Action on Postpartum Psychosis
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PP and the menopause

Hi all, I just want to start a post about PP and the menopause, to see if anybody on here has any knowledge or experience that they can share. I had PP 11 years ago with my first baby, and postnatal depression after my second 7 years ago. The final time I saw my perinatal psychiatrist she told me that I'd be unlikely to have another psychotic/manic episode if I had no more children, but that I could be at risk of it during the menopause. I guess that's because PP is somehow related to hormone imbalance? At the time I put that to the back of my mind, but now I'm approaching my mid 40s I worry about it a bit. It particularly concerns me because my Mum developed psychotic depression after having a hysterectomy, which I also assume may relate to hormones (although I don't think any professional ever said so.) The other thing is, an older friend enlightened me to a thing called the "perimenopause", which seems to be about hormone changes in the years leading up to menopause, and she thought that it had made her quite depressed.

It's not that I'm obsessively worried about this, but I know from planning a second child that being forewarned of my mental health risks gave me an opportunity to prepare and develop a preventative plan. Can anyone share any experience that might help me to prepare in some way? Or maybe someone knows something that will reassure me that the risk isn't as high as I'm thinking it could be?


Tracey x

10 Replies

Hello Tracey

Welcome to the team ......this is a really good post to ponder. I had PP twice in the mid 70's and early 80's which you might have read about here.

I had a hysterectomy due to fibroids in the mid 80's and made a good recovery, with help from my husband. You probably know the advice given is not to lift even a kettle when you first return home! I hope you will be reassured to know that I didn't have any mental health issues after my hysterectomy or during the menopause ...... just disturbed sleep ..... but only due to hot flushes!

Thankfully I'm in good health all these years on ...... busy at work and loving the sanctuary of home.

Good to 'meet' you here.


Hi Tracey

I have told you a bit of my story already but just wanted to respond to your post as the menopause risk is something I have been thinking about a lot lately.

I had PP in 1988 with my first child and then miraculously didn't have PP with my second child in 1993 in spite of being told that my risks of a second episode were extremely high.

Prior to my first pregnancy I had experienced several episodes of highs and lows and was depressed during this pregnancy which culminated in a premature birth at 32 weeks a trauma in itself without the added distress of PP.

I then experienced a psychosis again in my 40's in 2002 which was completely out of the blue and was followed by a very long period of depression. Several years before this, when I was suffering with extremely heavy periods I had a procedure called an endometrial resection which meant that I no longer had periods and so was totally unaware about whether my monthly cycle had become irregular. I now believe that I was in the perimenopause stage and that this is why I was ill again.

In 2002 I had a lovely consultant psychiatrist who did his very best to get me better but he wasn't a perinatal specialist and at no point did my bipolar episodes, my PP and my episode in 2002 get connected up. I believe, that this unfortunately resulted in my recovery taking a lot longer this time than it should have done.

So I guess what I'm trying to say is that forewarned is definitely forearmed and preparing a preventative plan sounds a great idea, and lets hope that you don't need it.

There was no information at all when I had PP all those years ago, and I only discovered the APP website a year ago. So, to now read the comprehensive information about the risk factors and the ways in which it can be managed for women in subsequent pregnancies has been quite an emotional experience for me.

And now that I finally understand why I was ill again in 2002, this has been the last piece of my mental health jigsaw. If only I had known all this information at the time, I could have been prepared.

I hope all goes well for you Tracey

Best wishes



Hi Tracey,

A big welcome and great to meet you on here.

I can relate to your fears about menopause, I have always been a bit uneasy about approaching the menopause since having PP.

I had PP 20 years ago and following PP I was diagnosed with Bipolar. I started on Lithium 19 years ago and remained well for 15 years until I was advised to come off the contraceptive pill wen I was 40. Since stopping the pill I have had what I think is hormonal depression. I started having very low spells following my period which were very debilitating.

It was around the time that I had a lot of other stresses such as being bullied in work by my boss. It's difficult to tell if the low spells were because of my hormones or because of the long, difficult legal battle with my ex employer.

I started a new job 17 months ago which is very intense. I continued to have depression at hormonal times every month for about three or four days. This resulted in getting behind with my work and I worked late every night and on my days off to catch up.

To cut a very long story short I wondered if HRT might stop the low spells. I spoke to my GP who agreed for me to try HRT. I am now in my mid forties and I haven't had any symptoms of the menopause but I'm at the peri menopausal stage.

I also wrote to the Professor who got me better 20 years ago to ask his advice. He suggested I try an SSRI antidepressant for two weeks a month, for the last two weeks of my cycle. I was a bit wary of taking antidepressants as 20 years ago I had a severe manic episode when on antidepressants.

Amazingly I have been so much better since taking Sertraline 50mg for two weeks of the month. I am also on HRT. I know it's early days with the new medication but before taking it I couldn't plan anything, I couldn't drive and I felt so low that I struggled to function.

The last couple of months I feel so much better and I'm looking forward to things again. I've also dropped a day in work which is helping!

I think there is a strong link with hormones and moods and I often wonder if having a hormone drip during labour may have caused problems and also my Mum had an Oestrogen deficiency. My Mum had no problems during the menopause.

Hopefully we will get through the menopause ok!

Take care and hopefully will meet soon,

Sarah x


Hi all

I don't have much to add but will be following the thread With interest.



I don't have any experience with menopause but I know that I want to be prepared eventually for that hormonal upheaval. After pp I was medicated with invega which after 6 months completely wrecked my hormones and it stopped my periods and I had to go to an endocrinologist. Since then I've looked into info about hormones. I know that food has a lot to do with keeping them balanced. I follow a lady on YouTube and periscope named Melissa Ramos- her business is called sexy food therapy and she talk all about balancing hormones and staying well. Check her out!


Tracey - Great subject. I had PP with my second son, but no issues in my first or third childbirth. My PP was due to sleep deprivation and the stress of having a preemie when my husband was overseas in the Air Force.

I did have a lot of issues with sleep disturbance when I went through menopause. I was also having a lot of stress at the time. It helped a lot to keep the bedroom cool and use a ceiling fan for white noise. I'm a firm believer in various natural methods to maintain mental health. That includes daily exercise, sensible eating, and enjoying relaxing time in nature. I also start the day with a spiritual meditation.

A lot of women have sleep disturbances during menopause. You will probably be more vulnerable, but don't be afraid. Just take it one day at a time and you will get through it.


Hello Tracey,

Like you, I am getting that amber warning light. I do appreciate your concerns, being in a similar situation. I remember being warned to watch my stress levels prior to the menopause. With my PP, it came out of the blue with my firstborn. Luckily, I have had no relapses and now have two children. The risk of childbirth as a trigger is no longer there, but now I am aware that I need to watch for signs. I think that awareness is key. My loose plan is to limit stress. Be kind to myself (or try!). Reflexology helped to rebalance my hormones in the past. I will also not be reticent to visit my GP if I get any indications that my body/mind are overreacting. I have already made them aware of my situation (having moved since PP), so they have my history in their notes. I was told that sleep is key; so thinking of practical solutions to achieving that, and cat napping when I can. I am quite determined to avoid medication if at all possible.

I am hoping that someone might like to study this time of life in more depth (following women with experience of PP). If there is anyone out there who needs a suggestion for doctoral research, this could be a worthwhile subject.

Take care,



Hi Tracey, what an interesting question...

I know from having had PP with my 1st child and not with my 2nd, I may be at risk when I get to menopause if it's the hormones to watch. It would be great to have more research and info out there. In the meantime, I'll be reading others' experiences and filing them away for future use I think.

Take care, xx


Thanks for all the replies - so interesting to see from your experiences the very obvious impact of hormone changes on mental health, yet it seems such a poorly researched area. Hopefully that will change and improve. I was advised not to use any form of hormonal based contraception after PP so I never have, but my natural cycles have me anxious with poor sleep for a few days each month. I do notice that exercise and a healthy diet can improve that though. Recently I've also been doing mindfulness practice, which I found tricky to get used to at first but do feel it really soothes and calms my mind now. I totally agree that minimising life stress where possible is important too, especially making careful choices about pressured work roles and how many hours to work. I've made the mistake of getting that wrong in recent years, and have paid the price with high anxiety and low mood. I'm making changes in that now though as I've realised that for me the mental health risks are too high.

I'm just noticing as I type this how much this conversation has helped me by reminding me that there are lots of ways that the coping strategies I already know wIll be the mainstays of my prevention plan for menopause. So despite being told there's a risk I can take a lot of control over that rather than just waiting and dreading what may happen. Thanks so much - I feel better about it already! And I know that if it doesn't go well a few of us might be in it together on here for lots of peer support.

Tracey x


Thanks for this. I'll be following this post with interest. I too am 43 so approaching 'that age' lol. I had PP 18 years ago. I am terrible for a few days a month but then I always have been! In my 20's though it used to be more like two weeks out of four. I truly felt like Jeckle n Hyde.

These days it's much more brief but still debilitating. My meds are - Venlafaxine (daily) which I have been on since my PP; and Lithium which I've been on for 8 years since my third and youngest was born. Lithium really has worked for me. I think partly because I was diagnosed as Bi-Polar. Goodness knows why they didn't prescribe it years earlier for me and do us all a favour!

I'm very interested in the treatment Sarah mentioned where her Professor recommended of using an SSRI for just the two weeks prior to your period. This interests me as it is the recommended treatment for Premenstrual Dysphoric Disorder. This is what I suffered from before I had my first child but no doctor picked up on it or treated it despite numerous appointments with me desperate for some help. I don't think it was heard of back then and doctors are only just beginning to treat it.

Good luck everyone in their 40's & 50's who all have concerns along these lines. I'm most thankful we have this forum where we can glean advice from each other and approach doctors/consultants armed with as much information as possible.


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