What is menopause/menopausal depression?
Menopause occurs later in life when a woman’s body stops producing eggs and fertility ceases. Missing a period for 12 consecutive months (in the absence of other obvious causes) is the main criteria for being menopausal. The average onset of menopause is 51. Hormonal changes can lead to menopausal depression.
Interesting facts about menopause:
There is a high suicide rate in women aged 45-54 years. This may be related to the biological changes associated with menopause.
Management can include psychotherapy and other non-drug interventions. Drug intervention treatments include hormone replacement therapy, an antidepressant, or both.
If a woman has had well-controlled depression that is well managed prior to menopause, menopause can disrupt this balance. This is known as a “Perimenopausal relapse”. Agomelatine is a newer antidepressant with a positive sedative impact and fewer adverse effects in menopausal women.
The economic cost (estimated by the Australian Bureau of Statistics) of menopausal anxiety and depression has been estimated at around $22 billion per year.
The psychological symptoms of menopause often present much later on (up to five years later) than the physical symptoms (menstruation stopping). This delay can make diagnosis difficult.
Along with menopause comes many hormonal changes. The body ‘s oestrogen production slows down and this can result in various side-effects:
- Mood swings/feeling tearful – Mood swings and feelings of sadness and irritability are common occurrences during perimenopause and menopause (menopausal depression).
- Menopausal acne
- Hot flushes
- Night sweats
- Irregular periods
- Sleep problems
- Memory problems
- Changes in sex drive – Many perimenopausal and menopausal women experience a loss of sexual desire and this can be the result of multi-hormonal problems related to oestrogen as well as androgens.
- Vaginal dryness
How to cope with menopausal depression
Menopausal depression can come on suddenly and you may not always realise what it is right away. You may feel out of sorts and low in mood. Your skin may erupt when you have never had skin issues before. Hormones have a pwerful influence over our bodies – physically and mentally.
1) Hormone Replacement Therapy
Although there are risks associated with Hormone Replacement Therapy (HRT), it is worth exploring options with your GP. HRT can also help prevent osteoporosis (thinning of bones).
Breast cancer, blood clots and risk of heart disease are the risks associated with HRT but generally, the evidence suggests that HRT can be more beneficial than a danger. Consult with your doctor if you find menopausal depression to be severely affecting your daily life.
It usually takes a few weeks before you will feel the initial benefits of HRT and up to three months to feel the full effects. It may also take your body time to get used to HRT.
2) Daily exercise
Brisk walking is one of the simplest, lowest-cost aerobic exercises for menopause that you can do . Walking at a brisk pace is a great calorie burner and may also help with menopausal depression and mood swings, because aerobic exercise can help fight depression and anxiety — both of which are common menopause symptoms .
For most healthy women, moderate aerobic activity is recommended for at least 150 minutes a week or vigorous aerobic activity for at least 75 minutes a week. In addition, strength training exercises are recommended at least twice a week. Feel free to spread out your exercising throughout your week. Weight gain can be an issue during menopause and maintaining a healthy active lifestyle is important for your physical and mental wellbeing
3) Stay connected with others to minimise menopausal depression
The emotional effects of menopause can range from irritability to anxiety to depression. It’s no wonder many women report having relationship issues during this time. You don’t have to work through the changes alone, though. Making that extra effort to stay connected with your nearest and dearest companions won’t always be easy, but you’ll be glad to have them by your side once the hot flashes have cooled and your symptoms have subsided.
Engage in productive outlets that foster a sense of self-esteem and achievement. If you’ve had a longstanding desire to become more involved in charity work or to help your church or synagogue, this may be a good time to do so. These types of activities, which can also include sports and leisure pursuits, help you feel better about yourself, which improves the way you interact with others.
The worst thing you can do while going through menopause is to withdraw from those closest to you. This can exacerbate menopausal depression. Even if you don’t feel up to it, you should schedule family (and friend) time on a regular basis. Invariably, you’ll feel better after you’ve seen people you hold near and dear.
4) Change your diet
1. Calcium for bone health
Osteoporosis gets a fair amount of attention, and most older women understand that the risk of developing this bone disease increases with age. In fact, 1 in 3 women over 50 is at risk of a bone break caused by osteoporosis. Osteoporosis affects men, too, but not at such high rates.
We absorb less calcium as we age, and some women’s ability to tolerate dairy — the best sources of calcium — also decreases as they get older. Dark leafy greens and calcium-fortified orange juice are other good sources.
Women over 50 need 1,200 milligrams of calcium daily. Use the Nutrition Facts label on food products to keep track of your intake.
2. Protein for healthy muscle mass
Older women tend to sit more, exercise less. That compounds a natural aging process called sarcopenia, which is the loss of muscle mass. By the time women near 80 years, they may have lost as much as half of their skeletal muscle mass. Eating enough protein reduces the impact of that muscle wasting.
Choose more soy, quinoa, eggs, dairy, nuts, seeds and beans.
Your protein needs depend on how much you weigh. For women over 50, experts recommend 1 to 1.5 grams of protein per kilogram of weight (1 kilogram = 2.2 pounds). If you weigh 140 pounds, for instance, you would need at least 63 grams of protein a day.
3. Vitamin B-12 for brain function
As women age, they absorb fewer nutrients from their food. One key nutrient they may not be absorbing enough of is vitamin B-12, which is essential for maintaining both healthy red blood cells and brain function.
The best sources of vitamin B-12 are eggs, milk, lean meats, fish and fortified foods like cereals and grains. Vegans, in particular, will need to choose more fortified foods, but even elderly people who eat all foods may have difficulty absorbing enough vitamin B-12.
While the recommended daily intake of vitamin B-12 for women over 50 is 2.4 micrograms a day, talk with your doctor to see if you also need a supplement.
- Make whole foods the foundation of your diet. Focusing on whole grains, fruits and veggies will help avoid a lot of common problems that come with age.
- Drink before you’re thirsty. The way your body detects thirst changes as you age. Make sure to drink plenty of water, even if you don’t feel thirsty. Carry a water bottle, and drink a glass with every meal.
- Make an appointment with food. (And keep it.) Create concrete plans that lay out exactly how they’ll get key nutrients. Write the plan on a calendar. By simply making an ‘appointment’ with that apple, you’re more likely to eat it.
Minimising your alcohol intake is also important to consider.
5) Find your inner calm
A self-calming technique, such as yoga, meditation, rhythmic breathing, reading, or prayer can help you balance your wayward emotions, reduce menopausal depression and keep your relationships on an even keel. Try to be mindful (aware and present) of each and every moment of your life. This practice prevents you from worrying about the future (often fraught with anxiety) or dwelling on the past (often tinged with regret). Combine positive thoughts, a healthy lifestyle, and relaxation techniques.
Mindfulness has been used as a natural approach to treat both the physical and psychological symptoms of menopause. A 2018 British study found that mindfulness-focused therapy significantly reduced hot flashes and weakened other menopausal symptoms such as depression, anxiety, and insomnia.
Although meditation is the most obvious form of mindfulness, you don’t have to sit in silence for long periods. If you are exercising mindfulness, you are, in turn, participating in a form of meditation. While the two are linked, it is possible to practice mindfulness without meditation in its practical sense. You can be mindful without making great changes in your life.
However, you may find that the little ways you include mindfulness will inhibit positive outcomes. Start with a mindful activity, like going for a walk outside, and noticing what you see, smell, hear, taste, and feel. Mindfulness can be practiced through the things you are already doing, such as exercising, cooking, cleaning, or driving. Mindfulness is about being fully present when doing these things.
6) Protect your relationship by looking after yourself
It’s okay to put yourself first and treat yourself with self-compassion. The better you feel, the more inner resources you will have to share with others your time, your interest, your energy.
Communicate regularly about your experience of menopausal depression or anxiety
Trust is key to a healthy sexual relationship, and communication is key to trust. An honest exchange of feelings, needs, and preferences between partners is the best way to avoid disappointment, find mutual solutions, and nip resentments in the bud. Communication is particularly critical as the physical changes of middle age emerge. For instance, without good communication, the challenges posed by vaginal dryness might be misinterpreted as a woman’s loss of interest in sex, which might lead her partner to feel rejected. Good communication allows couples to identify and address the real issue.
Consider couples therapy
No matter what steps you might take to address sexual problems in your relationship, if you are no longer close to your partner emotionally or if there is anger or mistrust in the relationship, you’re not likely to have a satisfying sex life. It’s important to recognize when relationship issues are at the base of sexual problems and to focus on the underlying relationship—through counseling, if necessary—when that’s what’s really needed.
The suggestions below, from Jean Hailes, are for your partner to read to help them better understand menopause.
|Listening is often better than trying to fix things||If your partner talks about the symptoms and challenges of menopause, you may well want to try and help to fix the problem. Often all your partner wants you to do in order to help her is for you to listen and be supportive.|
|Understanding ‘menopause’||Menopause can cause physical and emotional symptoms. Your attitude to this is important. Knowing the symptoms your partner may experience and what treatment options are available can help you both cope.|
|Menopause is an individual experience||Each woman will experience menopause in her own way. Some women experience severe symptoms while others don’t realise they have gone through menopause. How each woman deals with her menopause will also depend on her personality and coping skills. Be careful of generalisations.|
|Understanding the priorities||Ask your partner to list her symptoms and prioritise what is causing her the most distress, this allows you to better understand her experience.|
|Changes you might make||If your partner has symptoms of menopause that are affecting her enjoyment of life, she may ask you to make changes so she can cope better. For example she may ask you to sleep in a separate bed because hot flushes keep her up all night and she worries about disturbing you.|
|Consider going to the doctor together||Going to medical appointments together (if you both feel comfortable with this) can help in a number of ways: Your partner will feel supported if she knows you will take the time to go with her to understand what is happening to her. You and your partner will also be able to discuss what the doctor said, which helps with decision making.|
|If there are relationship problems try to discuss how you’re feeling||One of the most important things is to be able to discuss your thoughts and feelings openly. If this is difficult perhaps you could visit the doctor with your partner and discuss your concerns together. Another alternative is visiting a psychologist who specialises in couples’ therapy. You may only have to go for one or two sessions and the therapist should be able to help support you in your communication.|
|What else is going on||At the time menopause usually happens, there are often many other things going on, like changes in the family, changes to roles and work, changes in friendships, with parents and in relationships. These changes influence your partner’s health and her experience of menopause.|
|It’s not about you….||If your partner is not as interested in sex as she used to be it does not mean she’s lost interest in you. It may be more that she’s experiencing hot flushes, sleeplessness and/or a dry vagina that is making sex painful. She may need encouragement to seek treatment for her symptoms, and you can also suggest ways to be intimate other than sexual intercourse.|
|It may not be menopause||Even though menopause may be an easy explanation for grumpiness, sadness and moodiness, you need to be careful to distinguish between what is menopause-related and what may be caused by other life issues. Doing this will help your partner get the right treatment, if it’s required|
|Seek help from a range of practitioners if appropriate||There are many different ways of managing menopausal depression and it is important your partner gets appropriate, balanced information and treatment. This may be from a doctor, accredited naturopath, psychologist, dietitian or physiotherapist.|
Menopause can be hard to deal with and it can even lead to suicidal tendencies and divorce. Try not to minimise what you are going through and communicate regularly with others, especially your partner. Menopause can make you feel that you are going mad because it’s highly possible to feel very out of control. You are not alone and this is common – it’s just that many people don’t talk about it much.
Most importantly, try to remember that menopause is only a phase, and that you will soon get past it into the calmer emotional waters that lie ahead. Hang in there!
Menopause guide: CLICK HERE