Depression during the menopause
The menopause (and the years leading up to it) can have a seriously negative impact on how we feel. Brain fog, mood swings and depression are all common experiences in the menopause.
These changes can be distressing, but it’s important to remember that mood changes are a very common symptom of the menopause.
Here are some of the ways the menopause might affect our mood. We’ve explained how to make these negative moods and depression more bearable to restore some emotional balance in our lives.
Mood swings and hormones
Many women ascribe mood swings, grouchiness or low moods to “feeling hormonal”. 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. In doing so, it releases the stress hormones adrenaline and cortisol that 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. While hormones are undeniably a contributing factor, other circumstantial changes can trigger plummeting emotions and self-esteem. These can include things like 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.
So, what can we do?
The type and severity of menopause symptoms are as unique as the women experiencing them. The remedies that help one woman’s symptoms may be different from her best friend’s.
Studies show that mindfulness is a really useful tool for alleviating feelings of anxiety, particularly if there’s a link 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. What’s more, 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. This shows that grounding yourself in the reality of the present moment rather than being overwhelmed by your symptoms is a powerful tool.
The participants’ hot flush symptoms didn’t 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 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. This is especially true when our brains feel foggy and frazzled, and our memory isn’t as razor-sharp. Adding some structure in our day, e.g. scheduling meals at optimum times, can be a helpful way of regaining a sense of control. 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. This means our bodies won’t have to rely on spikes of stress hormones to keep our energy levels up. Others find intermittent fasting can help for mental clarity as well as weight control.
If you struggle 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 concluded that diets rich in high-glycaemic foods, such as white bread and white rice, may make post-menopausal women at greater risk of first-onset depression. Choosing low GI recipes is a useful strategy here.
Think happy thoughts
One of the most annoying things we can be told when we’re feeling blue is to “just cheer up”. A number of studies, however, suggest that women with a more positive attitude towards the menopause tend to suffer less. Seeking out a local counsellor and getting on board with CBT, if possible, could help to reframe our thoughts. While symptoms can be unpredictable, we can control 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 in Liz’s e-book, The Truth about HRT.
The most important thing to remember when the menopause brings on low moods is that we are not alone.