Menopause, Depression and Anxiety

Every woman’s experience of her menopause is individual and the majority of women have symptoms that negatively affect their personal, family and work lives. The menopause can lead to many different symptoms occurring because oestrogen (the main hormone that reduces in your body during the menopause) affects many different areas of your body, including your brain and emotions. Symptoms of the menopause can last for many years, even decades. You may start to experience symptoms during your perimenopause (the time in which you experience menopausal symptoms but are still having periods) that can last for several years.

Most people associate the menopause with hot flushes and night sweats, but these are actually the symptoms that bother my patients the least. It is the symptoms that other people cannot see that lead to the most difficulties and these are the psychological symptoms.

Low mood and feelings of depression can be very common symptoms of the menopause and perimenopause. Other psychological symptoms include feelings of low self-esteem, having reduced motivation, anxiety, irritability, panic attacks, poor concentration and low energy. These symptoms can be mistaken for depression and I see many women in my clinic who have wrongly been given antidepressants by their doctors for these symptoms.

It can be common for women to feel more irritated and angry than they used to which can really affect their families and their ability to function at work. Women often feel more tearful and frequently have mood swings.

If you have had postnatal depression in the past, or a history of PMS, then it is more likely you will experience these types of symptoms during your menopause. This is because your body is more sensitive to changing levels of hormones.

Lifestyle

During your perimenopause and menopause it is really important to consider your wellbeing and lifestyle. You should look at your diet and consider ways of improving it to eat a healthy, balanced Mediterranean-style diet, and reduce your intake of processed foods. You should consider limiting alcohol intake and stop smoking (if relevant). Undertaking regular exercise is really beneficial to your body, especially at this significant time in your life.

HRT

Hormone replacement therapy (HRT) is the best treatment for menopausal symptoms as it replaces your body with oestrogen. There are many different types and doses of HRT and they all contain oestrogen. The oestrogen can be given as a tablet, gel or patch. If a woman still has her womb then she also needs a progestogen which can be given as a tablet or by having a Mirena® IUS. Women who have had a hysterectomy in the past (operation to remove the womb) do not need to take a progestogen, unless they have a history of severe endometriosis.

Taking the right type of oestrogen can really help improve this low mood and other symptoms related to the menopause. Many women find that they feel calmer, have more energy, are more motivated and generally much happier when they take HRT.

Some women also need to take the hormone testosterone which is usually given as a gel but can also be given as an implant. Testosterone is produced by your ovaries before the menopause in higher levels than oestrogen. This hormone is important for libido and also can help to improve mood, energy and concentration. It can be really beneficial for younger women and I have many patients who take testosterone with excellent results. They describe that their “emotional energy” has returned.

Too many women are scared about HRT following very negative reports in the media. The biggest worry they have is associated with breast cancer. However, there are some really important facts about this. Firstly, all the studies have shown that women who do not take a progestogen (so those women who have had a hysterectomy in the past) have no increased risk of breast cancer with taking HRT. Secondly, women who start HRT when they are under 51 years of age (the average age of the menopause in the UK) do not have an increased risk of breast cancer. Thirdly, the small increased risk of breast cancer that has been demonstrated in some studies has shown that this risk is lower than the increased risk of breast cancer if you are overweight or drink a couple of glasses of wine a night.

Taking HRT actually reduces your future risk of really important diseases such as osteoporosis, heart disease and diabetes. So, in addition to helping you feel better, you can be reassured that taking HRT is actually a real investment for your future health.

Last updated: February 2018

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