When it comes to mental health, menopause gets a bad rap. It is true that women who are depressed before menopause, or who have had premenstrual or postpartum depression, sexual dysfunction, are physically inactive or who have a lot of hot flashes are at more risk for depression as they enter menopause. But women who are not dealing with any of these issues before they enter perimenopause, will overwhelmingly transition into menopause without experiencing severe problems. Still, up to 23% of women do report some mood changes, primarily during perimenopause.
Part of this has to do with how we are wired. There are gender differences between how men and women perceive emotions. Dr. Mark George of the National Institute of Mental Health performed PET scans (Positron Emission Tomography) on both male and female subjects while asking them to conjure up their saddest memory. PET scans maps the flow of blood within the areas of the brain that are active during a given time. To his surprise, the total area of women’s brains that were active during memories of strong emotion was eight times larger than the area of men’s brains.
There are other differences too. According to scientists at McGill University, serotonin production is 53% higher in men’s brains than in women’s. Serotonin is a brain chemical that is believed to be lower in people who suffer from depression and is the hormone that drugs like Prozac, categorized as selective serotonin reuptake inhibitors or SSRIs, increase in the brain. One in four women and 1 in 10 men in America will require treatment for depression at some point. Here is a tip to be aware of if you are treated with an SSRI; they are associated with loss of bone mass. So if you are on one of these medications, talk with your doctor about taking calcium and vitamin D and getting a bone density test to make sure you aren’t developing osteoporosis.
While all of this is important, none of it happens specifically because of menopause. Despite the myths and stories of “the middle-aged woman” suddenly becoming depressed or a shrew, the truth is quite to the contrary. Sure, there are mood swings, and perimenopausal women often describe PMS type symptoms. And some women clearly are more sensitive to loss of estrogen than others. But published reports on more than 13,000 perimenopausal women in Norway (Holte A. Influences of natural menopause on health complaints: A prospective study of healthy Norwegian women. Maturitas 1992;14:1127-141), Canada (Kaufert PA, Gilbert P, Tate R. The Manitoba Project: A reexamination of the link between menopause and depression. Maturitas 1992;14:143-155.) and Massachusetts (New England Research Institute, Inc. Women and Their Health in Massachusetts: Final Report. Watertown, Mass.: 1991.) did not find an increase in psychological symptoms. That doesn’t mean that a woman who is depressed before perimenopause won’t feel even sadder going through menopause, or if perimenopause is long and symptomatic, some feelings of depression won’t creep in. But how a person feels in menopause depends a lot on how she felt before it.
We are also the “sandwich generation” – sandwiched in between our children who demand and need our time and attention and our aging parents who do as well. Life is stressful without menopause and people have different coping skills. If perimenopause and menopause is creating a stressful life for you, it’s treatable. Seek the help of a therapist. Discuss the problem with your doctor. In addition to hormonal fluxes, symptoms like depression and mood swings can also be due to diet and hypoglycemia, or low blood sugar. Thyroid disease is also more common in women than in men and is affected by changing estrogen levels, diet and exercise. Both hypoglycemia and thyroid disease can have a major effect on mood and can be treated. Many women who don’t have one of these problems will find relief from lifestyle changes.
- Eat with an emphasis on a plant based diet
- Exercise daily
- Cognitive behavioral techniques that train your “self-talk” to be more positive
- Self Nurturing such as making time to get a massage or a manicure
- Meditation, yoga, tai chi, Relaxation Response or similar techniques 20 minutes daily
- Learn more about menopause so you don’t fear the unknown
- Improve sleep
Until next time,
Dr. Mache Seibel, Founder of My Menopause Magazine http://bit.ly/MyMenoMag
Professor, University of Massachusetts Medical School
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