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Rethinking menopause: Focus on care, not catastrophe

Attitudes towards menopause help shape younger women's expectations. A negative attitude towards menopause increases the future risk of developing depressive symptoms over perimenopause.

News Arena Network - Melbourne - UPDATED: September 17, 2024, 11:13 AM - 2 min read

Rethinking menopause: Focus on care, not catastrophe

Rethinking menopause: Focus on care, not catastrophe

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Menopause is having a cultural moment.

 

Sick of suffering in silence, globally women and their doctors are speaking up and demanding access to open conversations and better menopause care.

 

For decades, some women have endured an enormous amount of unnecessary suffering around menopause.

 

There have been countless stories of healthcare professionals failing women, for instance through dismissing menopausal symptoms and failing to provide adequate care.

 

So this attention is long overdue.

 

But with this spotlight has come a lot of messaging that menopause is catastrophic for mental health.

 

For example, in a submission to the 2024 Australian Senate Inquiry into menopause, which is due to hand down its findings on September 17, this life stage was described as a time of "damage, despair and death" due to untreated menopausal mental illness.

 

Changing estrogen levels over menopause have been reported to cause a "destabilising" effect on the brain and mental health.

 

But while research shows some women may be more mood-sensitive to estrogen changes than others, overall the best available data shows that mental illness is not a core or common experience over the menopause years.

 

Anger is not mental illness Some midlife women self-report feelings of anger or rage around the time of menopause.

 

Anger is not a mental illness, but should be followed up if it becomes severe or is negatively affecting your daily life.

 

Being dismissed in a doctor's office because "my wife coped fine with menopause" or because a GP explains they are not trained to manage menopause and refers on to a specialist clinic that has a 12-month waitlist are legitimate triggers for anger and unnecessary suffering.

 

As a society, this anger can be mobilised to demand improved care for menopause and ageing women's health issues, while providing appropriate care for distressing or impactful symptoms as needed.

 

Most women remain mentally well

 

A Lancet Series paper on menopause and mental health reviewed findings from prospective studies that tracked changes in women's mental health across the menopause transition.

 

Specifically, depressive symptoms and disorders were looked at, as well as anxiety, bipolar, psychosis and suicide.

 

It found rates of depressive symptoms remained relatively low over perimenopause, which is the time of irregular periods culminating in the final menstrual period at menopause.

 

In the studies reviewed, 17 per cent to 28 per cent of perimenopausal women reported depressive symptoms compared to 14 per cent to 21 per cent of premenopausal women.

 

Only two studies have investigated the risk of developing major depressive disorder assessed uniformly by a clinician, and neither found that women were at increased risk of new-onset depression over menopause.

 

Women typically start to go through menopause in their late 40s.

 

Australian Bureau of Statistics data shows no increase in the prevalence of depressive disorders in women of this age. Instead, it is men who experience an increased prevalence of depressive disorders at midlife.

 

In other words, the hormonal changes of menopause don’t appear to have a "destabilising" effect on mental health for most women.

 

This information is important to help women feel more confident about transitioning menopause.

 

Attitudes towards menopause help shape younger women's expectations. A negative attitude towards menopause increases the future risk of developing depressive symptoms over perimenopause.

 

By avoiding unhelpful and inaccurate messages that menopause often spells doom for mental health, we can help improve expectations for the next generation of women entering menopause.

 

However, research shows that certain subgroups of women are at risk of mental health issues over menopause and there is more that could be done to support these groups.

 

Risk factors for mental health 

 

The most evidence has been collected about the connection between menopause and depression. While most women don't develop depressive symptoms or disorders over menopause, some women are at risk.

 

Several factors relating to menopause and broader life circumstances help explain this.

 

These include severe hot flushes, especially those that disturb sleep, going through a particularly long menopause or being thrust into menopause due to surgery rather than as a result of natural ageing.

 

When these collide with other risks — previous history of depression, life stress or minority status — then the risk of mental health decline compounds.

 

Unfortunately, the lack of adequate medical training to manage menopause has only added to this burden.

 

Supply issues with access to menopause hormone therapy for those who need it is another factor at play.

 

While hormone therapy is very effective for symptoms like hot flushes and night sweats, it has not been shown to treat symptoms such as depression, anger, brain fog or fatigue which some women experience at midlife.

 

These factors are all alongside a broader culture that devalues ageing women's voices.

 

The path ahead

 

The messaging that menopause is a time of decline and decay and that mental illness is common at this life stage has its origins in the 1950s.

 

Dr Herbert Kupperman and Dr Meyer Blatt were the first to compile a scale to describe and measure "menopausal syndrome", and considered psychological symptoms as central to the experience of menopause based on their observations of women they treated in menopause clinics.

 

They described the uterus as the "Achilles heel" of the organs and menopause as a "rather unpleasant and possibly dangerous" time of life.

 

Women deserve better than this outdated messaging because it is not backed by good science.

 

Equally, dismissing women's mental health concerns at midlife, or the potential impact of menopausal symptoms on mental health, is just as problematic.

 

Improving high-quality training in menopause management for medical students and practitioners along with improving the skills of psychologists and other health professionals could go a long way to address this issue.

 

Perhaps most importantly, midlife women's voices need to take centre stage.

 

As the next generation of women enter perimenopause, they probably hope to be wiser, more powerful and compassionate versions of themselves due to the life experience and leadership opportunities gained by age.

 

Balanced clinical care that acknowledges and treats any menopause symptoms — without framing menopause as a disaster — would help empower these women to thrive over the midlife years.

 

With arrangement between PTI/360info.org

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