visiting me at home and I didn’t go back to work then because it was all about getting better. Because of the issue with Joe’s birth I was put down for a C-section to try and help with back trouble and the way in which Joe was born and to avoid that. There were measures put in place. They also put me in a room on my own and let me stay for three nights after the birth to try and monitor my mental health. And I knew what to look out for. And in fact, when I then went home with Jacob, I definitely felt that difference in relation to feeling different about myself, I guess, and the experience versus what had happened previously.
So, yes, you’re right, there was anxiety over that, but it was different from feeling mentally ill. As you say, anxiety and worry and concern, although it’s linked to mental health, isn’t a mental illness. I learned that difference very clearly. And then they stayed with me until Jacob was around six months old, I was discharged. So it took some time, but I gave myself that time because I recognised I absolutely needed it.
Dr Louise Newson: [00:20:27] And did anyone give you or talk to you about hormones in postnatal period at all?
Emma Hammond: [00:20:33] No. I mean, clearly I knew by then that the diagnosis of me being perimenopausal and my periods stopping was not that, it was clearly the stress and the mental illness had literally shut everything down and it was quite illuminating for me to see how I’ve heard about periods stopping when people go through a trauma. But it literally did happen. Everything just shut down. Even my ability to swallow and almost digest food. And that’s something I love. So all of that pleasure just went. It was as though my body was saying, no, I’m not functioning for you at the moment. But nobody talked about hormones at all. I did have to have some scans for Jacob when he was in utero for 20 weeks because there was a risk of his heart not being right through the lithium consumption. But happily, he was absolutely fine. And really, I didn’t talk to anybody about hormones until I came to see you. So I was 47 by then and Jake was seven years old. And I probably realised about 45 that I was starting with what I would now recognise as proper perimenopausal symptoms.
So interestingly, no, and I never make that connection that the hormonal aspect of the birth was what saved me. I was thinking it was my cognitive brain switching over on, moving to a place where I needed to look after him and me.
Dr Louise Newson: [00:21:51] Yeah. And we talked quite often about this reproductive depression, actually. So women who have PMS, or PMDD, women who have postnatal depression, are more likely to have psychological symptoms during the perimenopause and menopause. And it’s just the sensitivity to hormones. And I was talking to an eminent neuroscientist yesterday actually, in America, and she does a lot of work actually on rats’ brains looking at estradiol. And a lot of it seems to be the change in levels rather than the actual level. And we see that a lot because we know in the perimenopause the risk of suicide really increases the risk of mental health, clinical depression, even schizophrenia can increase by a lot.
And it’s these shifts of change that happen. And we know postnatally there’s a rapid decline. I’ve already said the 17,000 average level of estradiol, it plummets. And many, many women, myself included, have night sweats when babies are young. Often I was told it’s because I was breastfeeding. Well, it’s rubbish. It’s because my hormones were low. A lot of us experienced vaginal dryness, joint pains, but we don’t think about it because we’re concentrating on our baby. No one tells us. But actually, it’s due to the change in hormones. And, you know, I think what’s really sad is that because we call it hormone replacement therapy, everyone thinks we’re replacing hormones and it’s really hormonal support treatment, it’s just helping. And so what we’re trying to do, we’re working with a lot of psychiatrists. We do a huge amount of education through the Royal College of Psychiatrists. We’ve written an e-learning module.
But beyond that, what we have been doing is trying to engage with people who look at women postnatally as well, look at postnatal depression, because postnatal depression is the commonest reason for suicide in women, yet very few women are given their own hormones back. But we know that some of the symptoms, not all, but some of them are related to this hormonal decline. And we also know that hormones are very safe and HRT body identical hormones are safer than the contraceptive pill. So we really need desperately to do some proper research in this area because some of the research that’s limited has shown that giving hormones can improve mental state, reduce, you know, postnatal depression. So it’s really, really key that we’ve just not pushed away thinking, oh, she’s going to feel like that because she’s got a history of mental illness or because she’s had a baby or she had a difficult time before. And certainly for you also the other trigger with some of your hormonal changes, with your migraines as well, which I have spoken about on another podcast. But migraines can be really triggered by any changes in the body. But when you’ve got hormonal changes, your migraines have been really crippling, I hope you don’t mind me saying for you, haven’t they?
Emma Hammond: [00:24:36] They have, in fact they were very well managed before I had Jacob. Age 40, I had him, and ever since I got home from hospital they’ve been really debilitating for 12 years. I’ve tried so many things to manage them. Being on HRT has helped, and also taking magnesium and various things that I’ve researched. I have been doing head massages, holistic treatments, all sorts of things I do. And of course, as I said to you in the other podcast, working in the Gunnercooke way, being in charge of my own time, my own business has been transformational in relation to managing my migraines for sure, but my job is stressful and therefore I need to be very careful with how much I take on, all those other factors.
But I think, yes, clearly hormonal treatment has been part of the make-up of me getting them to a place where I can manage them better, but I still need extra help. Yeah, it’s an ongoing challenge, as you know with yours. Upsetting that you’ve got a condition that you just need to learn to manage as opposed to thinking it’s going to go away.
Dr Louise Newson: [00:25:43] I think that’s really important. Definitely with migraines, but also mental health, lots of chronic conditions and sometimes people misinterpret the word chronic. I think it means bad, but chronic means long term. And so I’m always going to have migraines. It’s the frequency that I want to reduce, but I’m always going to have them. So making everything as even as possible is really important, and we’re all different, but finding tools that can help.
But I’m very grateful, Emma, for your time today, and I know it’s always easier talking about work than it is talking about your own personal experience. But I hope as harrowing as it’s been, there’s a happy ending because you are so well now you’ve got two lovely boys. It’s great. But also, I’m really hoping that people can learn from that and learn from what you’ve been talking about and think about their hormones, either their own or looking at others as well. And no-one is too young to be perimenopausal or menopausal. And most women know that there might be some hormonal changes. We need to alert ourselves to try and get the right help, support and treatment. Before we finish, I’d really like three tips. So for women who think their mental health might be related to their hormones, they might be postnatal, they might be perimenopausal, or they might have PMS. What would you say to them?
Emma Hammond: [00:27:01] I mean, firstly, clearly it’s about seeing a GP or speaking to a medical expert. I left that far too long because I was convinced that something else was afoot and I was also convinced that I could fix stuff myself. I think that’s very sort of typical often of women just trying to crack on and sort stuff out, and I think it’s about asking for help as early as possible when you see changes in yourself and trying to get answers.
I also think it’s about being honest with your family. It took me quite a while to actually accept that I wasn’t well. And again, as I said earlier, just through being a coper, never wanting really to be a burden to anybody, never wanting to need looking after. I just cracked on. And I think that the two, the medical support and the family and friends support is absolutely fundamental to getting better, whether it’s through hormonal reasons or not. You need answers and you need treatment.
And I think the third thing is about opening your mind to a myriad of different treatments on top of the hormones. Recognising that, yes, you might be able to partly fix this by getting hormonal treatments or medication, but also analysing how you’ve been living. And one of the big things for me, and a lot of my closest friends from primary school and very early days noticed an enormous change in me, they said, after I recovered, which was that I stopped being all Pollyanna about life and I suddenly found it much easier to say yes, I’m having a bad day, I’m having a bad moment, I’m having a difficult time. Can you meet? Can you help? Can you chat? Can you take one of my boys for a bit or whatever it was at the time. And they said they’d noticed about me over the years that I’ve never asked for help. I wanted to often help other people, but never thought that I deserved it really. And being so poorly made me realise that actually it’s not embarrassing to have a bad day or to feel rubbish. It’s just human nature and it’s normal. And the more we talk about feeling off, whether that’s, as you say, due to sort of more low level mental health symptoms or in fact something that manifests itself as a formal mental illness, it doesn’t matter. It’s nothing to be ashamed of. And this is the first time I actually talked publicly about this. I always wanted to, in fact, so thank you for giving me the opportunity.
Dr Louise Newson: [00:29:33] Thank you.
Emma Hammond: [00:29:33]. My closest friends who were there for me through thick and thin, that at one point if I had the opportunity, I would like to be able to speak about this. And it’s really refreshing, actually, and quite cathartic to me to be able to, because if I can help one person, then that’s job done.
Dr Louise Newson: [00:29:49] I’m really, really very grateful and I know it will help more than one person. Definitely.
Emma Hammond: [00:29:54] I hope so.
Dr Louise Newson: [00:29:56] So thank you ever so much, Emma. Thanks for all the work you’re doing, too. So thanks for coming today.
Emma Hammond: [00:30:00] Thanks for having me.
Dr Louise Newson: [00:30:04] For more information about the perimenopause and menopause, please visit my website, www.balance-menopause.com, or you can download the free balance app, which is available to download from the App Store or from Google Play.