Depression and anxiety during the menopause
From brain fog to mood swings, to feeling anxious and low, the menopause (and the years leading up to it, called the perimenopause) can have a seriously negative impact on how we feel. While we can find these changes from our “normal self” distressing (not to mention exhausting), it’s important to remember that mood changes, particularly prolonged periods of low mood and anxiety, are a very common symptom of the menopause and you don’t have to be overwhelmed by them. Following on from Liz’s best-selling book, The Good Menopause Guide, we’ve outlined some of the ways the menopause might affect our mood, how to make these negative moods more bearable and restore some emotional balance in our lives.
Mood swings and hormones
Many women ascribe mood swings, grouchiness or low moods to “feeling hormonal” – and throughout the perimenopause our hormones are definitely a contributing factor. Mood swings are a classic perimenopausal symptom, as our hormones are constantly fluctuating. Progesterone in particular is a hormone that can significantly drop during the perimenopause and menopause (to as little as 60% or lower!). This hormone is a natural sedative and has a calming effect on our body. During the perimenopause, our bodies are constantly trying to counteract our declining progesterone levels, and in doing so release the stress hormones adrenaline and cortisol which can make us feel anxious, tense, low or irritable. These fluctuations happen without warning and can blind-side us out of the blue, leading to flashes of blood-red rage.
Low moods, low self-esteem, low libido
Many experts agree that our greatest challenge during the menopause is accepting our changing selves. During the perimenopause and menopause, women often experience very low moods – and while hormones are undeniably a contributing factor, plummeting emotions and self-esteem can be triggered by other circumstantial changes and menopause symptoms, such as changing family dynamics, physical transformations and insomnia. In such a period of change and flux, it’s not surprising that we can feel overwhelmed, low, and unconfident. This can affect not only our relationship with ourselves, but our relationship with others too, particularly our partners. Communication here is key, and talking to our other halves more openly the normal changes affecting our self-esteem is really important. This can help families work out solutions and manage expectations together. As they say, a problem shared is a problem halved.
Some women may be more predisposed to experiencing low moods during the menopause, particularly if they’ve experienced postnatal depression in the past, or have a history of PMS. This is due to the body’s higher sensitivity to changing hormone levels.
Too many women are wrongly prescribed antidepressants when they go to their GPs with menopause symptoms that are similar to anxiety and depression. While these drugs can, in some cases, help some women, menopausal symptoms are distinct from clinical depression and require different treatment: medication for a mood disorder may not be able to deal with hormonally-caused mood changes. Thankfully, there are many other mood-improving options available.
Perhaps there’s no ‘convenient’ time to go through the menopause, but it seems particularly unfair that it occurs at a time of general upheaval in our lives, with children going through exams or leaving home, our parents ageing and all manner of other life stresses to manage. Add this to fluctuating hormone levels and physical symptoms that may feel unfamiliar and beyond our control and we have a perfect storm for feeling anxious. Perhaps you are apprehensive of when the next hot flush will strike, or are railing against the physical changes and mood swings that stop you from feeling yourself.
Whatever the cause may be for feelings of anxiety, there are ways to manage and improve your symptoms. However, if you are experiencing frequent panic attacks or constant anxiety, be sure to book in an appointment with your GP, who can offer further medical advice.
So, what can we do?
The type and severity of menopause symptoms are as unique as the women experiencing them and the remedies that help one woman’s symptoms may be different from her best friend’s.
Studies have shown that mindfulness can be a really useful tool for alleviating feelings of anxiety, particularly if it is linked to your physical symptoms. In one study, a group of women who experienced hot flushes partook in a Mindfulness Based Stress Reduction course. At the end of the course, the women’s levels of anxiety were considerably reduced, and the improvements were still shown three months after the trial finished. Interestingly, the participants were not specifically instructed to apply their mindfulness training to their menopausal symptoms. Perhaps this shows that grounding yourself in the reality of the present moment rather than being overwhelmed by your symptoms is a powerful way of escaping the hold they have over you. It’s worth noting that the participants’ hot flush symptoms did not actually show marked improvement over the course of the study. Instead, their emotional resilience had improved to the extent that the discomfort of their hot flushes no longer caused them intense bother.
Cognitive Behavioural Therapy (CBT)
The most recent NHS NICE guidelines recommend cognitive behavioural therapy (CBT) as an effective, medication-free treatment. CBT involves finding coping strategies by developing an understanding, and acceptance, of your current situation. The therapy helps women to recognise that their anxious or depressed thoughts are not facts. CBT can even help with other menopause symptoms such as hot flushes, by enabling women to reframe their reactions to the uncomfortable sensations through reinforcing their ability to cope.
Feeling as though we’re losing control is a common concern during the menopause, especially when our brains feel foggy and frazzled, and our memory isn’t as razor-sharp. Imposing some structure on our day through scheduling meals at optimum times can be a helpful way of regaining a sense of order and control when things start to feel out of hand. Eating at the perfect time also provides us with mood-boosting benefits. Eating breakfast within 45 minutes of waking up, for example, may help stabilize blood sugar which means our bodies won’t have to rely on spikes of stress hormones to keep our energy levels up. Others find intermittent fasting (allowing 12 – 15 hours between our last meal and first meal of the day) can help for mental clarity as well as weight control.
If you are struggling with feelings of anxiety, it may be wise to cut down on caffeine and alcohol, as these can exacerbate this symptom.
As well as eating at the right time, it’s important to eat the right types of food. Studies suggest that certain foods may actually have a detrimental effect on mental health – one study by the department of psychiatry at the University of Columbia, for example, concluded that diets rich in high-glycaemic foods such as white bread and white rice may in fact make post-menopausal women at greater risk of first-onset depression. Choosing low GI (glycaemic index) recipes is a useful strategy here – and is one we promote throughout the pages of our magazine.
Think happy thoughts
One of the most annoying things we can be told when we’re feeling blue is to “just cheer up”, but a number of studies suggest that women who think negatively overall about the menopause reported having more problems with their symptoms, while those with a more positive attitude tend to suffer less. Seeking out a local counsellor and getting on board with CBT, if possible, could help to reframe the way we perceive the situation. While symptoms can be unpredictable, perhaps the easiest thing to take control of is how we choose to respond to them.
Hormone replacement therapy (HRT)
For some women, levelling out their hormone levels can help to alleviate mood swings. One way to achieve this is through taking HRT, prescribed by a doctor. Find out more about HRT and whether it is right for you, here.
The most important thing to remember when the menopause brings on low moods is that we are not alone.
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