As Menopause Nears Be Aware It Can Trigger Depression And Anxiety Too
“Technically, menopause is only one day in a woman’s life, which is exactly when she has not had a period for 12 months,” she says. “It’s the period of time leading up to menopause that causes all the trouble.”
And it can start earlier than you might think. Many listeners wrote to us in response to our call-out for individual experiences with menopause to say that they struggled to get medical support for perimenopause in their mid-30s and early 40s.
When Edrie went back to her OB/GYN with the fertility clinic’s conclusion, she says the doctor shrugged again and told her that menopause is a normal part of life. She wasn’t satisfied with that answer. “Yeah, it’s a normal part of life, but it would be great if we could talk about it and figure out strategies.”
With that spirit in mind, we reached out to endocrinologists, gynecologists and psychiatrists for advice about navigating this major life transition.
How early can perimenopause start?
It’s quite possible for women to start to notice things changing in their mid-30s. Most women arrive at menopause between the ages of 45 and 55, but perimenopause can start as much as a decade beforehand. And about 1% of women in the U.S. reach menopause at age 40 or younger.
What Are The Complications Of Menopause
Menopause occurs alongside a range of lifestyle and metabolic changes in women. These include:
- Heart disease Menopause has a significant impact on a womans risk of getting heart disease.
- Osteoporosis during menopause, your body starts to break down bone tissue more quickly than it replaces it.
- Sex drive Women often find their sexual feelings and desires change around the time of menopause.
These changes are common, and it may help to discuss them with your partner, your doctor or a trusted friend.
Can Menopause Cause Depression
Your body goes through a lot of changes during menopause. There are extreme shifts in your hormone levels, you may not be sleeping well because of hot flashes and you may be experiencing mood swings. Anxiety and fear could also be at play during this time. All of these factors can lead to depression.
If you are experiencing any of the symptoms of depression, talk to your healthcare provider. During your conversation, your provider will tell you about different types of treatment and check to make sure there isnt another medical condition causing your depression. Thyroid problems can sometimes be the cause of depression.
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What Can I Do To Help Myself
To help you manage hot flushes, simple things like wearing light clothing, using a fan and keeping your bedroom cool could help.
If youre struggling with your mood, consider trying self-help measures like relaxation, getting enough sleep and staying active.;Regular physical activity and eating a healthy diet can also help to improve menopausal symptoms.
What Is Premature Menopause
Menopause, when it occurs between the ages of 45 and 55, is considered “natural” and is a normal part of aging. But, some women can experience menopause early, either as a result of a surgical intervention or damage to the ovaries . Menopause that occurs before the age of 45, regardless of the cause, is called early menopause. Menopause that occurs at 40 or younger is considered premature menopause.
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General Recommendations For Ht
Current guidelines support the use of HT for the treatment of severe hot flashes that do not respond to non-hormonal therapies. General recommendations include:
- HT may be started in women who have recently entered menopause.
- HT should not be used in women who have started menopause many years ago.
- Women should not take HT if they have risks for stroke, heart disease, blood clots, and breast cancer.
- Currently, there is no consensus on how long HT should be used or at what age it should be discontinued. Treatment should be individualized for a woman’s specific health profile.
- HT should be used only for menopause symptom management, not for chronic disease prevention.
Initiating Therapy
Before starting HT, your doctor should give you a comprehensive physical exam and take your medical history to evaluate your risks for:
- Heart disease
- Osteoporosis
- Breast cancer
While taking HT, you should have regular mammograms and pelvic exams and Pap smears. Current guidelines recommend that if HT is needed, it should be initiated around the time of menopause. Studies indicate that the risk of serious side effects is lower for women who use HT while in their 50s. Women who start HT past the age of 60 appear to have a higher risk for side effects such as heart attack, stroke, blood clots, or breast cancer. HT should be used with care in this age group.
Discontinuing Therapy
Safety Concerns
Women who should not take hormone therapy include those with the following conditions:
Oral Contraceptives And Vaginal Treatments
Oral contraceptive pills
Oral contraceptive pills are another form of hormone therapy often prescribed for women in perimenopause to treat irregular vaginal bleeding. Women in the menopausal transition tend to have considerable breakthrough bleeding when given estrogen therapy. Therefore, oral contraceptives are often given to women in the menopause transition to regulate menstrual periods, relieve hot flashes, as well as to provide contraception. They are not recommended for women who have already reached menopause, because the dose of estrogen is higher than that needed to control hot flashes and other symptoms. The contraindications for oral contraceptives in women going through the menopause transition are the same as those for premenopausal women.
Local hormone and non-hormone treatments
There are also local hormonal treatments for the symptoms of vaginal estrogen deficiency. Local treatments include the vaginal estrogen ring , vaginal estrogen cream, or vaginal estrogen tablets. Local and oral estrogen treatments are sometimes combined for this purpose.
Vaginal moisturizing agents such as creams or lotions as well as the use of lubricants during intercourse are non-hormonal options for managing the discomfort of vaginal dryness.
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Can Menopause Affect My Sex Life
After menopause, your body has less estrogen. This major change in your hormonal balance can affect your sex life. Many menopausal women may notice that theyre not as easily aroused as before. Sometimes, women also may be less sensitive to touch and other physical contact than before menopause.
These feelings, coupled with the other emotional changes you may be experiencing, can all lead to a decreased interest in sex. Keep in mind that your body is going through a lot of change during menopause. Some of the other factors that can play a role in a decreased sex drive can include:
- Having bladder control problems.
- Having trouble sleeping through the night.
- Experiencing stress, anxiety or depression.
- Coping with other medical conditions and medications.
All of these factors can disrupt your life and even cause tension in your relationship. In addition to these changes, the lower levels of estrogen in your body can actually cause a decrease in the blood supply to the vagina. This can cause dryness. When you dont have the right amount of lubrication in the vagina, it can be thin, pale and dry. This can lead to painful intercourse.
I Got My First Period Early Does That Mean Ill Go Through Menopause Early
I have many patients tell me, I know Im going to go through menopause earlier because I started my period really early, says Streicher. The reason women think that is because they think menopause occurs when you run out of eggs. This isnt going to happen; were born with millions of eggs and many of those are never used. When you go through menopause is really about the aging of eggs and what causes them to age more quickly, she says.
The average age of menarche in the United States has gotten younger for a variety of reasons, but that hasnt made women go through menopause earlier, she points out.
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What Age Will I Start Menopause
What most women are probably asking when they ask this question is, At what age will I start perimenopause? since thats actually when noticeable symptoms arise for most of us.
Its pretty much impossible to tell a woman when her menopause will occur unless menopause is the result of a medical intervention such as breast cancer treatment or hysterectomy.
However, there are factors that may help her understand her body better. According to an article in the National Center for Biotechnology Information , the following may have some impact on when a woman begins her menopause transition.
How Do I Know If Changes In My Periods Are Normal Perimenopausal Symptoms Or Something To Be Concerned About
Irregular periods are common and normal during perimenopause . But other conditions can cause abnormalities in menstrual bleeding. If any of the following situations apply to you, see a doctor to rule out other causes.
- Your periods are changing to become very heavy, or accompanied by blood clots.
- Your periods last several days longer than usual.
- You spot or bleed after your period.
- You experience spotting after sex.
- Your periods occur closer together.
Potential causes of abnormal bleeding include hormonal imbalances, hormonal treatments, pregnancy, fibroids, blood-clotting problems or, rarely, cancer.
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What Age Is Considered Early For Menopause
If you reach menopause before age 40, that is considered premature menopause, says Faubion. This occurs in about 1 to 2 percent of women, she says.
Experiencing menopause at 40 to 45 years of age is called early menopause, and that occurs in about 5 to 7 percent of the population, so its safe to say that at least 7 percent of women are going to go through menopause early or prematurely, says Faubion. Menopause at age 46 or older is considered normal, she says.
How Long Does The Menopause Last
Symptoms of the menopause can start months or even years before periods stop completely. They usually continue for around 4 years after your last period, though some womens symptoms continue for much longer.
The menopause usually happens between the ages of 45 and 55, but its very difficult to predict when it will take place in an individual.
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Determining Your Menopause Age
Theres no simple test that can tell you when youll reach menopause, but researchers are working on creating one.
Examining your family history may be the most accurate way to help you predict when you might experience the change. Youll likely reach menopause around the same age as your mother and, if you have any, sisters.
Perimenopause: Rocky Road To Menopause
What are the signs of perimenopause? You’re in your 40s, you wake up in a sweat at night, and your periods are erratic and often accompanied by heavy bleeding: Chances are, you’re going through perimenopause. Many women experience an array of symptoms as their hormones shift during the months or years leading up to menopause that is, the natural end of menstruation. Menopause is a point in time, but perimenopause is an extended transitional state. It’s also sometimes referred to as the menopausal transition, although technically, the transition ends 12 months earlier than perimenopause .
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When Does Menopause Usually Start
Every woman is different, but the menopausal transition usually starts between ages 45 and 55, per the NIA. Some women can start as early as 35, while others may not start it until theyre 60, says , M.D., M.D., a clinical professor of obstetrics and gynecology and reproductive sciences at Yale Medical School.
Family history is a reasonable predictor, she says. If everyone in the family went through menopause on the early side, there is a good chance you may, too.
When you got your first period could also help predict when you’ll experience perimenopause. According to a 2017 study in the journal Human Reproduction, women who started their menstrual periods at 11 years old or younger had an 80% higher risk of hitting menopause before the age of 40, compared those who got their first period at 12 or 13 years old.
Home Remedies: Plant Estrogens
Plant estrogens
Isoflavones are chemical compounds found in soy and other plants that are phytoestrogens, or plant-derived estrogens. There is a perception among many women that plant estrogens are “natural” and therefore safer than HT, but medical researchers haven’t proven this scientifically. Most scientific studies have not shown a benefit of phytoestrogens in controlling hot flashes. In addition, there is concern that some phytoestrogens might act like estrogen in some tissues of the body. Therefore, many experts recommend that women who have a history of breast cancer avoid phytoestrogens.
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What Causes The Menopause
The menopause;is caused by a change in the balance of the body’s sex hormones, which occurs as you get older.
It happens when your ovaries stop producing as much of the hormone oestrogen and no longer release an egg each month.
Premature;or early menopause;can occur at any age, and in many cases there’s no clear cause.
Sometimes it’s caused by a treatment such as surgery to remove the ovaries , some;breast cancer treatments, chemotherapy;or radiotherapy, or it can be brought on by an underlying condition, such as Down’s syndrome;or;Addison’s disease.
Page last reviewed: 29 August 2018 Next review due: 29 August 2021
Lifestyle Factors In Controlling The Symptoms And Complications Of Menopause
Many of the symptoms of menopause and the medical complications that may develop in postmenopausal women can be lessened or even avoided by taking steps to lead a healthy lifestyle.
- Regular exercise can help protect against cardiovascular disease and osteoporosis. Exercise also has proven mental health benefits.
- Stop smoking
Which types of doctors treat menopausal symptoms?
The symptoms of menopause are often treated by a womanâs gynecologist. Primary care providers, including family medicine specialists and internists, may also treat the symptoms of menopause.
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What Other Medications Treat Menopause Symptoms
The classes of drugs known as selective serotonin reuptake inhibitors and selective norepinephrine reuptake inhibitors , typically used in the treatment of depression and anxiety, have been shown to be effective in reducing menopausal hot flashes. Paroxetine is an SSRI that has been approved for the treatment of moderate to severe hot flashes associated with menopause. Another SSRI that has been tested and shown to be effective is venlafaxine , although other SSRI drugs may be effective as well.
Clonidine is a drug that decreases blood pressure. Clonidine can effectively relieve hot flashes in some women. Side effects include dry mouth, constipation, drowsiness, and difficulty sleeping.
Gabapentin , a drug primarily used for the treatment of seizures, has also been used successfully to treat hot flashes.
Progestin drugs have also been successfully used to treat hot flashes. Megestrol acetate is sometimes prescribed over the short term to help relieve hot flashes. Serious effects can occur if the medication is abruptly discontinued, and megestrol is not usually recommended as a first-line drug to treat hot flashes. An unpleasant side effect of Megestrol is that it may lead to weight gain.
Several medications may be used for preventing and treating osteoporosis.
Other Drugs Used For Menopausal Symptoms
Despite its risks, hormone therapy appears to be the most effective treatment for hot flashes. There are, however, nonhormonal treatments for hot flashes and other menopausal symptoms.
Antidepressants
The antidepressants known as selective serotonin-reuptake inhibitors are sometimes used for managing mood changes and hot flashes. A low-dose formulation of paroxetine is approved to treat moderate-to-severe hot flashes associated with menopause. Other SSRIs and similar antidepressant medicines are used “off-label” and may have some benefit too. They include fluoxetine , sertraline , venlafaxine , desvenlafaxine , paroxetine , and escitalopram .
Gabapentin
Several small studies have suggested that gabapentin , a drug used for seizures and nerve pain, may relieve hot flashes. This drug is sometimes prescribed “off-label” for treating hot flash symptoms. However, in 2013 the FDA decided against approving gabapentin for this indication because the drug demonstrated only modest benefit. Gabapentin may cause:
- Drowsiness
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What Is Hormone Therapy
During menopause, your body goes through major hormonal changes, decreasing the amount of hormones it makes particularly estrogen and progesterone. Estrogen and progesterone are produced by the ovaries. When your ovaries no longer make enough estrogen and progesterone, hormone therapy can be used as a supplement. Hormone therapy boosts your hormone levels and can help relieve some symptoms of menopause. Its also used as a preventative measure for osteoporosis.
There are two main types of hormone therapy:
- Estrogen therapy : In this treatment, estrogen is taken alone. Its typically prescribed in a low dose and can be taken as a pill or patch. ET can also be given to you as a cream, vaginal ring, gel or spray. This type of treatment is used after a hysterectomy. Estrogen alone cant be used if a woman still has a uterus.
- Estrogen Progesterone/Progestin Hormone Therapy : This treatment is also called combination therapy because it uses doses of estrogen and progesterone. Progesterone is available in its natural form, or also as a progestin . This type of hormone therapy is used if you still have your uterus.
Hormone therapy can relieve many of the symptoms of menopause, including:
- Hot flashes and night sweats.
- Vaginal dryness.
