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GUEST BLOG FOR WORLD MENOPAUSE DAY 2014
Professor Myra Hunter examines the impact that the menopause can have on emotional and mental health, and outlines the steps women can take to improve their wellbeing.
The relationships between menopause, hormone changes and emotional wellbeing have troubled women and doctors alike over the centuries, and distressed mid-aged women have been subject to a range of generally unhelpful treatments, including prolonged bed rest, application of leaches and even gynaecological surgery. Today, fortunately, we have evidence from research, which greatly improves our understanding of women’s emotional wellbeing during the menopause.
Does menopause affect mood?
Happily, studies following women through the menopause suggest that the menopause transition is not associated with depression or adverse psychological symptoms in most healthy women. Some women say they feel better, and some notice no mood changes during menopause. And after the menopause, women generally report improvements in mood! However, we know that around 10% of women are at higher risk of depressed mood during menopause.
What causes low mood and depression during menopause?
Depressed mood in menopause can result from biological, cultural, social and psychological factors – or a combination of these things. Women at highest risk are those with:
- a past history of psychological problems
- social problems, or going through stressful life events
- poor health
- negative attitudes and expectations about the menopause
- troublesome hot flushes and night sweats that affect sleep and ability to cope.
There is no clear evidence that hormonal changes directly predict psychological symptoms, but some women do have tension and low mood, similar to premenstrual symptoms, and may be more sensitive to hormonal changes during the perimenopause – a stage when hormones fluctuate. Typically women who seek help have a mixture of problematic hot flushes, stress, sleep problems and low mood, which can form a negative cycle.
Depressed mood shouldn’t automatically be put down to the menopause. Psychological and social factors are also very important. The menopause happens at a time of lots of other changes, due to life events and ageing, so it can be difficult to tease out the specific causes if we feel low or depressed.
Does it matter how women view the menopause?
Interestingly, we know from research into other cultures that there are wide variations in the way that women from different cultures and living in different countries view the menopause – and how they experience it.
Studies suggest that in some countries, such as China, Japan and India, menopause tends to be viewed more as a natural part of life rather than a medical problem, with less focus on ‘symptoms’. It can be seen as a neutral or even positive event. In Western societies, the menopause is more generally seen as a time of poor emotional and physical health. These cultural beliefs and traditions are important, but lifestyle (diet and exercise), general health, poverty and climate are also likely to influence how we experience the menopause. Nevertheless, there is evidence from research showing that overly negative attitudes (before the menopause) have been found to predict depressed mood and hot flushes during the menopause, so it is helpful to be informed beforehand.
What can help?
Having up to date information and talking with other women in similar situations can be supportive and empowering and can reduce embarrassment about this stage of life. Medical treatments include antidepressants, and a range of treatments including hormone treatments for hot flushes.
I have been working to develop non-medical treatments for menopausal women using cognitive behaviour therapy (CBT), which offers a practical approach to emotional problems, such as anxiety and depression (www.nice.org.uk/guidance/CG90), and over the past few decades CBT has been applied to range of mental health and physical health problems with positive outcomes.
CBT is available on the NHS for depression and anxiety and for sleep problems, as part of the Increasing Access to Psychological Therapy services in primary care. We have also developed a self-help treatment for hot flushes and night sweats that has significantly helped women to manage these symptoms as well as improve mood and wellbeing.
Professor Myra S Hunter, Institute of Psychiatry, Psychology and Neuroscience, King’s College London
Myra Hunter and Melanie Smith have written a book, Managing Hot Flushes and Night Sweats which provides women with up to date and balanced information about menopause and a self-help guide to reduce the impact of hot flushes and night sweats in just four weeks.