UNDERSTANDING PERIMENOPAUSE PSYCHOSIS THROUGH FIONA WEAVER’S JOURNEY

"Before the perimenopausal symptoms began, I was living my dream life—no mental health history, a thriving business, and a wonderful family. But when I hit 35, everything changed..."

Fiona Weaver, a women’s adventure community leader and founder of Wild Island Women, shares her journey through perimenopause psychosis, a little-known mental health condition affecting women during midlife. In this blog, we dive into Fiona's story to shed light on her journey with perimenopause psychosis and provide a deeper understanding of this complex issue.

FIONA WEAVER'S PERIMENOPAUSE JOURNEY

When Fiona Weaver first noticed changes in her mental health, she wasn’t thinking about perimenopause. An adventurer and the founder of Wild Island Women, a community encouraging women to break through barriers and embrace the outdoors, Fiona had spent her life pushing physical and mental boundaries. But like many women, Fiona was unaware that her sudden mental health challenges could be related to perimenopause - a phase of life often associated with hot flashes and irregular periods, but rarely with serious psychiatric symptoms.

Perimenopause psychosis is a rare but significant condition that can have a profound impact on a woman's mental health.

WHAT IS PERIMENOPAUSE PSYCHOSIS?

Psychosis is a set of symptoms such as hallucinations, disorganised thinking, and/or delusions that can be triggered for a variety of reasons. Also termed menopause-associated psychosis (MAP), perimenopause psychosis is a severe mental health condition that may be triggered during the significant hormonal transition of perimenopause.

Perimenopause psychosis is typically characterised by hallucinations, delusions, paranoia, psychotic states, and severe mood swings. Unlike the more commonly recognised symptoms of perimenopause, such as hot flashes and menstrual irregularities, psychosis can be frightening and disorienting.

MAP is a term some researchers use to describe severe psychiatric symptoms triggered by hormonal changes during menopause. While not yet a universally recognised diagnosis, MAP can encompass conditions such as late-onset schizophrenia and schizoaffective disorder, highlighting the need for awareness of these potential risks.

WHY DOES PERIMENOPAUSE PSYCHOSIS OCCUR?

A particularity of psychosis in women often occurs during periods of estrogen withdrawal, such as postpartum and menopause. Changes in your brain’s chemistry occur during major life transitions like puberty, pregnancy/post-partum, and peri/menopause. The hormonal transitions can predispose you to developing a new psychotic disorder.

During perimenopause, the body undergoes significant hormonal changes, particularly in levels of estrogen and progesterone. These hormones play a critical role not only in reproductive health but also in brain function. Estrogen is very protective of the brain and cognitive function.

When estrogen levels drop or fluctuate, it can lead to increased vulnerability to mood disorders and, in some cases, psychosis. This is because estrogen modulates the levels of serotonin and dopamine — neurotransmitters that are directly involved in mood regulation and psychotic symptoms.

As these hormone levels fluctuate, some women may experience changes in mental health. The sudden and dramatic changes in hormone levels can trigger a range of psychiatric symptoms, which are sometimes diagnosed as bipolar disorder, schizophrenia, or other mental health conditions.

Other factors relevant to midlife, such as increased life stressors (EG changes in work, health and illness, marital status), also contribute to increased risk for psychosis. Genetics, drug use, infections, medications, thyroid disease, and even iron deficiency (because of its impact on the body’s ability to make neurotransmitters) may also play a role.

FIONA'S JOURNEY THROUGH PERIMENOPAUSE PSYCHOSIS

EARLY SYMPTOMS AND MISDIAGNOSES:

For Fiona, the early signs of perimenopause were subtle yet impactful. “I started noticing changes around age 35 - my periods became heavier, and I was more irritable and tired than usual,” she recalls.

Initially, these symptoms, especially the heavy bleeding, were dismissed by Fiona’s doctor, despite frequent visits that something wasn’t right. Like many women, she was told she was too young for perimenopause, leaving her without a proper diagnosis or understanding of what was happening. Finally, with some data of how much blood she was losing each month, Fiona was referred to a gynaecologist for her heavy bleeding symptoms to be addressed. Fibroids and adenomysosis were diagnosed, and Fiona had the fibroids removed.

Around this time, Fiona experienced what she now knows was a period of hypermania, followed by hypomania. “I started waking up at about 2 or 3 o'clock in the morning and then not being able to get back to sleep. So that's kind of where it started with me was the sleep. And then it really started with irritability. And I was experiencing like a lot more rage. I was a very passionate person around politics and environment and the patriarchy and all those things. I got even more intense, to the point where even my husband said on tours, it was becoming a little bit uncomfortable. I couldn't really rein myself in, I had no filter. And again, like it happened over time, not straight away. The poor sleep really did exacerbate everything and then really started to quicken things up. And then, so it kind of just got worse and worse.”

ESCALATION TO PSYCHOSIS:

By the time Fiona reached her early 40s, in October 2022, her symptoms had intensified again, and she moved into hypermania. “I started having severe anxiety, trouble sleeping, and episodes of rage,” she shares. These symptoms eventually culminated in a full-blown psychotic episode.

Fiona says, “It's not until I go back and just really think about where it started and when I first had the symptoms and what they were, and it looked like having a psychosis or a psychotic episode just came out of the blue for me. But now that I'm learning more about it and seeing more psychiatrists and things like that, I definitely know that there are signs and symptoms of these things earlier.”

Fiona’s story highlights the importance of recognising the impact that fluctuating estrogen levels may be having on your mental health earlier. Many care providers may not associate these severe mental health symptoms with hormonal changes, leading to delays in appropriate treatment.

Fortunately Fiona’s psychiatrist had awareness in the impact estrogen can have on mental health, and suggested hormone therapy for her, alongside the psychiatric medications.

NAVIGATING PERIMENOPAUSE PSYCHOSIS – WHAT YOU NEED TO KNOW

RECOGNISING THE SYMPTOMS EARLY:

Early recognition of mental health issues, especially the potential for development of a schizophrenic or psychosis is crucial for effective management. Women should be aware of the signs and symptoms, which can include severe mood swings, hallucinations, delusions, and paranoia. Keeping track of these symptoms, along with menstrual changes, can help in seeking timely medical advice. Fiona advises, “Keeping a symptom diary was a game-changer for me. It allowed me to present concrete data to my doctor, which finally led to the right diagnosis and treatment.”

ADVOCACY FOR HOLISTIC AND COMPREHENSIVE CARE:

Fiona’s journey underscores the importance of a holistic approach to treating mental health in perimenopause, and particularly psychosis. After her initial diagnosis, she was referred to a psychiatrist who had an interest in the impact of women’s hormones on their mental health. A collaboration between her psychiatric and gynecological care providers has led to a comprehensive treatment plan that includes both hormonal therapy and psychiatric support.

“It was a relief to find a team that understood the interconnectedness of my symptoms and treated me as a whole person, not just a set of symptoms,” Fiona reflects.

SUPPORT SYSTEMS AND RESOURCES:

In addition to medical treatment, Fiona emphasises the importance of support systems. Her involvement in the Wild Island Women community provided her with a space to share her experiences and receive support from others going through similar challenges. “The community was a lifeline for me. Knowing I wasn’t alone made a world of difference,” Fiona says. For women experiencing similar symptoms, joining a support group or seeking community resources can provide much-needed emotional and practical support.

FIONA'S MESSAGE TO OTHER WOMEN

Fiona’s story is a powerful reminder that (unfortunately) women must be advocates for their own health. She encourages women to educate themselves about perimenopause and its potential impact on mental health. “Don’t accept dismissal from healthcare providers. Trust your instincts and keep pushing for answers,” Fiona advises. By sharing her journey, she hopes to inspire other women to speak openly about their experiences and seek the help they need.

CONCLUSION:

Perimenopause psychosis is a challenging and often misunderstood condition, but with the right knowledge and support, it can be managed effectively. Fiona’s journey through misdiagnosis, confusion, and eventual understanding highlights the importance of awareness, advocacy, and a holistic approach to care.

If you or someone you know is experiencing symptoms like those described here, reach out to a healthcare professional familiar with hormonal health and mental well-being. Don’t hesitate to seek a second opinion or request a referral to a specialist who understands the nuances of perimenopause and menopause.

ABOUT FIONA WEAVER:

Fiona Weaver is an adventurer, entrepreneur, writer, and speaker. In 2003, after a stint in the corporate world, she rejected the acceptable path of formal education to pursue a life of travel and adventure. Nowadays, she lives with her husband in a sustainable cabin on a permaculture property on the outskirts of Mount Field National Park in Tasmania’s Derwent Valley. She juggles curating adventures for others in her tourism business while creating space in her calendar to dedicate time to new projects and her own adventurous pursuits.

While facilitating adventures for over 10 years, Fiona noticed that most women need a little extra support before signing up and trying a new outdoor activity, and there are still barriers that prevent women from feeling comfortable in the outdoors. In 2016, Fiona began Wild Island Women, an adventure community supporting women to break through the financial, cultural, mental, and physical barriers that hold them back from living their dream life.

Join her community on Facebook here.