Menopause and Mental Health
A popular myth pictures the menopausal woman shifting from raging, angry
moods into depressive, doleful slumps with no apparent reason or warning.
However, a study by psychologists at the University of Pittsburgh suggests that
menopause does not cause unpredictable mood swings, depression, or even stress
in most women.
In fact, it may even improve mental health for some. This gives further
support to the idea that menopause is not necessarily a negative experience. The
Pittsburgh study looked at three different groups of women: menstruating,
menopausal with no treatment, and menopausal on hormone therapy. The study
showed that the menopausal women suffered no more anxiety, depression, anger,
nervousness or feelings of stress than the group of menstruating women in the
same age range. In addition, although more hot flashes were reported by the
menopausal women not taking hormones, surprisingly they had better overall
mental health than the other two groups. The women taking hormones worried more
about their bodies and were somewhat more depressed.
However, this could be caused by the hormones themselves. It's also
possible that women who voluntarily take hormones tend to be more conscious of
their bodies in the first place. The researchers caution that their study
includes only healthy women, so results may apply only to them. Other studies
show that women already taking hormones who are experiencing mood or behavioral
problems sometimes respond well to a change in dosage or type of estrogen.
| Studies indicate that women of childbearing age, particularly those with
young children at home, tend to report more emotional problems than women of
other ages. |
The Pittsburgh findings are supported by a New England Research Institute
study which found that menopausal women were no more depressed than the general
population: about 10 percent are occasionally depressed and 5 percent are
persistently depressed. The exception is women who undergo surgical menopause.
Their depression rate is reportedly double that of women who have a natural
menopause.
Studies also have indicated that many cases of depression relate more to
life stresses or "mid-life crises" than to menopause. Such stresses include: an
alteration in family roles, as when your children are grown and move out of the
house, no longer "needing" mom; a changing social support network, which may
happen after a divorce if you no longer socialize with friends you met through
your husband; interpersonal losses, as when a parent, spouse or other close
relative dies; and your own aging and the beginning of physical illness. People
have very different responses to stress and crisis. Your best friend's response
may be negative, leaving her open to emotional distress and depression, while
yours is positive, resulting in achievement of your goals. For many women, this
stage of life can actually be a period of enormous freedom.
What About Sex?
For some women, but by no means all, menopause brings a decrease in sexual
activity. Reduced hormone levels cause subtle changes in the genital tissues and
are thought to be linked also to a decline in sexual interest. Lower estrogen
levels decrease the blood supply to the vagina and the nerves and glands
surrounding it. This makes delicate tissues thinner, drier, and less able to
produce secretions to comfortably lubricate before and during intercourse.
Avoiding sex is not necessary, however. Water-soluble lubricants can also
help.
While changes in hormone production are cited as the major reason for
changes in sexual behavior, many other interpersonal, psychological, and
cultural factors can come into play. For instance, a Swedish study found that
many women use menopause as an excuse to stop sex completely after years of
disinterest. Many physicians, however, question if declining interest is the
cause or the result of less frequent intercourse.
Some women actually feel liberated after menopause and report an increased
interest in sex. They say they feel relieved that pregnancy is no longer a
worry.
For women in perimenopause, birth control is a confusing issue. Doctors
advise all women who have menstruated, even if irregularly, within the past year
to continue using birth control. Unfortunately, contraceptive options are
limited. Hormone-based oral and implantable contraceptives are risky in older
women who smoke. Only a few brands of IUD are on the market. The other options
are barrier methods--diaphragms, condoms, and sponges--or methods requiring
surgery such as tubal ligation.
Is My Partner Still Interested?
Some men go through their own set of doubts in middle age. They, too,
often report a decline in sexual activity after age 50. It may take more time to
reach ejaculation, or they may not be able to reach it at all. Many fear they
will fail sexually as they get older. Remember, at any age sexual problems can
arise if there are doubts about performance. If both partners are well informed
about normal genital changes, each can be more understanding and make allowances
rather than unmeetable demands. Open, candid communication between partners is
important to ensure a successful sex life well into your seventies and
eighties.
Reprinted from the Archives of US
NATIONAL INSTITUTES OF HEALTH, National
Institute on Aging
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