Menopause marks a milestone in a woman’s life. This usually occurs in her fifties and it is defined as not having her periods for 12 months. The years leading up to this is called perimenopause. During this period of transition, a woman may experience hot flashes, night sweats, vaginal dryness, lowered sex drive, poor sleep and mood swings.
Whilst minor mood swings may be common during menopause, depression is not. If the low mood or irritability is sustained for more than two weeks and it affects her daily activities, then it is likely that she is suffering from a clinical depression.
Research has found that up to 20 per cent of women with perimenopause suffer from depression of varying severity.
Signs and symptoms of depression:
- Low mood
- Loss of interest
- Negative thoughts
- Poor sleep
- Loss of appetite, loss of weight
- Excessive self-blame and even suicidal thoughts
A significant proportion of women with perimenopause also suffer from anxiety symptoms.
Signs and symptoms of anxiety:
- Excessive worry
- Feeling tensed
- Poor sleep
- Panic attacks – episodes of breathlessness, palpitation, tremors
For some women, they are confronted by the issues of ageing and may feel sad and insecure.
What causes the perimenopausal mood swings?
It is often an interplay of many factors, rather than just hormonal factors alone. Otherwise, every woman would experience depression as she transitions to menopause.
Hormones. Oestrogen is protective of our mood state, by interacting with brain pathways that affect our mood. So, with dropping oestrogen levels seen in perimenopause, mood changes can develop. This also explains why when eventually oestrogen levels plateau at a stable low state after menopause, women tend to experience an improvement in their symptoms.
Physical perimenopausal symptoms. Some women find the hot flashes and night sweats distressing which disrupt their sleep and in turn affect their mood.
Psychological issues. Menopause marks the end of a woman’s reproductive cycle. For some women, they are confronted by the issues of ageing and may feel sad and insecure.
Social. Women may be faced with ‘mid-life’ changes. For the married women who had focused her life on her children, now find that her children have grown up and spend less time at home or have left the home. This is especially difficult for those who have grown estranged from their husbands.
For the single women, they may be faced with fear of growing old and loneliness. For the career women, stress may also come from changes in the workplace that may coincide with perimenopause – a younger boss or retrenchment.
When to seek help?
You should see your doctor if your mood swings are sustained for more than two weeks and it affects your day to day functioning.
How do we manage the menopausal depression and anxiety?
Medication. With the recent concerns about hormone replacement therapy, antidepressants are recommended as first line for the treatment of menopausal depression. Antidepressants which act on the serotonin pathway such as Sertraline, Fluvoxamine, Paroxetine and Escitalopram are recommended. Other medications that are helpful include Mirtazepine and Venlafaxine. These medications also have an anti-anxiety effect and are used in treating anxiety. Recent research studies have also shown that Escitalopram may improve the hot flashes.
Therapy. Psychotherapy or counselling may help the individual understand herself better and hence make changes to the negative thinking and mindset. Marital and family therapy may be helpful if there are problems with the marriage or conflicts in the family.
Exercise. Exercise releases endorphins, our ‘feel good’ hormones, and this will boost the mood. Exercise has also been shown to improve the hot flashes.
Coping with stress. Learn to let go of stress. Find ways to reduce stress, e.g. listening to music, going for a walk, gardening or talking to a friend. Know your strengths and your limits and only take on what you can manage.
Support groups. Joining a support can be beneficial. It allows you to share your experiences with and learn from others suffering from similar issues during menopause. KKH has a “Women-to-Women” Menopause Support Group. Besides providing a platform for women to discuss the myths and fears of menopause, we also have a panel of medical advisers and free counselling provided by trained volunteers.
More information on the support group can be found here: https://www.kkh.com.sg/patient-care/areas-ofcare/support-groups
The contributor is a Senior Consultant at the Department of Psychological Medicine, KK Women’s and Children’s Hospital.