Birthday Candles and Bullsh*t: Menopause, Depression, Anxiety, and Grieving

Monday, March 30, 2015 by Meg   •   Filed under General

Nothing makes you want to say “fuck you” to Mother Nature quite like menopause. 

From irregular periods to vaginal dryness to sleep issues to weight gain to hot flashes to thinning hair, to dry skin to a loss of breast fullness, it’s a bitchslap of epic proportions. There is also a loss of elasticity in the vagina which can lead to pain or bleeding during intercourse. As if we needed any more bullshit going on down there after pregnancy made our bladder leak every time we sneeze. 

Menopause can be caused by hormonal changes, hysterectomy (particularly of the ovaries were removed), chemotherapy, or ovarian insufficiency, a condition where your ovaries don’t produce enough reproductive hormones. Ovarian insufficiency can be related to genetic factors or environmental factors such as lack of proper nutrition and is more common in those with certain autoimmune diseases. 

But the changes are not all physical. There's shock, grief at aging, a sense of uselessness, depression and anxiety, insomnia and the list goes on. Let's check out why those things happen and some remedies that can help reduce the symptoms.

Fucking Mother Nature.

When Menopause Strikes

Women, particularly younger women, are often given inadequate information on the causes of menopause1. And many practitioners skip over the fact that along with the physical issues, women in menopause also tend to suffer from self esteem issues1,2. And the symptoms don’t only come as a shock to younger women going through menopause3; it can also be shocking to women over fifty who just weren’t ready yet. Some think that because their mother didn’t begin menopause until later that they had more time. We grieve this loss of fertility even if we had no intention of having more children.

And this might be partially connected to our evolutionary history. 

Grieving a Lack of “Usefulness”

In our ancestral past, menopausal women were great assets to the community, rearing grandchildren while younger women went out to forage or hunt. They were not bonuses; grandmothers were vital for survival of the next generation. (See more here in The Grandmother Hypothesis.)

Fast forward a few years and they are seen as the candy providers, the irritating toy senders the “mother in laws from hell”. This does not bode well with an evolutionarily relevant desire to assist. We’re hardwired to help. We don’t like that we are no longer needed.  And it doesn’t help that menopause usually strikes when children are getting ready to leave the nest for good. 

Grieving Aging

Botox, wrinkle creams and make-up designed to hide the signs of aging are a huge money maker because we fight so vehemently against getting older. The media ensures that our sense of self revolves around thin waists, pert breasts and a lack of wrinkles (more here in "You're Not Pretty (Enough)"). If we don’t buy into the whole, “You need to look younger to be better!” idea, we wouldn’t buy their shit. They devalue aging to such an extent that  it is difficult to see beyond it. It is no wonder we grieve as if losing a part of ourselves.

Menopause and Grieving a Loss of Choice

It’s one thing to say, “Eh, I don’t really want more kids.” It is quite another to not be able to have more because you have passed the stage where it is possible. This upheaval can also happen to younger women whose husbands have had vasectomies or who have had some other procedure to derail fertility, despite making a well-thought-out decision. As menopause approaches, we may even have a spike in sex drive and a last ditch craving to sleep with the pool boy because it is our last physical chance to score another source of long-lasting support. In our evolutionary history, more fathers equaled more provisions and less chance that we'd be left alone. While this drive may no longer be as socially relevant as it once was, it doesn't stop the pool boy from being sexy as hell.  

Outside of reproduction, we can't choose our wrinkles, we can't choose when the kids will leave home, or maybe we can't do all the things we used to do because of an injury or arthritis issues. Choice matters in every element of our lives (check out The Art of Choosing for more).

While there are clearly a myriad of things we may grieve during this time, changes in life create a great deal of emotional upheaval. Pair that with hormonal changes and we feel like we might lose our shit.  

Menopause, Anxiety and Depression

Hormones are sneaky fuckers especially when it comes to mood. Depression rates are far higher in menopausal women compared to non-menopausal  counterparts, and anxiety can go along with it4. This might be related to the FSH (follicle stimulating hormone) and LH (Luteinizing hormone) and E2 (Estradiol) all hormones related to reproduction which plummet after menopause4

Estrogens like E2 have many effects on the central nervous system and interact with the Hypothalamic Pituitary Axis (more here) either of which can trigger anxiety and/or depression when not functioning properly5. Despite this, estrogen replacement therapy (or supplementing estrogen) does not usually lead to improvements in mood in postmenopausal women6

And because those hormones are so related to these internal systems, the moods we have might be linked to the symptoms we experience depending on how the whole thing is working. Depressed menopausal women are more likely to have headaches, whereas anxious menopausal women are more likely to have numbness or nausea7. Those who are more predominately anxious also tend to have significantly more hot flashes than women without anxiety (nearly five times more to be exact) and anxiety peaks during these flashes8. This suggests that for some, treating the anxiety or anti anxiety medications may reduce some of these other symptoms by default, though researchers are unclear about the mechanism behind it. Which blows because you know if it was happening to men they would be all over that shit. 

“The man” is kind of a bastard.

But all these differences in how menopause symptoms play out, is probably due to the differences in neurotransmitter function going into menopause. A history of depression changes the brain in a number of ways that can alter other systems over time. (More on that here in Depression and Brain Changes.)  And if you want more information on hormonal regulation, menopause and mood, I highly recommend Why Do I Still Have Thyroid Symptoms When My Lab Tests Are Normal?

Insomnia and Menopause

Insomnia is prevalent in those going through menopause. These women have trouble initiating sleep and have “non-restorative sleep” which basically means you wake up still exhausted. Those with trouble getting to sleep are more likely to be anxious, whereas those with non restorative sleep have more depression9.

This is partially related to melatonin a hormone that regulates sleep and wake cycles.  As women age and progress through menopause, night levels of melatonin decline10. And this interacts with other hormones too. Melatonin given to younger women (age 43-49) has been shown to decrease LH levels, but it does not have this effect on older or menopausal women10. Most of the women in this study (younger and older) reported improvements in their mood and much less depression, which led researchers to conclude that the melatonin helped the pituitary glad and the thyroid ( both hormone producers) to recover a younger pattern of regulation. 

Neat-o. If you want to try melatonin, get it here. And on that note, let’s check out some natural remedies for menopausal symptoms. 

Natural Remedies for Menopausal Symtoms

  • Red clover is effective in reducing anxiety and depression in postmenopausal women when two 80mg capsules are taken daily11. This may be due to it’s antioxidant properties, anti-inflammatory properties and its interaction with other enzymes that promote health through these interactions14. It also seems to have a fairly low side effect profile unless you are allergic to the clover, so stop taking it if you get rashes or hives. If you are on blood thinners or are going into surgery, avoid it too due to a compound called coumarin that acts as a blood thinner. I have heard good things about this brand

The following have also been shown to be effective in decreasing mood and anxiety changes during menopause: 

Other Ways to Cope with Menopausal Symptoms

  • Exercise to help your body regulate itself, reduce stress and boost feel-good chemicals in your brain. Brains love endorphins as much as Rush Limbaugh loves being an asshole. (So I hear.)
  • Get Social to combat isolation, a known trigger to depression, anxiety and low self esteem. Go to the movies. Have a game night with women in your neighborhood. Make it a point to visit friends once a week for coffee. Make plans with children or grandchildren as often as possible. Make sure that loneliness doesn’t inadvertently trigger more emotional issues as you try to traverse the sea of changes that come with menopause. 
  • Work Through Triggers As always, identify any other psychological triggers to emotional issues. If you are experiencing intense sadness related to an empty nest, talk about this with your partner, with friends or with a professional. If you are feeling lonely or “unnecessary” talk to your family about your emotions and you might be surprised by their responses. Write your thoughts and feelings out in a journal to process them. Get creative and write some poetry, start sketching or take a local art class if you feel you need another outlet for our emotions. And if you still have negative or scary thoughts, anxiety or depression, try mindfulness, thought replacement, deep breathing exercises or even humor. (click on the words for more on those.)

Menopause, as with any life change presents a number of challenges. This should not be written off as, “Don’t worry about it, it happens to everyone.” We need to discuss these issues to normalize them for the women suffering and to ensure that more research will be done in this area. And check out What Your Doctor May Not Tell You About Menopause. It's worth it, I promise.

If you are suffering, you are not abnormal. And you are not alone. 

Related Posts: 

Citations
  1. http://www.ncbi.nlm.nih.gov/pubmed/21762006
  2. http://www.ncbi.nlm.nih.gov/pubmed/10818847
  3. http://www.ncbi.nlm.nih.gov/pubmed/11843980 
  4. http://www.ncbi.nlm.nih.gov/pubmed/11205708
  5. http://www.ncbi.nlm.nih.gov/pubmed/16554740 
  6. http://www.ncbi.nlm.nih.gov/pubmed/22016254 
  7. http://www.ncbi.nlm.nih.gov/pubmed/23379427
  8. http://journals.lww.com/menopausejournal/Abstract/2005/12030/The_role_of_anxiety_and_hormonal_changes_in.6.aspx
  9. http://www.ncbi.nlm.nih.gov/pubmed/22326659 
  10. http://www.ncbi.nlm.nih.gov/pubmed/11226744
  11. http://www.ncbi.nlm.nih.gov/pubmed/19948385
  12. http://www.ncbi.nlm.nih.gov/pubmed/17194961
  13. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2529395/
  14. http://www.ncbi.nlm.nih.gov/pubmed/22876957 



Topic-Relevant Resources

What Your Doctor May Not Tell You About Menopause (TM): The Breakthrough Book on Natural Hormone Balance
Fabulous overview on hormonal issues in menopause and what to do about them.

Why Do I Still Have Thyroid Symptoms (when my lab tests are normal)
Exploration of the causes and effects of thyroid malfunction on mental health and other body systems

Against Depression
Detailed explanations of the systems involved in depression along with personal stories of success from psychiatrist Peter Kramer.



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