Robyn Malcolm on menopause: ‘I remember being in a state of really profound despair’

“I remember having a screaming match – well, I was the only one screaming – at my partner. I remember being a foul mother, for a moment. I remember being in a state of really profound despair at not being able to stop weeping. I remember that.”

As anyone who saw her in 2022’s documentary You, Me and Anxiety will know Malcolm is an open and honest teller of her own story. If Menopause and Us had been simply that, it would still have been worthwhile television. But it expands beyond personal testimony into a series of fact bombs that make it compulsory viewing.

“Like Robyn, I thought I knew quite a bit,” says producer-director Rachel Currie, who reprised her partnership with Malcolm on the anxiety documentary to make this new one. “But once you really get into it, I realised I actually knew very little.”

For Currie, the big shock was discovering that the apparent risks of hormone replacement therapy (HRT), identified in the global Women’s Health Initiative study a quarter of a century ago – which led to a warning from our own Ministry of Health – are not now regarded as significant for most women.

Malcolm, whose mother had suffered a deep vein thrombosis, was seen to be in a risk group and was not prescribed HRT. Ironically, it’s her alternative treatment – unregulated “bio-identical” hormones put together by compounding pharmacists – that now looks questionable. They didn’t work, she tells the Listener’s health columnist Niki Bezzant, who assures her she was not alone: “Marketers are gonna market,” she says.

The symptoms of menopause and perimenopause, it becomes clear, are poorly understood, even by doctors. “I had no idea what was happening to my body,” Dr Linda Dear ruefully tells Malcolm. “It made me realise that if I’d missed it in me, even with all my supposed knowledge, it means I’d been missing it in so many other women, so many patients.”

The signs may not be what anyone expects. They might include, for example, the painful condition of frozen shoulder. There is also evidence that oestrogen has an antipsychotic effect, and when the body stops producing it, some women develop severe psychiatric conditions, including schizophrenia. Their symptoms can be reversed with HRT, Australian psychiatric researcher Dr Jayashri Kulkarni tells Malcolm – who understandably reflects on whether her years of clinical depression would have happened if she had been able to try HRT.

The documentary takes its lead from Malcolm’s experience, says Currie. There were other issues it did not have time to explore, including the implications for neurodivergent women (“that really qualifies for its own documentary”). Some of the solutions Malcolm explores – from weight training to mindfulness exercises – won’t suit every woman. A number of her interviews involve getting in the sea: “Robyn is quite keen on a bit of cold-water swimming.”

But Currie is pleased to have got to air a documentary she and her presenter have wanted to make for some time As well she might be: Menopause and Us has a lot to offer women entering those years, and the men in their lives.

It is, in other words, a programme everyone should watch.

Menopause and Us screens on TVNZ 1 on Monday, September 7, at 8.30pm, and TVNZ+.