Midlife, Menopause & Mental Health: What Every Woman Needs to Know
- Two Women Chatting
- Jun 22
- 20 min read
In this conversation from a full Two Women Chatting episode, Michelle and Kate Muir explore the often-overlooked aspects of midlife, particularly for women. They discuss the redefinition of the midlife crisis, the impact of menopause on mental health, the importance of HRT, and the need for better healthcare practices. They also touch on the benefits of wild swimming, the significance of vaginal health, the UTI scandal and the connection between hormonal changes and neurodiversity. Ultimately, they emphasise the joy and liberation that can come from embracing midlife and prioritising self-care. Grab a cuppa and join the conversation!
Kate Muir is a Scottish writer, filmmaker, former journalist, and campaigns advocate whose work has reshaped public understanding of women’s health—all with insight, passion and wit.
Over the past few years she co‑executive‑produced two Channel 4 documentaries with Davina McCall:
Sex, Myths and the Menopause and Pill Revolution, reaching millions and dramatically increasing HRT uptake
Kate's new book How to Have a Magnificent Midlife Crisis is out now.
Kate Muir
I just think we've been neglected. Our midlife crisis has been neglected forever for women. And we really have a much more serious midlife crisis because our brains completely rewire around menopause and perimenopause. So there's about a 15 to 20 year brain change going on that nobody knew about until recently. And then, you know, we've got questions with our fertility, our families, we're looking after older people, our domestic burdens have changed. Maybe we have none.
And I just think this is the great leap forward and we should really be enjoying it. And one of the ways we're going to enjoy it is if we know about our health and if we know about our mental health and if we can know about all the mad things we can do.
Michelle
Tell me about wild swimming - what are the benefits for us?
Kate Muir
It makes a huge difference to all of our mental health. It just gives us an enormous kick up the ass in the morning, a very joyful one. And a lot of the time you see the dawn, you see the sun and the weather never matters because if it's raining, you're already wet and you watch the big blobs of rain bounce off the water and you laugh. And somehow it just gives you a kind of whole piece of freedom to my life. Even just one dip a of a week really improves your immune system, really improves your brown fat, which burns energy much better. It just is really, really good for you. And there's these great studies they're now doing, which are also in the book on depression and swimming and the effect it has compared to antidepressants.
The other thing I was thinking is we all think about our bodies and worry about our bodies, even though we've got quite mature bodies. And being in the showers with a bunch of naked women who really do not give a damn every day and there's people who have breast operations. There's people like me who've had three kids and have got stretch marks and a bit of a tummy - it just makes you feel so honest about your body. And we've all got these very different bodies from a Lucian Freud kind of magnificent body to a wee skinny body. And you feel like none of that matters. It just takes you back to your sort of essence. And actually even though I can intellectualise stuff about my body, emotionally, I'm still a bit of an idiot, you know?
And so it was really, really lovely to kind of be in that world every couple of days and just feel like I am me, I am naked and I don't care.
Michelle
What I love about your book is it's thoroughly researched. You've got incredible experts that you have talked to. You also weave in a lot of stories of real people so you feel like you can connect on that level as well and you cover a lot of subjects. A couple of them, I can't go into all of them as you know because we were just saying it really does cover an awful lot but here's one I'd like you to just touch on if you don't mind and I think a lot of women of our age do experience this.
Anhedonia.
Kate Muir
Well, that means so what a great word. It just means feeling flat, really, not taking any joy in anything - and that comes to a lot of people in perimenopause. So it crashes in there and you start feeling flat and not enjoying things as much because your oestrogen is lower and oestrogen works with serotonin in the brain and keeps it going and keeps you up - and when it's suddenly gone, it can take huge leaps and plunges.
You can suddenly have quite a lot of crashes and be kind of just very sad and not want to go out. I don't think anyone is explained to us enough about these brain changes. So there's the business of the slight feeling of depression. Most women know this is not depression like clinical depression, because they know nothing's changed in their lives, but suddenly everything's a bit meh.
Also combined with that, there's the rage because women get quite angry because their progesterone is decreasing too. The progesterone is really crashing and that is your calming GABA hormone. When that is right down very quickly, quite often, you just don't have that calm. You don't have that buffer and you're not sleeping so well because you've got that anxiety in the night - that 4 a.m. wake up.
All these things are conspiring against you together, so you're not getting enough sleep, your oestrogen is going down and suddenly sometimes peaking as well and you are just a hormonal orchestra gone incredibly wrong. But there are ways of dealing with it. Once you know what's happening, that is already a step forward because you can watch yourself from the outside and say, I'll be better in a day or two or I'll cope with it in this way.
But what I realised writing this book and it is huge - we are not clearly talking about menopause and mental health. I talked to the people who deal with people with serious mental health problems like being bipolar or serious depression and when you add the menopause or hormones or crash to that, that can really send people back into hospital. Psychiatrists and psychotherapists are really not trained in the menopause - and psychiatrists don't prescribe HRT very often, almost not at all. But yet there's a whole group of women from 45 to 55 turning up suddenly for the first time in their lives. Nothing has changed.
So the serious mental health element, the appearance of things like bipolar disorder, serious depression, it's just not being acknowledged enough. The connection with that and hormonal change. I'm really keen to educate psychotherapists and psychiatrists so I'm working with a couple of groups actually on that now as a new campaign to bring the hormones into people's heads and that conversation because it's so important. HRT makes a huge difference to the majority of women.
Michelle
You revolutionised menopause in many ways. Your incredible book, Everything You Need to Know
About the Menopause, But Were Too Afraid to Ask, and then of course your documentaries that you did with Davina McCall. People still talk about that being the moment when people started understanding what was happening to their bodies. And we started that shift into not being scared about talking about it in public or being embarrassed or feeling like it's the beginning of the end, the shriveling up, the drying up. It is a huge time of flux. But what still surprises me, and this goes back to HRT as well, we learned so much from that, but we're still not seeing enough change in the NHS because the 40 plus health check still doesn’t talk about perimenopause, menopause or osteoporosis. Why? I mean, I know people like you and Davina, Louise Newson, so many incredible menopause warriors in this field like the menopause charity, Menopause Mandate. You all try so hard to be heard and yet a fairly basic change to this health check would change the lives of so many women by dealing with their health before rather than after.
Let's not wait until that stable door has closed. Can you talk a little bit about that, please?
Kate Muir
Well, it's been really frustrating because we've been up there in parliament. We've been with Carolyn Harris. We've had a meeting on osteoporosis in the House of Commons. We've done everything and so has Menopause Mandate. What we need now is the NHS is just sitting there like a ‘fatberg’, not changing. But we also know that Wes Streeting is really interested as health minister in changing the NHS. My theory is we kidnap Wes Streeting for five minutes and explain to him how hormones work in the female body and say, Wes, how could you save, you know, four billion pounds a year? Give women who've got osteoporosis, before they get osteoporosis, give them oestrogen, progesterone - and testosterone is also good for osteoporosis. You could save billions. How would you reduce your diabetes bill by a third, Wes? Well, you know, guess what? HRT, getting your oestrogen right and getting your diet right, informing women, that will make a big difference too!
Would it be good to lower cardiovascular disease, Wes? Yes, because women who take transdermal HRT are far less likely to get a stroke etc etc.. So, I mean, it's an absolute no brainer. The menopause charity have done a superb paper on this, which they did send to the government, which looks at all the signs in terms of longevity and better health, not just hot flushes, but the effect keeping your hormones going will have for the rest of your life.
Also, it's not like we've got anything to prove. If you look at women who are in early menopause in their 30s and 40s, they are far more likely to get cardiovascular disease, osteoporosis and dementia. I think it is a crime that we are not getting that message out and we are doing the best we can. I'm hoping this book will do it because this book doesn't come labeled menopause because menopause only part of it. This book is about longevity.
It's both intellectual longevity and bodily longevity and how we will come into our powers. I don't think people understand that menopause is a massive metabolic event that puts them at risk of diabetes and cardiovascular disease and osteoporosis and all these things. And the minute they do, they are on it. Women are on it. You tell women the information and you give them the science, which is what these doctor influencers on Instagram and on television have been doing. It comes from women up because women are brilliant at protecting their own health and finding out stuff from one another. It’s a big piece of sexism, up there at the top. It's also a horror in the medical establishment that there are people out there with AI, with everything, that can now read the science papers that were locked up in universities.
We are learning every day and if there's a new study, I get an alert on my phone every day and I work with groups of doctors. I just feel this is what someone in the NHS should be doing too.
Michelle
So we need to kidnap Wes Streeting. We also need to debunk myths. Another thing that you mentioned is “a crime against humanity” is the report that came out over 20 years ago linking HRT to breast cancer.
Now that has been debunked. Can you tell us the benefits? There's so many benefits of taking HRT. Of course, it's not for everyone. It's not possible for that to be right for everybody if there's, you know, certain underlying conditions or a cancer background or so on. But for the majority of women,
Kate Muir
I think clearly it's for mental health. I think it helps to keep us very, very sharp. I think it's really important for memory and all those metabolic things. One of the chapters in the book talking about HRT - because HRT makes you live about four years longer. You live a better life. You live a healthier life for longer, which I think is incredibly important. But I do have a chapter and there was a bit of a dispute of the title of the chapter, which is called ‘how to avoid midlife muffin top.’ My editors said, you can't say that about people. To which I replied, well, actually we need to talk about fat in midlife because it's a different kind of life. I am not fat shaming. I am fat explaining. People need to understand that the kind of fat we build up in midlife is because our hormones aren't there. So when the estradiol, which is the great hormone you get back in HRT, when that leaves the building in your late 40s, early 50s, your body compensates by making a not so good oestrogen called oestrone. And guess where it makes it? Round your middle like a little spare tyre. That midlife mop and top that hangs over your jeans, that sudden kind of sagginess in the middle, that is your body usually trying to build up oestrone. And your body reacts differently to protein, to insulin, it’s cholesterol changes. It behaves in a different way than it did 10 years ago. That's because it's trying to compensate - and that fat is strewn in it. That fat built up puts you at a higher risk of breast cancer as well. It's really, really worth knowing that visceral body fat is not what you want. And in fact, what you want to do, even if you're not taking HRT, is build muscle. You want to build muscle to burn that away and you want to seriously weight lift.
Obviously that's very hard to say to people who are working 10 shifts a week in Sainsbury's, looking after their grandkids, living somewhere where there's not space to go to the gym or something. There's a lot of middle-class people telling other people who are very stressed what to do. But one thing you can do is get HRT to everyone and make sure it's the right proportions for them. And from that basis of having a body that is not desperately trying to compensate and make oestrone around the middle, you can begin to move on and make the rest of your life healthier.
So often HRT is the first step off the ground that will just make you feel better and then you'll get off the sofa and then you'll start moving and your brain will be working better. So I feel really strongly about getting this information out to everyone and not just a sort of Instagram elite.
Michelle
So that's another thing that is not discussed at that NHS 40 plus that you should be looking after your bones and having a dexa scan at the age of 65, it's all a bit late then isn't it because then you could have bones that are like sponge.
Kate Muir
It improves bone density. We absolutely need preventative medicine and HRT is great. But the other thing, if you can't take HRT - and I went and did studies on this - because we did a big campaign called Give Your Bones a Break to try and get this message out. I looked at the kinds of exercise the NHS were advising people to do and what was actually working. Walking around the block isn't really enough. It's something, but it isn’t going to really change what's happening to your bones. You've got to really stress your muscles by lifting heavy weights. So you want to be doing not the little pink weights! You want to have a decent number of kilograms, be pulling them up. You can watch a five minute video. I do a five minute video off YouTube, but with quite heavy weights. Doing that and also jolting your body, like doing a sort of arm lift and then landing, jumping down onto your feet.
The jolting is really important because it wakes your bones up and it gets them working and bones work on hormones, So it's pumping, hopping, hopping also good. Skipping is good. Storming up and down the stairs angrily. Very good for bones! But the numbers are interesting because HRT can increase your bone density between 7-10 % over a couple of years. The actual weightlifting in one trial in America increased bone density by 3 % in eight months. These trials are not done yet, but you may be looking at 5 or 10 % over a number of years. That was really heavy weightlifting, including landing and jumping. So that's it. So lift heavy, jolt yourself a bit. And that is what makes a difference. And you could go and take one session or just get this on YouTube. A fantastic woman who's really good is called Dr. Vonda Wright, and she's on Instagram, and she's really worth following because she's into all that, and you can do these at home.
Michelle
. I think it's worth saying as well, that this is not going to turn you into Mr. Universe. It doesn't create enormous biceps that look somewhat unattractive. All it does is pinpoint that bone health and tone your muscles to help that protein be energised within your body for the right reasons. So every woman really should be doing some kind of weight bearing and it's not just a walk around the block.
Let's move on to something that I know you're quite passionate about discussing and that is the great UTI scandal. It's not something that you hear discussed very much, the great UTI scandal. I don't think I know a woman who hasn't had a UTI to be honest. I think everybody gets them but they can be really dangerous can't they?
Kate Muir
It's a huge cause of hospital admissions and sepsis eventually. And also even in the case of my own mum who had Alzheimer's and was living at home and she was 80 something and she got terrible UTI one summer when her carers didn't turn up for a couple of days and I was away on holiday and went into hospital and that UTI affected her mental health incredibly. And actually she never walked again. For older women, it's not just a bunch of antibiotics. It can really take away the last shreds of their ability and strength to hold on. So I was very aware of that, but at that point I had not heard of oestrogen having any effect on a UTI.
Then I started talking to doctors and everybody was saying, well, know, oestrogen makes a big difference to UTIs. We get far less UTIs if we're taking oestrogen, particularly vaginal oestrogen, which should be called vulva oestrogen, but you know, you can rub cream or gel or whatever all over your vulva or take a pessary and it's all free on the NHS and you can do it for the rest of your life. And you can do it if you've had breast cancer. - doesn’t increase any risk of anything.
There's a lot of different preparations out there. Everybody or pretty well everybody should be taking vaginal oestrogen one way or the other. If you've got HRT, it's already systemic in your body. So quite often we don't need it so much if we're on HRT, but it really, really helps. And what I came to understand writing the book, which was a joy, was...The Vagi Biome, the vaginal microbiome didn't know about that. Of course we all talk about the stomach microbiome with Tim Spector and how we need probiotics and all that.
Nobody talks about the vaginal microbiome enough and 50 % of people have one! In there, there are all these bacteria and what I came to understand quite simply is the sort of good bacteria, lactobacilli, which are the kind you get in yogurt and kefir and things like that. You can also take a pill, which has that effect too, if you don't have the right lactobacilli. You need that to fight off the E. coli. I mean, when you think about it, it makes complete sense, doesn't it? We all know E. coli is bad, you know, and that's what's causing it. That's one of the things that's causing your UTI. So basically there's a war going on in your vaginal biome and if you arm your people down there with oestrogen, it helps increase the numbers of different bacteria, it makes it a sort of happy environment along with lactobacilli. I found, particularly I was missing something called lactobacilli rhamnosus and there's another one called chryspartis. There's about four different ones, but these supplements are often really good plus the oestrogen and I really don't get UTIs at all anymore. I used to be a bit of a UTI manufacturer and obviously it increases in your 40s and if you're prone to them, you're prone to them and so paying a little bit of attention to what is going on in your vagi biome and I just love it. I love that I've got a new word. I know what it does and I know I could change it which is kind of really liberating that we've just sat there and killed every piece of good bacteria with antibiotics. We don't need to do that anymore. We can maintain that healthy atmosphere down there.
Michelle
We're getting much better about talking about embarrassing body parts ‘down there’ and not using euphemisms for them so much. But when you think about it, it makes sense as you age, skin everywhere changes and gets more ‘papery’ and more wrinkled and dry. You pop a serum on your face to keep it looking more plumped up and you kind of need to do it there as well.
Kate Muir
Well, the interesting thing here is the cream increases your collagen down there and so it all gets softer and the tissue gets softer and it's better to have sex and it's less likely to crack or anything like that and cause an infection. So fantastic! We're all lovely and spongy down there - makes our life so much better. But I actually get it privately because it's nicer than the one on the NHS and it only costs me about 30 pounds every six months.
There's been quite a few studies which I do in the book about the effects of oestrogen cream on the face. This is also, let's be clear, incredibly low dose eostrogen. You don't want to put your HRT on your face, which is kind of alcohol-based hard stuff. It is the very gentle stuff. And it's really interesting to think, well, of course, if your collagen's gone down by 15 % everywhere, why not pump it up? And, you know, there's a lot of fun things here that I'm learning.
Michelle
So one last thing I wanted to say about UTIs, because I've experienced this with my mother, is that you think that the symptoms will be the itching and things like that, but what we really noticed was she went a little bit loop-the-loop. We didn't understand what she was saying. Cognitively, she just completely lost the plot and we were really worried that, my gosh, is this sort of overnight dementia? She's talking like she's on something. And I think, you know, if anybody's listening to this and perhaps you've got an elderly parent who is not looking after themselves and they become very susceptible. I think we're 30 times more likely as women than men to get a UTI, look out for that sort of incomprehension, that like they're losing the plot a bit.
Let's keep going with oestrogen because what I have learnt since I've been doing this podcast and doing a lot of research for different subjects, we have oestrogen everywhere on our bodies and you do touch on neurodivergence as we get into midlife and menopause. Often we can find that the symptoms that we didn't have before or we didn't realise because it used to be boys that were always diagnosed as having ADHD or autism. Now a lot of women in their 40s and 50s and 60s are finding that their symptoms are likely to be ADHD or even autism and that is partly to do with oestrogen, isn't it? The depletion of oestrogen is sort of magnifying those symptoms.
Kate Muir
Yes - oestrogen and progesterone and basically when that disappears, you're left with a kind of very raw you, angry you and there's a strange sort of clarity that also comes.
There's been a study out of Bournemouth University that shows that people who are already neurodivergent have really hard menopause and it can really throw them off - they’ve found ways to cope and it can really cause chaos. But I interviewed a couple of people in the book who you wouldn't necessarily say that they were working, they were doing amazing jobs, they were living their lives, but they also were having trouble and they were masking all the time and being really careful with what they did and not knowing why they would suddenly have a freak out in a crowd or bouncing from one task to the other or whatever it was.
I'm not a huge expert on neurodivergence, but they were great and I talked to a woman called Emma Heathcote James, who runs a huge organic soap company, and she could do 20 tasks at once, but she was just sort of exploding around the time of perimenopause. She got a diagnosis of ADHD and she realised that was why she was both good and bad at things is that she was jumping from task to task, but she also had that ability to hyper-focus. She had hyper-focused on her business and set it up and got her soaps into Waitrose and Sainsbury's and scaled up the business but she'd also found in her personal life, it was all really struggling. She hated taking the train to London, all sorts of things. She talks about her diagnosis and actually there's a bit of autism there too. It's not as simple. She says it's like the sort of Mac rainbow different colours, and you could be anywhere on that sort of rainbow and a bit of both.
The other person I interviewed was Rose Matthews who discovered they were autistic and also non-binary in their late 50s. And they realised why they had been in so many jobs because they were the whistleblower. They were the person who'd seen things in black and white and called it out. You know, so in a way it's a superpower, but now they realise...I need to spend a couple of hours by myself if I'm going to an event. I need to have a place to sort of decompress afterwards. I need to schedule my train journey really carefully. And by that sort of level of self care and self knowledge, they are living a better life and they are happier. It’s a real joy to see because it's just people have been explained to themselves.
Kate Muir
I think one of the things of almost all the women I talked to who are in their 40s and 50s would be carrying this huge burden and everyone had a different burden.
I think given the state of the world at this second, the idea that we will be healthy women in our fifties deciding I'm doing this for me and I'm also doing this for X people I want to help or work to work with or have a creative renaissance with but to consider ourselves and our powers, because we are magnificent, we're really experienced, we know what we're doing!
Michelle
So this is really what your book is all about, is finding that joy of the midlife crisis, that it doesn't have to be the narrative of menopause is something to fear. We're gonna hurt all over, we're gonna be miserable, we're gonna be angry, we're gonna be sad, we're gonna be anxious. There is a lot of that narrative, but we do know what we can do about that, and we do know that a healthy lifestyle, HRT if it's the right thing for you, there are so many ways that we can apply these to ourselves and allow ourselves to prioritise our self-care. So I think what you've done with this book is really cover so many kinds of things that we can do for ourselves that doesn't necessarily have to cost anything at all, but just getting in our heads and making us realise that, at the age of 40, 50, 60, we still have got decades to live. I mean, we're looking, if we keep in healthy, in a healthy body, we might be looking at hitting a hundred more frequently, But we have to age-proof ourselves, don't we?
Kate Muir
Yes - there’s a woman in the book called Aviva Wittenberg Cox, who's a kind of business expert and academic. She's written about the four quarter life. So your first quarter up to 25 is because it is growing and then your second quarter is achieving. So from 25 to 50, you're making your family, you're doing your amazing job or career, you're doing whatever and then from 50 to 75, she calls that becoming, which I really like. So you become the person you really want to be. And then from 75 onward, it's harvesting. But I love that 75, 50 to 75 block. And it might be younger for some people, you you've got to start your midlife crisis early if you can. But I think to come to that time in your life and not make a decision to think about what you want to do and how you are going to create differently, how are your relationships going to change?
You can't just sit there and kind of dwindle away. Most of us are not going to have a big pension. It's just not going to happen. So we are going to have to work in some sort of way part time, probably for a lot longer. Do we want to give up being a teacher and become a part time geologist? Do we want to go back to university? You know, it is quite an exciting time to make a very odd decision, but I really think we need to have a midlife crisis.
My friend who's in the book, who's a psychotherapist, Kalanit, she said, we've got to go to pottery classes together. I've been already, you'll love it. Everybody in midlife has a pottery class. You need it to be creative. And we went and did it for six weeks. I was by miles the worst in the class. And I ended up really, even on week six with just a little pile of mud in the middle of the wheel and the wall sprayed with stuff. And I realised I couldn't get my left hand to tell my right hand. I just couldn't do it. I totally failed that midlife kind of barrier, which was pottery. We ought to try all the things we think we might fail at too!
Michelle
We should give life a go, do the wackiest craziest things, go wild swimming, just go and do what you want, go and walk the length of England if you want to on the salt path. Do something and don't settle - and read How to Have a Magnificent Midlife Crisis by Kate Muir.
