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Awaiting moderation 61875 Article

The signs of menopause: psychological problems and altered moods

‘The psychological problems [of the menopause] tend to be insidious and can impair a woman's ability to her domestic and work environment . . . They can destroy self-confidence and self-esteem and are an incomprehensible low point in the lives of previously well-adjusted and competent women.’ from The Menopause, J. Studd and M. Whitehead (eds.), 1988.
‘The only word I can use to describe how I felt during this period is wretched. I work in a doctor's surgery and spend my working day in contact with the patients. I was moody, bad-tempered and thoroughly unpleasant to everyone - yet I couldn't stop myself being tike that. My feelings about myself reached rock-bottom and my normal self-confidence disappeared completely until I could hardly bring myself to get out of bed in the morning. I think if I'd worked anywhere else I would have lost my job within a few weeks; but luckily the menopause specialist nurse in the practice recognised my changed personality for what it was, suggested I asked my GP about HRT, and I'm now back in the human race again.’
If you have had a similar experience, you are not alone. A great many women between the ages of 40 and 60 find they become moody, unable to concentrate, and very tired. Many of the psychological problems of the menopause are due to night sweats causing disturbed sleep, and will resolve themselves once broken nights come to an end. Others are due more directly to the loss of oestrogen. Part of the brain contains many oestrogen receptors, and if oestrogen levels fall, mood changes may occur; once the oestrogen is replaced by HRT, most women find their confidence and self-esteem restored and their problems with mood swings, forgetfulness and anxiety considerably alleviated. HRT is not as reliable in improving these complaints as it is for flushes and sweats, but if your general wellbeing and feelings about yourself have taken a plunge, then it's worth asking about HRT. It won't, however, do anything to alleviate depression, anxiety or unhappiness that existed before the menopause, and which is not due to lowered levels of oestrogen.
Oestrogen seems to have a 'mental tonic5 effect, and lowered levels of the hormone during and after the menopause can lead to a whole range of psychological problems, such as:
• less energy and drive
• irritability
• mood changes
• headaches
• feelings of unworthiness
• loss of self-esteem
• loss of self-confidence
• feeling unable to cope
• difficulty in concentrating
• feelings of aggressiveness
• depression
• anxiety
• forgetfulness
• fear of loneliness
• unusually prone to tears
• loss of libido (sex drive)
There are still too many doctors who, faced in the surgery with a woman aged between 40 and 60 complaining about any of these problems, will say, 'I'm afraid it's just your age, my dear,' or 'You'll just have to live with it -there's nothing I can give you that a good night's sleep/doing some voluntary work/joining an evening class won't cure."' And he writes out a prescription for some antidepressants and hopes she won't bother him again. (In this book, the doctor is depicted as male, simply to avoid confusion with the patient who, in matters concerning the menopause, is inevitably female.)
Prescribing tranquillisers and anti-depressants for problems in the mind that are caused by a fall in oestrogen is difficult to justify. Yet for many women, even nowadays, that is all they get, and then everyone is surprised that it seldom has the desired effect. It is hardly believable that 30-40 per cent of women aged 45-55 with menopausal depression are still prescribed tranquillisers and anti-depressants despite the fact that replacing their oestrogen will usually reduce these symptoms and thereby, in the majority of cases, lift the depression.
The majority of psychiatrists still believe that anti-depressants, tranquillisers or psychotherapy are the best forms of treatment for women at these three critical times of depression, yet they appear to have a low success rate. By contrast, replacing the oestrogen that is probably causing the depression appears to be very effective in many women. If the psychological symptoms are due to a lack of oestrogen, they will respond to a course of HRT; if they are due to some other cause, then HRT will not bring any real benefit. As HRT is a much cheaper form of treatment than psychotherapy or in-patient psychiatric care, it is surely worth considering as a first-line form of treatment for depression that occurs around the time of the menopause.


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