Women are accurately forecasting their menopause symptoms from how their bodies have responded to hormonal nosedives in the past and postnatal depression could be the clearest marker yet.

By mid-next year, there will be 1 billion women going through menopause globally. That’s almost a full China of women. Ahead of that, there are hordes of women waiting in the wings, teetering on the edge of perimenopause, panicking. The human brain likes pattern and is programmed to identify and utilize past experience to guide us through the next, that’s why uncertainty causes us to readily fill in the blanks and enter full-catastrophizing mode. But now global research studies show that you can reliably predict your menopause based on postnatal depression.

“There is strong scientific evidence to suggest that women who suffer from postnatal depression are far more likely to experience a difficult menopause,” says Consultant Obstetrician and Gynaecologist, Kevin Harrington at The Portland Hospital. “Hormonal levels drop around periods and again after childbirth but the women who’ve suffered during those events are significantly more likely to have a severe reaction to hormonal decline in menopause.”

Indeed, there’s a weight of medical research that proves there’s a subgroup of women who are particularly sensitive to reproductive life events and major hormonal fluctuations trigger mood illness episodes throughout their lifespan. “Women who had postpartum depression or have always had significant mood changes premenstrually are going to be at risk of having more symptoms,” confirms Jennifer Payne, expert in reproductive psychiatry directing the Women’s Mood Disorders Center at Johns Hopkins University.

One Danish nationwide study of 270,613 individuals analyzed the association between postpartum depression and depression during perimenopause. Postpartum depression was associated with 12.82 times higher hazard of depression during perimenopause. The study also concluded that prior depression, no matter the timing, is associated with markedly higher risk of depression during perimenopause.

This means it is entirely possible to predict the manner of menopause you might encounter. You’re already well-acquainted with your hormones. you’ve been dealing with them your entire life and every day of that journey, they’ve been gently recalibrating. Puberty, menstruation and childbirth are all headline hormonal life events when the delicate endocrine interplay transforms into giant leaps and dives. Investigating your experience of those events, serves as a reliable road map of how your body will weather the menopause. For instance, if you’ve previously suffered from severe PMS or postnatal depression, your symptoms can translate into similar symptoms during the perimenopause.

Harrington is keen to point out that the opposite is also true, so if you’re someone who never had your life interrupted by a period and fared pretty well after babies, there’s an overwhelming likelihood that you’ll sail through menopause, or something close to it.

“There are plenty of women who don’t notice any symptoms during menopause or even realize they’re in it and that’s down to genetic make-up and personality.”

No matter your checkered hormonal history, point number one on the ‘How To Have Good Menopause’ brochure needs to be individualized care. “The idea that one size fits all to manage menopause is completely wrong,” says Dr Harrington. “Menopause is totally individual and we must take a ‘needs first’ approach. How a woman is being affected by menopause, is the first question.”

As with all healthcare, the future of menopause is personalization. No more blanket statements, diagnosis by ethnicity or age bracket - it’s time to get full-blown forensic with menopause. Harrington says this starts by trusting yourself and being proactive, “Being able to function, to continue to be just as busy and capable is the priority for women in their fifties. They’re not retiring, they’re still dynamic, and many still have young children. Don’t wait for hot flushes, you know when something’s up and you don’t feel right. Be it insomnia, lethargy or a general lack of focus, go see your gynecologist.”

Blood tests give more of the picture, though results can differ depending if you menstruated that month and hormone screening of estrogen levels can be a good check to start you on the right treatment plan. And there are endless forms of treatment with sprays, gels, implants, tablets, the intrauterine coil and vaginal pessaries all offering varying levels of estrogen.

“Don’t be upset if HRT doesn’t work the first time, it can take trial and error over months and years to see what works,” says Harrington.

“Non-oral HRT is very much in vogue right now and my London patients love gels and patches. However, Middle Eastern women often dislike patches because as soon as they get too hot, they fall off. They prefer tablets that can be kept in the fridge when it’s 100 degrees outside. What matters most though, is what suits you and doing the job.”

Even if you don’t have symptoms, Harrington advises a low dose estrogen vaginal pessary such as Vagifem, makes a huge difference to the health of the pelvis. “It comes with an applicator so it’s not messy and you only need do it twice per week to deliver enough estrogen to keep you in shape.”

Whichever camp you fall into, there is comfort to be had in knowing that this is the same body on a continuation of its journey, and to some degree you’ve been here before.

We are not all predestined to have a dreadful menopause, though if you are someone likely to experience the full dumpster fire of menopause symptoms, knowledge is power and offers opportunity for preparation. Whatever it looks like, it’s entirely your menopause.