Mood Changes and Menopause
Mood Changes and Menopause: Truth in the Research
Historically, the ‘diagnosis’ of menopause has been held responsible for every mood change or unexplained feeling that women experienced throughout the climacteric 15 year period. Menopause, representing a state of decay, often required ‘treatment’ to protect women from their natural biological changes. Such interventions have included medication, verbal therapy, hormonal replacement therapy, or surgery. In fact, in the first half of the 20th century, women were thought to suffer from a post-menopausal depression, classified as ‘Involutional Melancholia’. The standard treatment of this “mental disorder” often required hospitalization. The association between hospitalization and menopause led many women to fear that the cessation of menstruation might precipitate lunacy. Thankfully, this “disorder” was eventually recognized as an inappropriate category and was subsequently omitted from diagnostics. However, the myth that menopause causes insanity persists (Greer, 2018).
What does the research say?
In stark contrast to the above, menopause in actuality may be a positive occurrence. Multiple longitudinal studies have indicated that menopause is not an adverse life event. A recent study examining the impact of menopause on mood followed 438 women over twenty years (Campbell, Dennerstein, Finch, & Szoeke, 2017). Using multiple validated measures of mood, the authors determined that mood was lowest during the transition to menopause, but resolved as women aged. When the authors (2017) assessed depressive symptoms overall and adjusted the study for age, they found that it was not menopause, but the variable of age itself that was positively correlated with mood, indicating that menopause may long have been blamed for depression and mood symptoms that are more reflective of the experience of aging itself. Furthermore, this study suggests that women become more resilient as they age, and report lower levels of depression as they get older. This reinforces the findings of an early study (NAMS, 1998), in which the majority of a sample of 750 American women between the ages of 45 and 60, reported feeling relief at no longer have to deal with the hassles of menstruation, for the first time since menarche. They further reported no longer having to experience monthly cramps, low back pain, rapid hormonal changes, blood-stained clothes, or worry about carrying pads/tampons. Overall, the women viewed aging and menopause as a positive event (NAMS, 1998).
While the above studies examined Australian and American women respectively, a third examined the experiences of Canadian women at the onset of menopause, also following them over the course of five years (Guerin, Goldfield, & Prud’homme, 2017). The results of this study determined that women’s moods were consistent and stable and, in fact, similar to the NAMS (1998) study, women reported higher scores on body image and self-esteem (Guerin et al., 2017). Furthermore, the overall general health of women was positively correlated with better mood, regardless of menopause status (Guerin et al., 2017). This suggests that women who age healthfully are more likely to experience a consistently better mood during the aging and menopause transition.
Validating the challenges women face at the beginning of menopause (Campbell et al., 2017), mood swings and depression tend to be caused by constant fluctuations of hormonal levels associated with mid-life events. Concomitantly, between the ages of 40-60, children are often leaving home, which can leave women grappling with role changes, the possibility of marital strife and/or divorce, in addition to other mid-life stresses such as professional changes, retirement, and even the death of a parent. Therefore, regardless of menopausal status, developmental stressors may make women more prone to mood swings and depression. When a woman experiences depression, this, in and of itself, can negatively impact the way in which she relates to both herself and others sexually. Moreover, depression tends to diminish awareness of positive sensations experienced by the depressed person. In order to effectively cope with the mood swings and depression, women should be encouraged to talk openly with others about feelings. In fact, participating in a support group women experiencing similar issues may not only be informative (recommendations of doctors, treatments, experiences…) but also normalizing. Women need to gain access to information and also to connect with others in order to subjectively experience that they are not alone in the mid-life feminine process.
What’s the bottom line?
While menopause has long been blamed for depression and mood fluctuations in women, research indicates that while the transition to menopause may be experienced as a challenge, it is likely that the life events associated with middle age may be more responsible for the emotions that have been consistently attributed to this physiological change. Furthermore, as women age, as long as they maintain good physical health, they may also experience an increase in overall happiness. It is therefore important for women to consider the many mid-life experiences that may impact their well-being, and seek support from a supportive physician, therapist, and peers who are going through the same experience. Finding a group of women who are ‘in the same boat’, so to speak, can help normalize and validate the many changes that midlife entails, assisting with coping, and facilitating a healthier change into life after menopause.