In my opinion, not enough attention is given to mental health in menopause. Just as the decrease in estrogen causes hot flashes, night sweats and vaginal dryness, it can also contribute to mood swings, forgetfulness, anxiety and depression. Women who have a history of depression are even more likely to relapse during the menopause transition. The hormonal changes coupled with other stressors like carrying for aging parents, children leaving home, financial strain and marriage woes, can negatively impact quality of life.
I recently saw a patient in clinic who was perimenopausal. Perimenopause is the timeframe when a woman experiences menopausal symptoms, but still has a menstrual cycle. This patient was on the verge of losing her job because of her inability to control her mood swings. She was tearful and relayed that she had no control over her emotions. Her anger was not only affecting her professional relationships, but was taking a toll on her personal ones as well. On one hand she shared that she didn’t want to be bothered with people, but on the other hand the isolation lead to loneliness and feelings depression. She was tearful throughout the visit. She also noted irregular menses and hot flashes. But the mood swings bothered her the most, so we decided to try an antidepressant. Within a week she felt like herself again. It just so happens that an antidepressant worked for this patient. With other patients, I have had success with hormone replacement therapy. Still others benefited from cognitive behavioral therapy or exercise and mind-body techniques.
Like many women in the perimenopausal phase of life, this patient also, rather timidly, expressed concerns about decreased libido. She is not alone. When talking to women about their sex lives in my clinic, decreased sex drive and difficulty or inability to have an orgasm are overwhelmingly two of the most common themes across all ages and ethnicities. These problems become even more prevalent during perimenopause and menopause. In my next blog, I will dive into more about menopause and sexual function, but for now I’ll say this: depressed mood, irritability, and mood swings can negatively affect libido. Thus, addressing mental health concerns in menopausal women is not only imperative for our general well-being, but also for our sexual function.
Sometimes just knowing that these mental and physical changes are normal symptoms of menopause help women feel comfortable seeking help. In my last blog, I spoke about how small changes in diet and exercise can lead to huge benefits in overall health. Likewise, I have found some consistent themes in patients that maintain a sense of happiness and well-being throughout menopause and beyond.
Fill your life with people, things and experiences you love
I was raised in a world where the glass was half-empty, never half-full. So loving life was not intuitive. It’s something I’ve had to work at quite diligently. This is where self-exploration comes in. One of the first steps for me was to completely purge my home of things that I did not use or love (thank you, Marie Kondo). I have already shared that I love yoga. Yoga keeps me physically fit, mentally stable and connected to some of the most peaceful people on the planet. I also love music, art, dance and books (Marie Kondo would be disappointed to learn, I did not purge my books). A few years ago, I realized I was stuck in a rut. I was a spectator in my life and generally unhappy. I made some bold changes including a challenging career move and daringly gave online dating a chance. Along with decluttering, these changes have absolutely paid off. I love my new job and I met a boyfriend. One of the first questions I asked him was, “What did you love to do as a child?” After a few minutes of deliberating, his face lit up and he said, “I loved studying bugs in my backyard, I had a bug kit and everything!” He was just the right amount of sexy and nerdy. I think he is a keeper.
Why am I mentioning this right now? It is always ironic to me how many patients are surprised when I share my personal insecurities and fears. My motivation for sharing is to show that I am human too. The struggles of midlife and perimenopause did not skip me (although, it would be wonderful if the medical degree bought me immunity). Just as I divulge my struggles, I share my triumphs to show what is possible, which leads me to the next point.
Seek out support
Bashfulness is not in my character, so when I encounter exuberant women, I ask quite frankly, “How do you do it!?!” Amazingly, a common theme that has come up is to engage the assistance of a life coach in some fashion, whether that means a career coach, therapist, or a favorite self-help book. It took me a while, but I finally jumped on the life coach bandwagon and it was by far the best money I ever spent on myself. I am grateful to the bold women who held no shame in sharing their secret to self-contentment and joy with me.
There are many resources online and books to help cultivate a spirit of self-love. These are some of my favorites*…
“Year of Yes” by Shonda Rhimes
“The Happiness Project” by Gretchen Rubin
“Simple Abundance” by Sarah Ban Breathnac
“The Four Agreements” by Don Miguel Ruiz
“Outliers” by Malcolm Gladwell
“The Last Lecture” by Randy Pausch
“Mindset” by Carol S. Dweck
“How to Win Friends and Influence People” by Dale Carnegie
“Acts of Faith” by Iyanla Vanzant
Prioritize your mental health
I know firsthand that this is easier said than done. I was raised to be a nurturer. This isn’t unique to me or even my family. Many years of taking care of the gynecologic health needs of women has shown me that most women put themselves last. The nurturing spirit coupled with natural hormonal fluctuations is a set up for emotional disaster. Depressed mood, anxiety and mood instability impact our relationships, achievements and overall quality of life. The number of women who suffer silently always amazes me. Hormones, antidepressants, counseling, exercise…all help. Treatment looks different for everyone and changes over time. Just as you wouldn’t consider not treating cancer, don’t neglect mental health. Depressed mood, increased anxiety, and irritability are symptoms of menopause. In women who have a history of depression, these symptoms can be severe.
Mental Health America (MHA) provides an on-line screening tool, resources and information to share with a healthcare provider. Mental health conditions are treatable and recovery is possible.
In the next blog, I will dive into the physical changes associated with menopause, including sexual challenges and the importance of the “oh so dreaded” gynecologic exams.
*These resources come at my personal recommendation and do not necessarily reflect the views of WomanLab.