Women, Menopause & Mental Health

We have many definitive turning points in our life. Some are better than others, and the rest are just a new adventure with new ups and downs. Childhood, puberty and adulthood, come with great moments and sad ones, forever engraved in our memories. Lots of these moments were all thanks to our hormones. Fluctuations in hormones can be focal to endings and new beginnings. These fluctuations can come about physiologically like in puberty or pathologically.

In this article, we will be dealing only with one concept of physiological hormonal fluctuation called menopause.

Menopause comes sooner or later for all women, just like puberty or gray hair. It’s a natural occurrence that happens around at the age of 50, (just like menarche first period starts around at the age of 13). Strictly speaking menopause in the medical community is the cessation of the menstrual cycle, but it can only be recognized as menopause after 12 months have passed since the last period. I would like to mention three other words that will be useful, PRE-menopause, PERI-menopause and POST-menopause. Peri-menopause is of outmost interest since it’s the transition time where hormones start fluctuating, menstrual cycles become irregular, fertility decreases and all the known symptoms of menopause come about.(Pre & Post menopause are self-explanatory and are not very relevant in this article)

Most articles and conversations in everyday life use the word menopause when perimenopause should be used instead. Perimenopause is essentially the time period that leads up to menopause and usually lasts around 7 years (but can also last up to 14 years). No matter the duration of perimenopause, symptoms like hot flushes and changes in menstrual cycle are not pleasant. Menopause is only a focal point in time, the transition (perimenopause) towards it though takes a toll on mental health. I’m sure you know someone that has been through this, and that person seemed anxious, depressed, mad, among many other emotions. It must be the hormones right? Well, not really according to the most recent evidenced-based studies.

Myriads of studies have been done since the 1960’s, but only the most recent ones are more indicative. To take precise data on the matter means studying a woman since menarche, over a span of around 37 years till menopause. The best studies have taken into consideration hormonal fluctuations, menstrual cycles, ethnicity, daily habits, susceptibility to mental health disorders and many more. We must also take into account the fact that a study that started in 1990, for example, must have more corrupt data than a study that started in 2000. This is due to advancement in technology, methods and breakthroughs in various fields. There was a time where psychologists/psychiatrists couldn’t differentiate between depression and bipolar disorder. As I mentioned above, the most recent studies show that there is no evidence of the hormones being the cause of depression, anxiety, bipolar disorder or any other mental health problems you have heard that were supposedly caused by menopause.( There are few studies that say the opposite, but lets not get deep into statistics) 

Without doubt everyone has heard of the menstrual cycle and the cocktail of hormones that come with it. The cocktail coordinates various parts of the body but especially follicles and oocytes. Putting it in a very simple way, the body needs to solve this riddle, “should I prepare for pregnancy?Are my eggs fertilized?”. The answer is always yes or no, and the messengers that carry the answer from egg to the rest of the body are hormones. This continues as an endless loop, each part involved gets feedback and sends its own information back, directly or indirectly. In the case of menopause though we should only talk about GnRH, FSH, LH, estrogen, progesterone, inhibin B and AMH. These “messengers” get their message through, not only through numbers (i.e., their blood concentration) but also with their relative concentration to the other hormones. Therefore, it’s not correct to say, “it is because of X hormone increase/decrease”, but it is more correct to compare the ratios of hormone X, Y and Z. Different outcomes come with each combination and ratio, hence the above mentioned characterization of a cocktail.

Ask your bartender to choose 7 liquids (hormones), and make 3 different drinks, one to be named Pregnancy, the other Menstruating and the other Menopause.

Do you think he can do it? Well, your amazing body can.

Why it takes around 50 years of a womans’ life to get this bitter-sweet cocktail?

The answer is simple, women are born with a certain amount of “eggs”, thus after years of releasing the eggs during the menstrual cycle, this number is depleted. Because of this depletion we lose a big “supplier” of estrogen, called the follicle. Wrongfully over the years people used to assume that the anxiety, depression, moodand irritability was caused by the low estrogen levels. Low estrogen is the cause of many symptoms, among them are the hot flashes (with sweats then chills), osteoporosis, fat gain around the trunk, breast changes, urogenital changes, increase of cardiovascular problems, skin changes, and more. Estrogen with progesterone happen to also be an important neuroprotector, thus the correlation with mental health problems; Research shows that the lack of these two hormones is what causes “brain fog” and nothing more.

“Now imagine for a few years, you get the sudden surge a few times a day of feeling hot then cold then hot again, and that feeling goes on for a couple of minutes each time. That is an outlining of what hot flashes feel like. People that have never went through menopause, get irritated just by sitting in a car on a hot summer day, and that irritation doesn’t go away till the A/C gets cold enough to satisfy our needs. Now imagine having that every day, for years, and it also comes out of nowhere. Additionally, you see your body changing, and you’ve been told you can’t have children anymore plus intercourse won’t be enjoyable. I repeat, this is not once every now and then, this is for years before menopause, and it lingers in our minds till that time comes. Even when the last menstruation comes, nobody is sure if it’s the last or not. So many questions and doubts, so much uncertainty”.

Stress has an effect on our mental health in the long term. Thinking about everything our body will go through, for years on end, is too much when it’s accompanied with negativity. Menopause is a natural process, not a disease. Menopause is a hallway with infinite doors that open up to new hobbies and ways of life. The only reason we get depressive symptoms is because we keep emotions and thoughts bottled up instead of discussing with the right people. If you’re transitioning towards menopause or already went through it, seek help from a professional.   

To sum up, I want you to think of every time you saw something new happening to your body. Firstly, period, the use of a tampon or serviette, first time having intercourse, first kiss, first time riding a bike without training wheels, think of all the times you overthought things, you got stressed but you still persevered. You planned and adapted. At the same time you always had help, you always had someone to ask for advice. Menopause is a bit different in this aspect, it’s tough to ask for advice but you can talk about what you’re going through more often with friends and family, and if you still feel overwhelmed seek help from a professional.

Research supports that physical exercise, healthy eating and be outdoors are one way to keep our body safe from ageing, but relieving our thoughts from stressful ideations are just as important, if not more important.

You’ve dealt with body changes before and you will deal with this one again.

Best,
Elena Aristodemou

REFERENCES:

1. Mood and Menopause: Findings from the Study of Women’s Health Across the Nation (SWAN) over ten years. Joyce T. Bromberger, PhD and Howard M. Kravitz, DO, MPH.
2. Menopause:  Susan R Davis, Irene Lambrinoudaki, Maryann Lumsden, Gita D Mishra, Lubna Pal, Margaret Rees, Nanette Santoro, Tommaso Simoncini. 2015 Apr 23;1:15004. doi: 10.1038/nrdp.2015.4.
3. Depression and midlife: are we overpathologising the menopause? Fiona K Judd, Martha Hickey, Christina Bryant. 2012 Feb;136(3):199-211. doi: 10.1016/j.jad.2010.12.010.
4. Influence of menopause on mood: a systematic review of cohort studies. K K Vesco, E M Haney, L Humphrey, R Fu, H D Nelson. 2007 Dec;10(6):448-65. doi: 10.1080/13697130701611267.
 
 

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