Managing Menopause-Related Mood Symptoms (Women's Health Matters article) (Web resource; WHM resource) Author: Patricia Nicholson Organization: Women's College Hospital, Women's Health Matters During menopause, changes in hormone levels can lead to psychological and emotional symptoms as well as physical ones. Managing these symptoms, and recognizing serious mood problems if they occur, can be an important part of a woman’s health and wellbeing during the menopausal transition. Menopause is often viewed as three phases: perimenopause, or the years leading up to menopause; menopause, which is defined as having no periods for one year; and post-menopause. ‘The perimenopausal period seems to be the most symptomatic,’ said Greer Slyfield Cook, a social worker with the Reproductive Life Stages Program, part of the Women’s Mental Health Program at Women’s College Hospital in Toronto. Slyfield Cook and her colleague Maura O’Keefe gave a presentation about menopause and mood at the Marion Powell Women’s Health Information Centre at Women’s College Hospital on Nov. 17, 2009. ‘The perimenopausal period . . . is a time when hormones are being depleted,’ Slyfield Cook said. ‘That’s what causes some of the symptoms.’ Some of the most frequently reported physical symptoms are hot flashes and night sweats. Psychological and emotional symptoms can include increased sensitivity in relationships, tearfulness, irritability and low mood. A spectrum of symptoms Most women experience some psychological or emotional symptoms during perimenopause, but there is a very broad spectrum of mood difficulties during this transition. Ten to 15 per cent of women report having no menopausal symptoms at all. However, at the other end of the spectrum are the 10 to 20 per cent who experience clinical depression or anxiety. The difference between having mood symptoms and having clinical depression can be a matter of the severity, impact and frequency of the symptoms, Slyfield Cook said. Symptoms that occur for part or most of the day for two weeks or more could be depression. Symptoms of depression can include: sad mood decreased interest of pleasure in things you normally enjoy decreased motivation appetite or weight changes sleep disruption memory problems or trouble concentrating feelings of hopelessness, guilt or a bleak outlook thoughts of suicide Symptoms of clinical anxiety may occur with depressive symptoms, or on their own: obsessive worry memory problems or trouble concentrating feeling on edge, jumpy or tense obsessive-compulsive features social anxiety panic attacks feeling rundown or easily tired It can be difficult to know what’s just a mood shift and what is a more profound problem, indicating clinical depression or anxiety. ‘It’s hard sometimes to tease out what’s going on because perimenopause can be such a symptomatic period,’ Slyfield Cook said. Complex causes There are some risk factors that may make some women more prone to develop depression or anxiety during perimenopause. ‘The biggest risk factor is having a previous episode of depression or anxiety in your lifetime,’ says Maura O’Keefe, a social worker with the Reproductive Life Stages Program. ‘It doesn’t automatically mean you’re going to have depression or anxiety in menopause, but that is the biggest risk factor.’ Other risk factors include a family history of depression or anxiety, and having other medical problems during menopause. O’Keefe stressed the complex mix of factors that contribute to menopausal depression. ‘We usually talk about a biopsychosocial framework, which basically means there’s biological factors, there’s psychological factors, and there’s social factors,’ she said. ‘They all kind of come together to cause a woman to experience depression or anxiety difficulties.’ In menopause, significant drops in hormone levels are the major biological factor. Sleep deprivation can also be a biological factor in mood problems, and many women don’t sleep well during perimenopause because of night sweats. The psychological aspect is how any individual copes with change and manages stress, and all individuals have different ways of coping – some of which may be healthier than others. Those who view the proverbial glass as half empty could potentially have a more difficult time during the menopausal transition, O’Keefe said. ‘Psychologically, how you think about stressors and how you approach those stressors can have an impact on how the stressor actually affects you,’ she said. ‘It doesn’t mean you’re supposed to be happy and rosy and that will protect you from depression. But it’s important to think about how you understand, how you interpret and how you react to what’s happening in your life. And that will have an impact on how you manage the menopausal transition.’ The social component of the biopsychosocial factors is an individual’s support system. O’Keefe described two different types of support that most people need in their lives. ‘One is emotional, so having somebody in your life that you can talk to,’ she said. ‘The other type of support is practical, so having someone in your life – it could be the same person – who helps you do stuff when you’re not feeling well.’ Having a dependable support system in your life can be protective against depression and anxiety. Treatment approaches There are several approaches to treating menopausal symptoms, including hormone therapy (HT). HT has been mired in controversy since studies released in 2002 suggested that HT was associated with increased health risks, including increased risk for breast cancer. Many women stopped taking HT, but further research and better understanding of the results suggests that not all women should rule out hormone therapy, O’Keefe said. ‘The problem is now there is a lot of fear and misconceptions around (HT), and it’s really important to talk to a medical professional – a gynecologist or your family doctor – about your particular situation, your symptoms. Because (HT) can be helpful and effective,’ she said. ‘Doctors are pretty aware now about having that discussion around what are the risk factors and who would benefit.’ Other medical treatments that address anxiety and depression are medications such as antidepressants. Another approach used in the Reproductive Life Stages Program is therapy. ‘We have both group therapy and individual therapy that we provide in our program for women who are going through perimenopause and menopause,’ O’Keefe said. Therapy focuses on several goals: providing people with an understanding of what to expect during menopause so they can put their symptoms in context, developing coping strategies for symptoms, and addressing factors related to life transitions. The program uses various coping skills, such as relaxation skills, mindfulness skills, yoga and cognitive behavioural therapy skills, to help people manage mood symptoms and also help them recover from depression and anxiety. ‘The other big piece that’s important that we do in therapy is talk about life transition issues or identity transition issues,’ O’Keefe said. ‘Some women who are going through perimenopause and menopause are also going through a number of other life changes in addition to the hormonal changes that are happening physically.’ These can range from empty nest issues and their changing role in their children’s lives, to career changes and retirement planning, to changes in relationships with their partners and families. ‘There are often physical symptoms that change your sex life,’ O’Keefe said. One focus of therapy can be exploring how that, as well as other transitional issues, may be affecting a woman’s relationship with her partner. There is a multitude of factors that can affect mood during menopause, and a vast range of symptoms different women will experience in different ways with differing severity. But in many cases, the tools for coping with mood problems will follow similar themes: managing symptoms, managing life stressors, and managing transitional issues. Version française :  Cliquez ici pour voir la description en français Purpose:  Consumer information/support; Health information Information Source:  Hospital/Clinic Geographic Origin:  Canada Language of Resource:  English Groups:  Adult women; Middle-aged women; Older women Date Published:  Jan. 26, 2010 Last Reviewed by Women's Health Matters:  January 26, 2010