I decided to ask my Twitter and Facebook followers if there was a mental health topic they felt wasn’t talked about enough, and what I could do to change that. This article is the response to the Facebook request based on the suggestion by Allison Holland to look into the menopause and its effects on mental health.
One of the reasons I was happy to take on this subject as a man, was because it wasn’t something I was taught at school. What I know about the menopause has come from the women in my family and the documentaries I’ve watched. Such documentaries and QI gave me random knowledge like, only humans, Short-finned Pilot Whales, and Orcas go through the menopause. Now you know that too.
As a result of my lack of education on the subject, I asked Twitter if they’d be taught it at school, and it seems none of them had been either. It seems strange that the menopause isn’t taught as part of sex education when about half the population will go through it and we’ll all know lots of people who’ll experience it.
What Is The Menopause?
For those of you who don’t know, the menopause is a significant biological event that will occur in the life of every woman who experiences the menstrual cycle, and that includes women with mental health issues (Sajatovic, Rosenthal, Plax, Meyer, and Bingham, 2003).
The menopause is the time in every woman’s life, 12 months after their last period (National Insitute of Aging), with their ovaries losing their reproductive function. Typical, the menopause occurs between the ages of 45-55 (NHS). However, in some rare cases, women may experience premature menopause in their 30s or younger (Women’s Health Concern).
The following is a list of possible symptoms that you could experience while going through the menopause, which, according to the NHS, should only last a few years. I’m not sure if that’s helpful to hear or not. Anyway, menopause induced depression and menopause induced anxiety, as well as the other symptoms, are a relatively short-term problem. Again, I’m not sure if that’s helpful or not.
- Hot flashes (Avis, Crawford, and Green, 2018; Dennerstein, Dudley, Hopper, Guthrie, and Burger, 2000; and NHS).
- Low-mood (NHS).
- Vaginal dryness ((Dennerstein, Dudley, Hopper, Guthrie, and Burger, 2000; and NHS).
- Reduced sex drive (NHS).
- Night sweats (Avis, Crawford, and Green, 2018; and NHS).
- Breast tenderness (Dennerstein, Dudley, Hopper, Guthrie, and Burger, 2000).
- Problems with concentration and memory (NHS).
- Anxiety (NHS).
- Insomnia (Dennerstein, Dudley, Hopper, Guthrie, and Burger, 2000).
Menopause And Mental Health
Menopausal women undergo significant biological and psychological changes, including a decrease in estrogen levels, which some studies have linked to depressive symptoms (Kim, 2020). As a result, many women might experience detriments to their mental health during their menopausal transition (Elavsky and McAuley, 2007).
According to Freeman (2015), changes in menstrual bleeding patterns signal the approach of menopause in mid-life women. With this impending change, many women report hot flashes, sleep disturbance, depression, and other symptoms along with these menstrual changes.
A study by Kim (2020) sort to assess the effects of the menopause on feelings of depression. The study was conducted on 644 premenopausal women and 459 women who were menopausal from Korea, aged between 40–60. The study found that women who were experiencing the menopause had far greater depressive symptoms than those who hadn’t started the menopause, at a rate of 2-3 times higher than premenopausal women.
This is supported by a study conducted by Freeman, Sammel, Lin, and Nelson (2006), who conducted an eight-year longitudinal study on 436 American women to investigate the risk factors of depression during the menopause who had no previous history of depression. The results of the study found that that menopausal women were four times more likely to experience depression than their premenopausal selves.
Therefore, if you take Freeman, Sammel, Lin, and Nelson (2006) and Kim (2020) studies together, there is a strong causal link between starting the menopausal transition and the risk of experiencing some form of depressive symptoms.
However, according to Bromberger et al. (2007), controversy exists over if the menopausal transition is a risk factor for depression and that even if it is, women may vary in their vulnerability. The latter part of what they claim makes sense as individual differences are always a factor in mental health, and often health as well.
However, again, the longitudinal observational study (evaluated annually from 1995 through 2002) by Bromberger et al. (2007) on 3302 African American, European Americans, Chinese, Japanese, and Hispanic women, aged 42-52 added support to the increased risk of depression. The study found that the start of the menopause came with an increased risk of high depressive symptoms which would remain elevated through the early stage of the menopause.
According to the study by Sajatovic, Rosenthal, Plax, Meyer, and Bingham (2003), 30% of women who have a mental health issue perceived their symptoms to be made worse by the menopause. However, that also means 70% of women with preexisting mental health issues didn’t perceive their mental health to be made worse from being menopausal. It all depends on how you choose to look at it.
The problem with the menopause and its link to depression are that it’s hard to untangle if the hormonal change is the cause or if it’s a result of the other physical symptoms of the menopause that cause it, such as hot flushes and insomnia (Freeman, 2015). The point made by Freeman (2015) on the cause of the depressive symptoms is a good point to make because if you’re experiencing the discomfort of hot flushes, sleep disturbance, and all the other physical symptoms women have to live with while going through the menopause, then it’s likely to have an effect on their mental health. This effect would be relevant for knowing how to treat the mental health of women going through the menopause.
Although depressive symptoms seem to be fairly common with the onset of the menopause, I struggled to find studies into anxiety being caused by the menopause. Therefore, we have to make do with what The North American Menopause Society (NAMS) says on their website for now. According to NAMS, few scientific studies support the idea that menopause contributes to anxiety, even though some women report such symptoms. However, I guess feeling like that is likely with such a change in life as it’s also an indicator of mortality.
Thus, could it be possible that the anxiety some menopausal women feel is related to their death anxiety and not as a direct consequence of the menopause itself?
How To Mitigate The Mental Health Effects Of The Menopause
Hormone replacement therapy (HRT)
This option pretty much does what it says on the tin, it’s a treatment that pumps up the hormones in your body as the menopause causes those levels to decline. However, there are risks with HRT, with some types being linked to breast cancer, according to the NHS.
A study by Elavsky and McAuley (2007) looked to see if exercise could be used to help manage the mental health side-effects of going through menopause. The study was a four-month randomized controlled exercise trial on 164 previously low-active middle-aged women participants aged between 42–58 and who were experiencing menopause. The results indicated that physical activity enhanced the participants’ moods and improved menopause-related quality of life. However, it should also be noted that the other mental health benefits may be as a result of a reduction in menopausal symptoms, rather than as a direct result of exercising.
Hot flush tips
According to the NHS, women can start to experience hot flushes before they have their last period, with most women only having the occasional hot flush that doesn’t really bother them. However, for some women, they can be disruptive, uncomfortable, and embarrassing.
- Reduce or cut out coffee and tea.
- Quit smoking.
- Keep your rooms room cool and use a fan (electric or handheld) if necessary.
- Spray water on your face (I had to do this to help avoid heatstroke during a heatwave, it can be quite effective).
- Use a cold gel pack (available from pharmacies).
- Wear loose layers of light cotton or silk clothes.
- Instead of a duvet, have layers of sheets on the bed as this will allow you to remove them as need.
- Drink less alcohol.
- Sip a cold drink.
- Avoid hot showers/baths.
Go talk to your doctor, that’s what they’re there for. You could even seek out support groups or talk to women around your age and older, because as I’ve stated in this article, pretty much every woman will have experience of this once they’ve reached a certain age.
As always, leave your feedback in the comments section below. Also, feel free to share your experiences of going through the menopause and any advice you have on dealing with it in the comments section below as well. If you want to stay up-to-date with my blog, then sign up for my newsletter below. Alternatively, get push notifications of new articles by clicking the red bell icon in the bottom right corner.
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Unwanted Life readers.
Avis, N. E., Crawford, S. L., & Green, R. (2018). Vasomotor Symptoms Across the Menopause Transition: Differences Among Women. Obstetrics and Gynecology Clinics of North America, 45(4), 629–640. Retrieved from https://doi.org/10.1016/j.ogc.2018.07.005 and https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6226273.
Bromberger, J. T., Matthews, K. A., Schott, L. L., Brockwell, S., Avis, N. E., Kravitz, H. M., Everson-Rose, S. A., Gold, E. B., Sowers, M., & Randolph, J. F., Jr (2007). Depressive symptoms during the menopausal transition: the Study of Women’s Health Across the Nation (SWAN). Journal of Affective Disorders, 103(1-3), 267–272. Retrieved from https://doi.org/10.1016/j.jad.2007.01.034 and https://pubmed.ncbi.nlm.nih.gov/17331589.
Dennerstein, L., Dudley, E. C., Hopper, J. L., Guthrie, J. R., & Burger, H. G. (2000). A prospective population-based study of menopausal symptoms. Obstetrics and Gynecology, 96(3), 351–358. Retrieved from https://doi.org/10.1016/s0029-7844(00)00930-3.
Elavsky, S., & McAuley, E. (2007). Physical activity and mental health outcomes during menopause: A randomized controlled trial. Annals of Behavioral Medicine, 33(2), 132–142. Retrieved from https://doi.org/10.1007/BF02879894 and https://www.researchgate.net/publication/6380732_Physical_activity_and_metal_health_outcomes_during_menopause_A_randomized_controlled_trial.
Freeman, E. W., Sammel, M.D., Lin, H., & Nelson, D. B. (2006). Associations of Hormones and Menopausal Status With Depressed Mood in Women With No History of Depression. Archives Of General Psychiatry, 63(4), 375–382. Retrieved from https://jamanetwork.com/journals/jamapsychiatry/fullarticle/209523.
Freeman, E.W. (2015). Depression in the menopause transition: risks in the changing hormone milieu as observed in the general population. Women’s Midlife Health, 1(2). Retrieved from https://doi.org/10.1186/s40695-015-0002-y.
Kim, K. (2020). Identifying the Factors That Affect Depressive Symptoms in Middle-Aged Menopausal Women: A Nationwide Study in Korea. International Journal of Environmental Research and Public Health, 17(22), 8505. Retrieved from https://doi.org/10.3390/ijerph17228505 and https://www.mdpi.com/1660-4601/17/22/8505/pdf (this link will download the study as a PDF).
Sajatovic, M., Rosenthal, M. B., Plax, M. S., Meyer, M. L., & Bingham, C. R. (2003). Mental illness and menopause: a patient and family perspective. The Journal of Gender-specific Medicine, 6(2), 31–34. Retrieved from http://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.627.8944&rep=rep1&type=pdf.
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