SYMPTOMS AND SIGNS OF THE MENOPAUSE: PSYCHOLOGICAL SYMPTOMS
Emotional changes are commonly complained of by women experiencing the menopause. They include mood swings, irritability, anxiety, a poor memory, lack of concentration, feelings of inadequacy, loss of energy, tiredness and depression.
Whether the increase of psychological symptoms at this stage in life is due to a lack of oestrogen or the consequence of factors such as hot flushes, sleep disturbance and social influences is not known. It is possible that pre-existing psychological or psychiatric problems worsen at this time, aggravating mood change.
It was suggested in a 1986 study that beliefs held before the menopause about the experience of it may influence the individual's emotional symptoms during these years. Other research confirms that oestrogen exerts a direct 'mental tonic' effect, militating against irritability, fatigue, insomnia, anxiety and depression.
Socio-economic factors
It has been shown that women of lower socio-economic groups have more psychological menopausal problems than those who are educated, financially secure, with pleasant homes, regular holidays and, possibly, rewarding jobs and/or sympathetic partners. The woman who is tired and overworked, with poor living conditions, financial worries and an inadequate diet, who has had little education and whose understanding of health matters is minimal, who has limited access to information, fears the unknown, feels inadequate and has a partner who finds it difficult to comprehend her menopause-related problems, may well have more difficulties in coming to terms with the 'change of life'.
Similarly, it may be perceived that a mature woman who has not had to face, as mothers do, the experience of offspring leaving home and the consequent 'empty nest' syndrome, with its attendant feelings of uselessness and unwantedness, may exhibit fewer psychological symptoms during the menopause. But there is no set pattern and the subject is a complex one.
Cultural attitudes
In Western society ageing generally and the menopause in particular are regarded negatively in the main. The anticipation of menopausal problems may therefore magnify their occurrence.
In other cultures age is revered and associated with wisdom. Consequently the menopause is welcomed as a positive event, bringing as it does an increase in status. This can be seen among certain castes in Rajasthan, for example, where the cessation of menstruation signals a woman's emergence from purdah, allowing her to mix freely with the male sex and to counsel younger members of her community. In Sub-Saharan Africa and Ethiopia postmenopausal women are accorded great respect and special status. Of course, in such Third World societies life expectancy is substantially lower, at about 40 to 50 years, than in industrialised countries, and contraception is not practised, so the women will have spent much of their time since puberty either pregnant or giving birth, which are potentially risky experiences in themselves. Therefore simply to reach the menopause confers status in a way which could not happen outside the Third World, and it may indeed be the last pregnancy which marks the point of transition to the menopause.
Western society, on the other hand, pursues the cult of youth and universally glorifies the desirability of the younger female at the expense of the mature woman. Faced with images of unattainable youthfulness throughout the media and society's preference for youth in most other areas of life, including the job market, the prospect of the menopause may seem to the middle-aged woman like a brutal reminder that the 'best' years of her life are now behind her.
But though her life may have changed in many ways it is likely to bring new opportunities and challenges. Some women change direction in their careers. Some start businesses or, free from the demands of raising their families, take an active role in their partner's career. Some re-direct their attention from the care of their children to the care of their elderly parents. For many, the approach of the menopause is a time for reflection and for reassessment of life's goals. Putting life into perspective will gready assist the self-management of menopausal symptoms and is essential if a positive outlook is to be developed.
Personality and the link with depression
A woman's personality will influence the way in which she responds to the hormonal changes taking place at the menopause. Positive attitudes and high self-esteem will help to minimise the psychological effects of its physical symptoms.
It is an interesting fact that from puberty onwards women suffer more from depression than do men, and that at times of marked hormonal change premenstrually, post-natally and around the menopause - this tendency to depression is heightened. The psychological symptoms of the menopause may in fact represent a continuation and extension of premenstrual syndrome, albeit in an exaggerated form.
In view of the variable and increasing hormone swings that take place approximately 10 years before the menopause, and for some years afterwards, it is quite probable that the balance between oestrogen and progesterone influences the intricate web of chemical messengers in the brain. These in turn initiate the physical and psychological symptoms, and in particular depression, which some women experience.
There is, however, more than one type of depression.
Depressed mood low spirits, sadness or despondency are common symptoms around the menopause and are considered to be caused by lack of oestrogen. Depressed mood may be a response to hot flushes, sweats or disturbed sleep. Oestrogen therapy can be of assistance, but it is interesting to note that in some studies there are indications that oestrogen is no better than a placebo.
Depressive disorder can exist quite independently of the menopause, and is quite different from 'depressed mood'. Its symptoms are lack of concentration and interest, loss of appetite, weight and sex drive, feelings of impending doom, guilt and worthlessness, slow and quiet speech, early-morning waking and an inability to take decisions.
Depressive disorder, which is both far more serious and far more debilitating than depressed mood, is not common at the menopause, nor have studies revealed any relationship between the menopause and depressive disorder. Depressive disorder is usually treated with anti-depressant medication together with talking therapies.
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Womens health