The Menopause Expert - Rebecca Hulem

Midlife Moods and Menopause: History or Hormones?

Midlife riddle: What do Elizabeth Taylor and Queen Elizabeth have in common (other than their name)? 
Answer: Menopause, of course!

We probably know more about Elizabeth Taylor's midlife mood swings than we do about Queen Elizabeth's (do you think she ever burst into tears watching a commercial of a couple holding hands or a cute baby?).  One thing is for certain; both of these famous ladies have experienced loss and disappointments, along with estrogen depletion.
Psychological "symptoms" often attributed to the menopause period include depression, mood swings, anxiety, irritability, "fuzzy thinking", difficulty concentrating, forgetfulness, and difficulty coping with daily life challenges. That said, menopause does not "cause" depression or mood swings.
For many years, medical specialists attributed these symptoms directly to the hormonal fluctuations that begin during perimenopause and continue into the postmenopausal period. Although sleep disturbances related to hot flashes can certainly be related to these hormone shifts (it's tough to sleep in a sauna), sleep deprivation can also be linked to worry about a woman's multiple, changing roles. Almost every midlife woman referred to me with symptoms of depression and anxiety has a history of sleep problems, even the ones who are not experiencing hot flashes.
Changing relationships with children, spouses, and aging parents, financial pressures, and apprehension about the future are all cause for both daytime and late night ruminations.

Results of recent studies have recognized that psychological distress during the menopausal period may have more to do with an individual woman's personal history, current life events and lifestyle habits than with hormones.
Women who have a genetic predisposition for depression may be more likely to be depressed due to hormonal fluctuations, but women with characteristics such as poor self-esteem, lack of social support and feelings of having no control over their lives may also be more prone to mood disorders during this stage of life.
Feelings of sadness and anxiety during midlife are normal and expected at times. Bursting into tears while watching a commercial or weeping while watching "Sleepless in Seattle" for the tenth time is normal for some and "not characteristic" for others. The bottom line is that if feelings of sadness and/or anxiety persist or impair your daily life, you should see your health care provider. A complete lifestyle, depression and sleep inventory should be administered to get a complete perspective.
Clinical depression must be addressed and treated. It may also be that a thyroid disorder, anemia, or other physical conditions may be diagnosed. Nevertheless, our minds and bodies are interdependent. We can't separate our physical health from our emotional state and wellbeing.

Medications may be indicated until the "fog" lifts, but be aware that antidepressants, antianxiety agents and sleep aids (prescription and over the counter) can all have a negative, long-term effect on quality (deep REM) sleep, which in turn effects mood.
Prolonged stress and sleep deprivation can have major physiological and psychological effects that make it difficult to get out of bed, let alone live your best life. If you are exhausted, it is almost impossible to exercise, eat right and do the other things you need to do to live a healthy lifestyle. On the other hand, if you aren't living these other aspects of a healthy lifestyle, you will feel stressed and exhausted.
It may be time to jump-start or enhance your personal wellness program. Many women I see in my practice are so focused on their specific symptoms and medications or HRT, that they are stunned when I begin to ask them questions about their lifestyle and habits. Sleep, nutrition, exercise, rest (quiet reflection), interests, hobbies and developing a strong support system are the basic foundation of a strong personal wellness program and that includes mental health.
It's not "selfish" it's survival.

Menopause may be a given, but life also throws some unexpected "curveballs".
START NOW to assess and develop your own personal wellness plan- physical, psychological and emotional.  This will strengthen your resilience during midlife transitions; allow you to field those curveballs with ease and to live your best life.
You may still get teary when Meg and Tom meet on top of the Empire State Building, but you'll smile through your tears.

Teresa Kraegel RN, M.A, CS-P
Director, Transition Counseling Services and WITTY® (Women in Terrific Transition Years)
RJH Communications 
Brentwood, CA 94513  
(818) 425-2886 


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