
Another year, and another World Mental Health Day is here. I often wonder what progress is being made to support women’s mental health, particularly perimenopausal women who are significantly more likely to suffer from major anxiety and depressive episodes than their premenopausal counterparts and middle-aged males.
We know this from several studies including one that launched in the U.S. in 1994, the SWAN study, that is a longitudinal study of women’s health across the menopause transition, including psychological health. Over a span of 13 years, 39% of perimenopausal women experienced a major depressive episode. More specifically, they observed that women entering perimenopause with a history of depression had a much higher risk of recurrence (59%) versus women without a lifetime history of depression (28%).
Don’t get me wrong, I love that there is a world mental health day for all of us, as the stigma around having a mental illness of any kind is still ripe with secrecy and shame. In my opinion, mental health is health, period, especially as science uncovers more and more about how our brains actually work. But I don’t love that of the studies and articles I’ve read about women’s mental health in midlife conclude with…wow, this major lift in mental health episodes for menopausal women is a big deal and we need to study it more. Sound familiar?
Of the $45M BILLION spent in the US on research, only 10% is allocated to women’s health, and even a smaller percentage on menopause.
I’m sure you also won’t be surprised to know that a “Menopause Fact Sheet” from the Office of Women’s Health (a federal office) published in 1997 doesn’t even mention mental health. But there’s hope at the end of the tunnel as we see what will come of the Menopause Research & Equity Act that was introduced to Congress last year.
While we all wait for things to change and for research to have impacts on mental health outcomes for menopausal women (who catastrophically have higher suicide rates more than any other midlife adult population), by trial and error, I have come to understand how I can manage a lifetime of anxiety and major depressive episodes.
[NOTE: if you aren't interested in my personal observations (!!!), here’s some of the cool science on how yoga helps in all the ways, not just mental health.]
Some lessons have been way harder for me than others (yup, alcohol and drugs, not asking for help, making yourself small and invisible, etc. don’t help at all). Some lessons have just been frustrating (finding the right therapist and the right dose of pharmaceuticals). Some lessons have been surprising - those episodes of depression in puberty, postpartum and perimenopause are linked to hormonal changes in the brain.
My happiest lesson (maybe at this point in my life, a reminder) is that my yoga mat can be my refuge when it all gets to be too much. As with other major moments in my life (finding purpose after college, grieving my mother’s death from breast cancer, becoming a mother), yoga has been such a beautiful salve, but especially for me now during perimenopause, as I manage fluctuating energy, moods, and increasing episodes of anxiety and depression.

I’m reenergized by how my practice has changed with me – and how the skills I’ve developed over the years to pay attention to the subtle cues of my mind and my body (“svadhyaya”) – are directing me in a new way. In my 30s and 40s, I used to think that I had to constantly show up on my mat to achieve something, and that it wasn’t worth doing if I wasn’t going to feel some muscle soreness the next day. While I’ve always been conscious of my edges and have never compromised the safety I need to feel in my spine, joints and limbs, I always pushed myself to show up, and not necessarily in a kind way.
Now, my yoga mat is akin to getting into my soft bed at night, except it’s less about tapping out from the world, and more about feeling held, balanced and supported (“sattva”). It’s about allowing myself to be vulnerable, honest, and whole again. Unlike having to get out of my bed in the morning (especially if I’ve been experiencing a bout of insomnia), I’m happy to leave my mat after a mindful practice, because I’m reminded that I have agency over this whole messy situation. Agency is everything to me because it challenges the unpredictability of the menopause transition and puts me back into the driver’s seat. Agency gives me a plan of action (“kriya yoga”) or nonaction (rest IS a radical act). Agency allows me to invite others into this journey with me.
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