Menopause and mental health

Mental health issues may occur during menopause; when is it time to seek help?
Menopause and mental health

What is menopause?


Menopause is the natural culmination of the woman’s menstrual cycles. In India, the average age of menopause is between the ages of 46 and 48. However, different women have different experiences mostly determined by their medical and family histories. Some women may experience menopause anywhere between the ages of 41 and 50. Menopause before the age of 40 is referred to as premature menopause; and menopause after the age of 52 is considered delayed menopause.

Women may experience menopause over a 10-year period. It begins with a change in the frequency of the menstrual cycle, change in flow, erratic periods, hot flushes, sweating and sleep disturbances. Family support becomes very crucial.

Menopause brings in changes in many domains of a woman’s life

For most Indian women, menopause occurs during a time when their children have left home; it’s also the age at which they are dealing with being the caregiver to their parents and in-laws, or losing them. They may also pay greater attention to their health and find out about the existence of health issues: diabetes, cholesterol, risk of heart attack, hypertension or thyroid imbalance. Women who work may be at a stage in their career where they are required to take up roles of responsibility, and they may struggle to meet all the demands that these changes make of them.

Physical health problems

During menopause, the body stops producing estrogen. Estrogen is essential for cardiac, skin and bone health, and many women have complications around these. The bones get weaker, and the person experiences backaches, and shoulder and joint pains. Some women experience stress incontinence, which they may be embarrassed about.

Most women report problems with sleeping; they find it hard to fall asleep or have trouble sleeping through the night. (A gynecologist in Bangalore says that at least 20-25 per cent of her patients complain of insomnia during this period).

Menopause and mental health

There are many women who expect menopause and are prepared for it; they are able to cope with the changes it brings. But for some others, menopause becomes a very challenging life event, and they may need to seek help from a mental health professional.

Some women find it hard to cope with the sudden realization that their body is aging physiologically, while they may be at the top of their careers or feel perfectly fit and young in their minds. Women who have set themselves high goals may see this as a reminder that a significant part of their life is already behind them. This realization could create anxiety, distress or hopelessness; the mind is still fit but their body begins moving in a different direction

Dr Sabina Rao, consultant psychiatrist, Sakra World Hospital

What to expect during menopause

During menopause, you may undergo several hormonal, physiological and emotional changes, including:

  • Fatigue; feeling tired and low on energy through the day

  • Disturbed sleeping patterns

  • Hot flushes, feeling sweaty

  • Racing heart and mood swings

  • Stress incontinence (for example involuntary leakage of urine while coughing)

  • Back and shoulder aches

When present in moderation, these symptoms are typical of menopause. But it is important to know when these symptoms stop being normal, and you need to seek help.

Mental health issues during menopause

At least one in five women suffers from depression during menopause. Women with a personal or family history of depression (including postpartum depression) are particularly vulnerable. Experts say that the discomfort caused by night sweats and hot flushes could lead to sleep disturbance, and affect mood stability.

Many women also experience problems with their cognitive function; they may have difficulty in remembering things or concentrating on specific tasks. Menopause may trigger schizophrenia, bipolar disorder, an anxiety or panic disorder in women already predisposed to these mental illnesses.  Women who have had a mental illness earlier are also more vulnerable to a relapse. 

When menopause isn’t ‘natural’

Women who undergo surgical menopause (removal of the ovaries, which leads to the end of their menstrual cycles) may experience distress, partly due to the fact that their menopause came out of the blue, without prior warning (natural menopause is experienced over a ten-year period, beginning with irregularities in the woman’s menstrual cycles). They may experience the loss of their uterus as unnatural, or see themselves as having lost the essence of being a woman; the change in hormone levels may lead to them putting on weight and developing body image issues. They may also develop symptoms of anxiety or depression.

Women in this category often find it easier to cope when they have good post-operative care, psychological support and family support. If you are experiencing surgical menopause, reach out to a counselor who can help you manage your thoughts and self-image.

Support from the family helps to cope with menopause

Whether the menopause is natural or surgical, the support from family – particularly from the spouse – can help a woman cope with the physical and emotional changes that menopause brings. Here’s what family can do to make this process easier for the woman:

  • It’s important for the family to be aware of what the woman is going through. The spouse can accompany the woman to her doctor’s appointments and support her in caring for herself.

  • The spouse can also plan activities that the couple can do together, such as going for a walk or a jog, or regular exercise, that will help the woman stay fit.

  • Offer emotional support to the woman; spend quality time with her.

  • Empathize with the woman when she finds it hard to cope.

  • If she is in a low mood, don’t put it down to PMS or a ‘woman’s thing’ – understand that what she is going through may be exhausting or overwhelming for her.

Staying mentally well during menopause

Making some lifestyle changes can help you cope with the changes brought in by menopause and stay mentally well.

  • Go for regular health check-ups and visit your gynecologist to rule out the possibility of a thyroid malfunction or a disease of the reproductive organs.

  • Exercise. If you have never exercised earlier, this is a good time to start a routine. Yoga and pranayama can help you stay flexible and maintain your bone health. Get enough exposure to sunlight.

  • Understand that your body is changing; and set your expectations accordingly. The focus should not be on losing weight, but rather on not gaining weight. Don’t assume that you cannot control it, and give up on keeping yourself fit.

  • Pay attention to your diet; eat more frequent meals in smaller quantities. Increase your intake of fiber, natural vitamins and minerals.

  • Most importantly, take time out for self care. Set aside some ‘me’ time and indulge in a hobby or activity you enjoy.

  • If you are overwhelmed and unable to cope, reach out to a counselor or a psychiatrist immediately.

This article has been written with inputs from Dr Sabina Rao, consultant psychiatrist, Sakra World Hospital, Dr Aruna Muralidhar, consultant obstetrician and gynecologist, Apollo Cradle Jayanagar, and Dr Geetha Desai,additional professor of psychiatry, NIMHANS, Bangalore.

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