Registered mental health nurse Kelly Forbes uses modern communication technologies to support her clinical work and reach new audiences. One of her key messages to all women experiencing hormonal changes is to protect their wellbeing. By doing this, as they get older, they can move from perimenopause to a new positive chapter in their lives.
鈥淚 see many women in their forties and early fifties who are struggling, and I don鈥檛 think this is a coincidence," says Kelly. 鈥淭hese are key years of transition when perimenopause and menopause symptoms are at their strongest for women who experience them.鈥�
There鈥檚 lots of help available, including from mental health nursing staff, general practice nurses and menopause specialists, and Kelly is someone who鈥檚 leading the way. She鈥檚 determined to help people understand the impact that perimenopause and menopause has on the brain and a person鈥檚 wellbeing. This still isn鈥檛 talked about enough, she believes.
鈥淢enopause isn't a mental illness, but it can have a negative impact on mental health and can exacerbate mental health conditions. Women need to be informed and knowledgeable about what鈥檚 happening to their bodies, because the impact on their personal wellbeing can be significant.
鈥淧eople tell me: 鈥業t鈥檚 a natural change.鈥� I reply: 鈥楽o鈥檚 a tsunami,鈥欌�� she adds.
鈥業鈥檓 leaving鈥�
Changes to how someone feels during their perimenopause can make an individual experience life-changing shame, and this is often misunderstood, Kelly says.
鈥淩esearch has shown that many women going through their perimenopause and menopause journey have a feeling of 鈥業'm leaving with a suitcase and I'm not sure if I'm coming back鈥�. I鈥檓 speaking metaphorically of course, but some women who are that age will know what I'm talking about. This needs to be spoken about and normalised.鈥�
Menopause is a time of transition and often symptoms are experienced at a time when demands on women are increasing. They may be juggling carer responsibilities, senior roles at work or relationship changes, for example, so the impact of symptoms can interfere with their day-to-day activities and quality of life.
Kelly says she frequently sees women revisiting unresolved issues that happened in their earlier life as they enter perimenopause. This is the time they may reach out for therapy for unresolved issues.
Women also report feeling less feminine, less beautiful and less sexual, and perceive their worth has decreased. This can have a negative impact and stop women asking for help, clarifying needs, sharing experiences and receiving health care.
Their feelings are often hidden, and attitudes aren鈥檛 challenged.
A personality change?
Meanwhile, women are dealing with other hormonal fluctuations which frequently result in low mood and an increase in stress and anxiety.
Kelly explains: 鈥淭his can feel catastrophic. Women report believing they鈥檙e not as connected to people, and they lack empathy. They wonder if they鈥檝e had a personality change or if they鈥檝e suddenly changed their life values.
鈥淭his really isn鈥檛 the case. There are clear biological and physiological changes happening. People need to know this so they can feel less guilty and instead focus on their own wellbeing.鈥�
A future to look forward to
While menopause can often be portrayed in a negative way in western culture, with a stigma around a woman鈥檚 experience, some cultures celebrate menopause as an achievement of wisdom and ageing.
Kelly鈥檚 message is that we must all switch our focus.
鈥淲hile life satisfaction may dip for some women as they come towards and during perimenopause, after menopause things are far more positive. Many women around the age of 60 tell me they've never been happier; and this is backed up by neuroscience.鈥�
In her book, The Menopause Brain, Neuroscientist Dr Lisa Mosconi focuses on how the menopause doesn't just have an impact on the ovaries, there鈥檚 also a significant impact on the brain. She argues that by taking care of themselves during perimenopause, women can come out the other side with a renewed, enhanced brain and this can usher in a meaningful and vibrant new chapter of life.
Kelly agrees: 鈥淚 explain it as an update for the brain, which also happens during puberty and pregnancy. Each wiring can be quite messy, but when you get to the other side, if you鈥檝e focused on your wellbeing during the difficult times, you鈥檙e rewarded with wisdom.
鈥淎fter menopause some women report feeling not as bothered by things that might have worried them in their younger years. Areas of the brain that are linked to empathy become increasingly powerful again.鈥�
This is another transition. Some women are also kicking out years of horrendous physical issues like PMS, soreness, migraines or bleeding. Now they find there鈥檚 no more need for tampons, pads and 鈥渂eing prepared鈥�. They鈥檙e also able to enjoy sex without thinking about pregnancy.
鈥淭his new stage in life 鈥� postmenopause 鈥� is a time that鈥檚 more about the individual and their personal priorities. That鈥檚 a message that many women need to hear,鈥� Kelly concludes.
RCN advice on living well and keeping healthy during perimenopause
Women should be encouraged to:
- keep a diary of the positives, and challenge the negative thoughts
- make time to laugh, as humour can help with tension, stimulate immune systems, help with coping, and enhance memory, learning and help women to feel connected
- use the support of others who have been through similar experiences, such as women in a support group or menopause café
- challenge any negative way women are treated in society and in the workplace
- access treatment and support for ongoing menopause symptoms from a menopause-trained health care professional.
Read more in Menopause: RCN guidance
Reaching new audiences
Kelly has taken a new approach to the way in which she spreads the word about mental health and wellbeing. With a busy and wide-ranging caseload, she鈥檚 found a way to ensure appointment time isn鈥檛 dominated by explanations rather than practical help.
Now, after a face-to face assessment, those working in her multidisciplinary team advise patients to look at Kelly's videos on YouTube before patients return for their next appointment. This gives people the chance to review information and practise in their own time before their next appointment.
鈥淭he films are easily accessible 鈥� you don鈥檛 need a password or an account to see them. You can also find them using a QR code which we鈥檝e printed on the back of our appointment cards,鈥� Kelly explains. 鈥淭hey can also be used independently or alongside our interventions."
Kelly hopes the videos will also be helpful to those who she doesn鈥檛 see.
鈥淧eople are busy and there鈥檚 still a stigma attached to seeing a mental health nurse, so although the information shared in my films is already available elsewhere, it鈥檚 important that it鈥檚 available in one place and it鈥檚 evidence-based,鈥� she says.
The most popular films address women鈥檚 mental health issues but all Kelly鈥檚 videos use simple language to aid understanding and cover issues that matter to her local community. This includes grounding techniques, the panic cycle, guided breathing techniques, sleep hygiene and thought-challenging.
Feedback on Kelly's YouTube videos has been overwhelmingly positive, and there are plans to promote them to a wider audience across the trust area.
Further information
Find out more about the RCN Women's Health Forum.
