His heart needed care. Her mind did too.
Menopause, mental health and the illnesses we recognize differently in women and men
I watched my grandmother struggle with anger, irritability, rage and anxiety for more than 30 years—the same feelings I recognize in myself now, after menopause.
For many of those years, she cared for my almost bedridden grandfather after his strokes and heart attacks.
Everyone cared for him. Everyone catered to his illness.
But when it came to her suffering, everyone had criticism. Why was she so angry? So difficult? Why couldn’t she just calm down?
His suffering was understood as something that had happened to him. Hers was treated as something she was doing to everyone else.
Looking back, I wonder how much went unrecognized. Her mental health. The changes she experienced after menopause. The exhaustion of caring for someone else while needing care herself.
They both deserved care and attention. But only one of them was consistently seen as ill.
That memory has stayed with me. Now that I am postmenopausal myself, it has taken on a different meaning.
I cannot go back and diagnose my grandmother. I do not know how much of her suffering came from menopause, depression, anxiety, caregiving, life traumas or some combination of these. But I can question why so few people seemed curious about what she was going through.
What I mean by “gender-specific illnesses”
Sometimes I think about women’s mental health after menopause in the way we think about heart disease in men.
I use “gender-specific illnesses” in quotation marks because these conditions are not exclusive to either gender. Women have heart attacks. Men experience depression and anxiety. Both develop Alzheimer’s disease.
But there are differences in how often certain illnesses occur, when they appear and how we respond to them.
Coronary heart disease is more common in men and tends to appear earlier. Depression and anxiety are more common in women. U.S. studies put women’s rates of depression and anxiety at roughly one and a half to two times those seen in men. These figures cover adults generally, rather than postmenopausal women specifically. [1–3]
We seem familiar with the idea of a man developing heart trouble as he gets older. We understand that something inside his body has changed and needs attention.
I wish we were equally curious when a woman’s mood, sleep or ability to cope changes around menopause.
Why do we so readily understand that a heart can become unwell, while expecting a woman’s mind to function normally through whatever changes and burdens she experiences?
Menopause affects more than periods
We often talk about estrogen and progesterone as though their only jobs involve periods, pregnancy and fertility.
But our brains respond to these hormones too. They influence systems involved in mood, sleep and how we respond to stress.
During perimenopause, hormone levels fluctuate. After menopause, estrogen levels remain much lower, and the usual monthly rise and fall of progesterone has ended.
Some women move through this with relatively little disruption. Others feel as though they have become someone they barely recognize.
They may feel more anxious, more easily overwhelmed or less able to tolerate things they previously managed. Sleep can fall apart. Patience can become harder to find.
Research supports taking this seriously. One long-term study found that women had approximately two to four times higher odds of a major depressive episode during perimenopause or early postmenopause than before the transition. That does not mean every woman develops depression, but it does tell us this can be a vulnerable time. [4]
And yet, how often does a woman hear:
“You’re overreacting.”
“You’re always angry.”
“Why can’t you just relax?”
I wonder how many times my grandmother heard some version of those words.
What if she needed help too?
My grandmother’s anger is part of what I remember. So are her irritability, rage and anxiety.
But I also remember a warmth, love and care that only she could provide.
Both were there. Her suffering did not erase her love.
Looking back, I wonder what it was like to care for someone so unwell while struggling herself. To have everyone notice his needs while noticing mostly her reactions.
Was she sleeping? Was she frightened? Was she exhausted? Did she feel trapped? Had she been carrying things for years that nobody had helped her understand?
I do not know all the answers. I do know that I don’t remember anyone having those conversations with her.
Now that I recognize some of those feelings in myself, I wish someone had.
A woman can love her family and still be struggling
Hormonal changes do not happen in an empty room.
They happen while women are working, raising children, caring for partners or parents, managing a household and dealing with whatever life has already asked of them.
Then add poor sleep.
A woman who is waking repeatedly, feeling anxious at night and starting each morning exhausted may have very little left by the time someone asks one more thing of her.
Hormones may be part of that experience. So may depression, anxiety, past trauma, another health condition or the sheer weight of her responsibilities.
We do not have to identify one single cause before deciding she deserves help.
And help should not depend on her being pleasant enough to ask for it.
Recognizing suffering does not mean every behaviour is acceptable. But criticism alone is not treatment or acceptable care.
Instead of stopping at “Why are you so angry?” we could ask:
“What are you feeling?”
“When did you start feeling this way?”
“What do you need?”
Those questions could have opened a very different conversation with my grandmother.
Women’s hearts need care too
My comparison is about what I witnessed in my family. Heart disease is not only a man’s illness.
Before menopause, estrogen contributes to some protection against coronary heart disease. After menopause, that protection changes and women’s cardiovascular risk rises. Aging, blood pressure, cholesterol, smoking, diabetes and family history matter too. [5]
So a woman going through menopause may need attention to both her mental health and her heart health.
Unfortunately, women can face dismissal in both areas. The National Heart, Lung, and Blood Institute notes that women may experience delays in cardiac testing and be less likely to receive certain treatments. [5]
That makes me think about how quickly we sometimes decide a woman is “just anxious.”
Her anxiety deserves attention. So do her physical symptoms. One should not become a reason to stop investigating the other.
And what about our brains as we get older?
Alzheimer’s adds another reason to take women’s brain health seriously.
Almost two-thirds of Americans living with Alzheimer’s are women. Women’s longer lives explain part of that difference, but researchers are also exploring the roles of hormones, genetics and cardiovascular health. [6]
Menopause is relevant because the brain is adapting to a different hormonal environment. Researchers have observed changes in how the brain uses energy across the menopause transition. [7]
That does not mean menopause brain fog is Alzheimer’s.
Forgetting why you walked into a room after a terrible night’s sleep is not the same thing as progressively losing the ability to manage everyday life.
But neither should a woman’s concerns be brushed aside. If changes persist or worsen, she deserves to be listened to and assessed.
The connection with insulin resistance
This is where the conversation connects with metabolic health.
Insulin is a hormone, and its role extends beyond blood sugar regulation. Insulin signalling also matters in the brain, including in processes involved in memory.
Researchers have found impaired responses to insulin in the brains of people with Alzheimer’s—even in some people who did not have diabetes. This is one reason you may have heard Alzheimer’s described as “type 3 diabetes.” [8]
That phrase is a research shorthand, rather than an official diabetes diagnosis. It describes part of the biology being investigated; it does not explain every case of Alzheimer’s.
We also know that people with type 2 diabetes have a higher risk of dementia. One large analysis found approximately 60% higher risk compared with people without diabetes. That does not mean someone with diabetes will necessarily develop dementia. [9]
For me, this reinforces why we need to consider the whole person.
Our hearts, brains, hormones and metabolism are connected. They deserve to be discussed together.
It does not mean that everything is caused by insulin resistance, or that one hormone treatment will solve everything. It means we should be curious about those connections instead of treating every symptom as an unrelated problem.
Who is taking care of her?
When a woman says, “I don’t feel like myself,” I want that statement to begin a conversation.
I want someone to ask about her sleep, her mood, her health and what her days actually look like.
Some women benefit from hormone therapy for menopausal symptoms. Some need treatment for depression or anxiety. Some need both, alongside practical support. Hormone therapy is not a universal treatment for depression and is not currently recommended specifically to prevent Alzheimer’s. [10,11]
But care is bigger than a prescription.
Does she have time to attend an appointment?
Can someone else take over the caregiving for an afternoon?
Can she rest without feeling guilty?
Does anyone notice when she says she is struggling, or only when she finally loses her patience?
My grandmother was caring for someone whose illness everyone could see.
I wonder who was caring for her.
They both deserved care
My grandfather’s illness was real. He deserved the care he received.
My grandmother’s suffering was real too. Whatever its exact causes, she deserved curiosity, assessment, support and treatment.
I cannot say what would have changed if she had received those things. I can say that blame did not provide them.
Now that I am postmenopausal, I understand her differently. I wish I could sit beside her and ask the questions I don’t remember anyone asking.
I wish someone had looked beyond her behaviour and wondered what she was going through and how they could help her.
We can do that for the women in our lives now. And we can ask for that care ourselves.
Everyone wondered why she couldn’t just “be” better.
But nobody wondered why my grandfather’s heart couldn’t just “do” better.
Sources and further reading
SWAN: Major depression during and after the menopausal transition
Talbot and colleagues: Brain insulin resistance in Alzheimer’s disease
Chatterjee and colleagues: Type 2 diabetes and dementia risk
Guidelines for evaluating and treating perimenopausal depression
The Menopause Society: Hormone therapy and dementia prevention
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