Ask an expert: How does menopause affect your self-esteem?

And yet menopause is an inevitable milestone in a woman’s life that has an inextricable link between bodily changes and body image. 

Researchers have suggested that engaging in various activities during menopause can positively impact attitudes towards menopause itself, as well as improve body image and decrease symptoms of depression. 

In the UK, the average age for a woman to reach menopause is 51. But around one in 100 women experience menopause before age 40, in what’s known as premature menopause or premature ovarian insufficiency.

A study on 75,256 postmenopausal women showed a prevalence of 83% of body image dissatisfaction, according to research published last year. 

The researchers also found that physical menopausal symptoms (weight gain, hot flushes, vaginal dryness) can trigger psychological problems, such as depression and anxiety, which could, in turn, influence body image

This is an issue that’s not going away. Meet Dr Clare Spencer, a registered menopause specialist, NHS GP and Clinical Director at My Menopause Centre, here to offer her insight…

How do symptoms of menopause impact self-esteem?

“Menopause really batters women's self-esteem,” Dr Spencer said. “So women can go either two ways. I don't tend to see those women who think: ‘brilliant, you know, I'm late 40s, early 50s. This is really liberating. I don't have periods anymore. The children are all getting older. I've got more free time. For women like that, menopause can be a really positive time of their life. 

“I tend to see women who have a more difficult time and symptoms can be debilitating. Sometimes they stop exercising — and women can go gain weight anyway as they go through the menopause — but if you stop exercising or moving because you're worried about incontinence, or you've got aches and pains or hot flushes or for whatever reason, that can all impact self-esteem And then obviously the weight gain exacerbates that. 

“So there are many reasons why women's self-esteem is knocked and it's to do with weight gain, symptoms, and changes of cognitive function — where you feel like your brain is full of cotton wool and it’s difficult to find the words. If you're at work and you're struggling with your concentration, memory, anxiety, and brain fog then your confidence is knocked and that knocks your self-esteem."

And there’s more. Dr Spencer continued…

“And then some people feel horrible, and are having hot flushes and think that others are looking at them because suddenly they've gone really hot, red and sweaty.”

Dr Spencer’s summary of the trials and tribulations of the precarious balance of maintaining good mental health and self-esteem is reiterated in the reams of clinical research. 

For example, symptoms of ageing, including weight gain, changing shape, wrinkles, losing muscle mass, changes in skin, hair and sexual function, flushing and osteoporosis can alter women’s perceptions and feelings about their own bodies.

The physical symptoms of menopause may also lead to a perception of losing attractiveness, negative body image, decreasing self-esteem and mental vitality and, as a result, this has a massive impact on women’s mental health.

Do pelvic floor issues and incontinence also impact self-esteem?

“Incontinence is one of the last big taboos,” Dr Spencer said. “I think people still feel worried about it, I think, they are genuinely more likely to talk about sex than incontinence.” 

Dr Spencer said that women really suffering specifically from pelvic floor issues will usually see a specialist gynaecologist. But as part of her specialism in menopause, and checking up on women’s general menopause history and bladder function, many of her patients will often “volunteer their sense that their pelvic floor is not what it used to be and has definitely worsened as they’ve transitioned through menopause”.

“A loss of oestrogen probably isn’t the only culprit,” she said, “but it can make pelvic floor issues worse.”

“The connective tissue that supports the pelvis can become weaker as a result of a loss of oestrogen and the vagina becomes more sensitive, delicate and drier. And so, symptoms of prolapse, which can also be related to stress incontinence, can worsen as well.”

There are also physiological reasons behind this: a loss of oestrogen can also mean a loss of serotonin (the ‘happiness hormone’) in the brain, which can pull your mood down. 

What effect do stigma, cliches and societal judgment play in our understanding of menopause?

“All of the physical and mental symptoms of menopause mean that it is not viewed positively in society,” Dr Spencer said. “This is true of ageing women in general. There are so few role models and figureheads - but it is improving which is brilliant.”

In May, Sophie, the Countess of Wessex, 57, became the first member of the Royal Family to talk openly about her experience of menopause. 

The Royal joined the launch of the Menopause Workplace Pledge by health charity, Wellbeing of Women, which is calling on all employers to sign up and support women going through menopause.

In a surprisingly candid interview, she revealed her own experience of menopause, her symptoms of brain fog and losing her train of thought on royal engagements.

She said at the time: "It's like someone has just gone and taken your brain out for however long before they pop it back in again, and you try and pick up the pieces and carry on."

“Things aren’t set, but I think women speaking out about menopause is relatively new,” Dr Spencer said. “Historically, it’s been viewed very much as a negative thing that we don’t talk about — and that’s going to have an impact, isn’t it? As you realise, as you go through menopause that it's not exactly embraced by society, that’s going to affect people. That is changing, and it's important to note that it is changing and lots of people are working very hard to change it.”

Is there any practical advice you can give for how women can regain their confidence?

“It’s all about finding the right activity for you,” Dr Spencer told Jude. “So for some that will be exercise, for some it'll be yoga, for others meditation is really important.”

“For example, I love running so for me, it's running — for others, it can be cycling. So it's whatever activity you can do that makes you feel better. So there are lifestyle changes women can make. For some, it's looking at diet, nutrition, and reducing alcohol, which can obviously increase weight gain, pull mood down and affect sleep. Other people will find benefits through alternative therapies and alternative medicine, homoeopathy and acupuncture.

“And then for others, it'll be HRT. Hormone replacement therapy can be a really good way of just making you feel like yourself, again, just getting yourself back on track. So then you can sort of use it as a springboard to then start to exercise again.

“There’s not one single key nor a one size fits all approach. I think the point is that it will be different for every woman, and then it's usually not one solution. It's a range of solutions that are all linked to each other.”

What is your take-home message?

“The key message is that help is out there,” Dr Spencer said. “Keep looking until you find the right help and support for you. Make the most of all the information that's available, arm yourself with knowledge about menopause so you understand that what you're going through, is also being experienced by many other women. And, you know if and if you don't get the support you need initially then just keep asking, whether you've got stress incontinence and you need a referral to a gynae physio, or you're really struggling with menopause symptoms and you want HRT, then keep asking until you get the answer that you would like. 

“Use all of the resources out there. For example, look at our website, we try to make the information really clear. We've written a menopause questionnaire that allows you to try and work out where and if you are in the menopause transition. So there's lots of free information out there as well. So make the most of it.”

What can employers or colleagues do to support people going through menopause at work?

Dr Spencer said it’s all about being supportive and not making fun of people if they don’t want to be made fun of.

“Some people do use humour to see their way through it themselves, but it has to be on their terms,” she added. 

“It's providing information so that younger men and women understand what the other person might be experiencing or feeling and how that they may have a knock-on effect on how that might be making them feel. So it's about education in the workplace, and creating a supportive environment to provide flexibility so people don't feel anxious about raising concerns or asking for the window to be opened, or a fan, for example.”