Treatment of menopause-related mood disturbances

More than 1.7 million American women are expected to reach menopause each year. Recent Canadian statistics show that a 50-year-old woman can now expect to live until her mid-80s, which implies living at least one-third of her life after menopause. The menopausal transition is typically marked by intense hormonal fluctuations, accompanied by vasomotor symptoms (eg, hot flashes, night sweats), sleeps disturbance, and changes in sexual function, as well as increased risk for osteoporosis, cardiovascular disease, and cognitive decline. More importantly, recent studies have demonstrated a significant association between menopausal transition and a higher risk for developing depression. In the post-Women's Health Initiative Study era, physicians and patients are questioning the safety and efficacy of long-term hormone therapy use. This article reviews the current literature on the benefits and risks of using hormone therapy for the treatment of menopause-related mood disturbances and alternate strategies currently available for the management of menopause-related problems, including antidepressants, complementary and alternative medicine, and selective estrogen receptor modulators.     

Perimenopausal mental disorders: epidemiology and phenomenology

Perimenopause, the interval of irregular menstrual activity which directly precedes menopause, is characterized by widely fluctuating hormone levels amidst a large-scale decline in circulating estrogen. This phase in a woman's life is typically accompanied by physical discomforts including vasomotor symptoms, such as headaches, insomnia, and hot flushes, as well as genital atrophy. Not surprisingly, studies suggest a significant increase in mood lability for women during this time. While some evidence points toward an exacerbation of bipolar mood symptoms and an increase in schizophrenic psychosis during perimenopause, the majority of research conducted on perimenopausal mental disorders has focused on unipolar depression. Studies vary widely in methodology, definitions of menopausal status, and degrees of depression among subjects; however, the majority of findings indicate an increased susceptibility to depression during the perimenopausal transition. This greater susceptibility may be due to neuroendocrine effects of declining estrogen levels, the subjective experience of somatic symptoms resulting from this hormonal decline, and/or the more frequent occurrence of "exit" or "loss" events for women during this stage of life. At this time, more research is needed to address questions of prevalence, risk, and etiology for depression and other major mental disorders as related to the physiological and psychosocial changes associated with perimenopause.     

MEDICAL PERCEPTIONS OF MENOPAUSAL SYMPTOMS

Thirty-five physicians in family practice or gynecology, 43 practicing nurses, and 35 menopausal or postmenopausal women rated the frequency, severity, and causality of 15 menopausal symptoms commonly reported in the literature. Subjects also rated their degree of preference for four possible menopause treatments (counseling, estrogen therapy, mood-altering medication, and no treatment) and answered an open-ended question asking them what they saw as the major factor in determining whether a woman would experience difficulty at menopause. The results overall suggest that medical persons see menopausal symptoms as more pathological than women who have experienced or are experiencing menopause and that physicians, relative to menopausal women, adhere to a more psychogenic model in which psychological causality and symptoms are given greater emphasis than menopausal women give them.     

Is menopause depressing? An investigation of three perspectives

This study examines three perspectives in the literature about menopausal depression. According to one, the physiological changes of menopause result in increased psychological distress. Another approach proposes that menopause is most depressing for women who occupy traditional female gender roles. The third asserts that menopause is not especially depressing for most women. This study empirically examines three perspectives using data from two community surveys. These analyses suggest menopausal status may not be associated with depressive symptomatology, either directly or indirectly through traditional gender roles.This research was supported in part by PHS grant numbers 5T32MH13043, 5T32MH16373, and 5T32MH15774. I appreciate the helpful comments I received from Janet Berkeley, Bruce Link, and an anonymous reviewer on earlier versions of this paper. I also am grateful to Lenore Radloff and NIMH for providing the CMHA data and to Harold Dupuy and NCHS for the HANES data.     

A Review of Symptoms Commonly Associated with Menopause: Implications for Clinical Neuropsychologists and Other Health Care Providers

Menopause is a process, either naturally or medically induced, that occurs in nearly all women at some point in life. Some of the most commonly reported symptoms associated with menopause are hot flushes/flashes, fatigue, headaches, irritability, insomnia, and depression. These symptoms overlap with symptoms commonly reported in Traumatic Brain Injury (TBI) as well as postconcussive syndrome. This overlap between symptoms commonly associated with menopause and neuropsychological conditions makes it necessary to have the base rates of these symptoms and conditions available. The purpose of the present review was to consolidate the clinical literature on the most commonly reported menopausal symptoms and to calculate the base rates associated with these symptoms.     

Spirituality and Severity of Menopausal Symptoms in a Sample of Religious Women

Menopause represents an important life change, particularly for religious women whose identity is significantly related to family. Two competing hypotheses are examined: one, because religious women have their identity focused on family and child rearing, spirituality will be related to increased menopausal symptoms because menopause represents a loss of identity and purpose; and two, because spirituality can provide strength and comfort during difficult times, it will, therefore, be related to decreased menopausal symptoms. To test these competing hypotheses, questionnaires were administered to 218 women (average age 55, 35% premenopausal, 26% peri-menopausal, 39% postmenopausal) who were members of the Church of Jesus Christ of Latter Day Saints. Regression analyses indicated that higher levels of spiritual strength were related to decreased levels of reported menopausal symptoms. Spiritual strength was also related to increased benefit finding during menopause, decreased concern with body appearance, and increased use of adaptive coping strategies. We conclude that finding strength in spirituality may help religious women cope better with the life changes associated with menopause.     

Health-related behaviours and their correlates in a general population sample of 45-year old women

Abstract

Preventive strategies for menopausal women to reduce the risks for osteoporosis and cardiovascular disease has been the focus of considerable attention, but understanding of mid-aged women's behavioural risk factors for these diseases is meagre. The current study describes a range of health-related behaviours and their psychosocial correlates, in a sample of 45-year old women, recruited from five general practices and assessed by postal survey (N=106, response rate 60%). Results suggest that health promotion for this group might best focus upon increases in regular exercise, calcium intake and breast awareness, and decreases in cigarette and caffeine consumption. The behaviours assessed were generally not inter-related. However, several associations were identified between behaviours and health and psychosocial variables. The main ones were the association between menopausal status and smoking, and the relationship between body weight, self-esteem and physical exercise. It is argued that the menopause transition can be an opportunity for preventive work.     

Factors Contributing to Depression during Peri Menopause: Findings of a Pakistani Sample

The present study aimed to identify the role of different factors in menopausal depression in Pakistani women. We hypothesized that physical activity, regular exercise, social support, and attitudes towards aging and menopause would predict menopausal depression in women going through perimenopause. The sample consisted of 110 women (M _age = 47.93 years) going through natural perimenopause. The Menopausal Symptoms Scale (Nadeem and Khalid 2012) and Social Support Questionnaire (Sarason et al. 1987) were administered along with a demographic questionnaire. Multiple regression analysis was conducted to analyze the data. The results showed that higher physical activity level, satisfactory relationships with husband, and availability of social support significantly predicted lower menopause-related depression. However, satisfaction with social support did not significantly predict menopausal depression. We also observed that positive attitude towards aging and menopause was significantly correlated with decreased menopausal depression. The implications for the need to promote awareness among health professionals and the general population about menopausal symptoms in Pakistani women to improve their quality of life are discussed.     

Effects of depressed mood on drinking refusal self-efficacy: examining the specificity of drinking contexts

College students with elevated depressive symptoms are more likely to engage in risky drinking and experience alcohol-related negative consequences. Efforts to understand the association between depressed mood and alcohol use have begun to identify the role of cognitive-motivational processes. Drinking refusal self-efficacy is one such process that influences the decision to drink, but its relationship with depressed mood remains unclear. The current study sought to clarify the role of these processes using a depressed mood induction procedure in a sample of college student drinkers. Eighty-six students were randomized to a depressed or neutral mood induction and completed assessments of drinking refusal self-efficacy. Depressed mood significantly decreased self-efficacy in high-risk drinking contexts related to depression, whereas ratings of other high-risk contexts were unaffected. These findings suggest that the association between hazardous drinking and depressed mood may be due in part to the direct influence of mood state on one's self-efficacy to resist drinking in relevant contexts.     

Menopausal stage and age and perceptions of body image

Abstract

The aim of This study was to investigate the association between menopausal stage and age and women's perception of their body image. Females from a community sample (n = 304. age range from 35 to 65 years) volunteered to complete a structured questionnaire which contained the Multidimensional Body Self Relations Questionnaire (MBSRQ) and the Stunkard Body Shape Figure Scale. One hundred and twenty women were premenopausal, 76 women were perimenopausal and 108 were postmenopausal. The effects of age and menopausal stage could not be separated in ratings of appearance evaluation, fitness evaluation, current, ideal and societal ratings of the Stunkard Body Shape Figure Scale. Premenopausal women (who were likely to be younger) had more positive ratings of appearance evaluation and fitness evaluation than menopausal women (who were likely to be older). Women who were premenopausal nominated smaller figures from the Stunkard Body Shape Figure Scale for ratings of the current, ideal and societal body shape than women who were perimenopausal and postmenopausal. The implications of these findings as they relate to women as they progress through the menopausal transition and as they become older is discussed.     

COMMENTARY ON "SEXUALITY AND THE MIDLIFE WOMAN"

In responding to Sandra Leiblum's clearly written, well-researched, and very well-balanced article, we would like to make three points about (a) the nature of language in menopause research and discussion; (b) the pathological and heterosexist bias in the scientific literature on menopause; and (c) our own research of menopausal lesbians.     

Impact of stress on objectively recorded menopausal hot flushes and on flush report bias

The hot flush (or flash) is the most widely reported menopausal symptom. Anecdotal reports suggest that women experience more hot flushes when stressed. Although stress may actually trigger hot flushes, another possibility is that women under stress may be more aware of the physiological changes associated with flushes and, therefore, more likely to report them. The goal of this study was to test these hypotheses by investigating the association between stress and both objective (i.e., physiologically recorded) and subjective hot flushes. Twenty-one postmenopausal women who reported having frequent hot flushes each underwent psychophysiological monitoring during stressful and nonstressful laboratory sessions. Significantly more objective flushes were recorded during the stress session than during the nonstress session. The stress manipulation, however, did not affect subjects' propensity to report flushes. These results suggest that the observed association between reported hot flushes and stress is not due to changes in report bias. The physiological mechanisms through which stress may stimulate hot flushes are discussed.     

Depressed mood: The role of negative thoughts,self-consciousness,and sex role stereotypes

Research typically finds that depression is twice as common among women as among men. This may relate to differences in socialization that result in different emotions, cognitions, and coping reactions. Sex-role stereotypes, employment and marital status, and differential social pressures may also be significant in making women more vulnerable to the development of depression. Women may have less decision-making power, face more adverse life events, and have limited access to resources, which may lead to feelings of helplessness and low self-esteem. Low self-esteem and negative cognitions about the self in turn may be proximal factors predictive of negative mood. Additionally, women may be more prone to ruminative self-focus rather than active coping, a significant risk factor for depression. This study examined individual predictors of depressed mood for each sex, including coping, self-esteem, negative thoughts, self-consciousness (rumination), as well as social factors such as the endorsement of sex-role stereotypes and decision-making power in the family. Results indicated that social factors were not related to depressed mood in either sex, but were related to coping styles and self-esteem. Depressed mood was associated with individual characteristics, such as avoidant coping styles, social anxiety for women, and ruminative self-focus for men. Regression analysis showed that coping through denial and negative thoughts explained depressed mood, and the latter was particularly true for men. These results point to the significance of examining both individual and social factors when attempting to understand depression in men and women.     

Effects of Depressed Mood on Drinking Refusal Self-Efficacy: Examining the Specificity of Drinking Contexts

College students with elevated depressive symptoms are more likely to engage in risky drinking and experience alcohol-related negative consequences. Efforts to understand the association between depressed mood and alcohol use have begun to identify the role of cognitive-motivational processes. Drinking refusal self-efficacy is one such process that influences the decision to drink, but its relationship with depressed mood remains unclear. The current study sought to clarify the role of these processes using a depressed mood induction procedure in a sample of college student drinkers. Eighty-six students were randomized to a depressed or neutral mood induction and completed assessments of drinking refusal self-efficacy. Depressed mood significantly decreased self-efficacy in high-risk drinking contexts related to depression, whereas ratings of other high-risk contexts were unaffected. These findings suggest that the association between hazardous drinking and depressed mood may be due in part to the direct influence of mood state on one's self-efficacy to resist drinking in relevant contexts.     

(Un)Changing Menopausal Bodies: How Women Think and Act in the Face of a Reproductive Transition and Gendered Beauty Ideals

Biomedical literature suggests that menopause primarily represents negative change in women’s lives. Feminist literature on menopause proposes that it can represent positive change or is a neutral experience for individual women. Conflicting characterizations result from different empirical emphases; biomedical research has focused on bodily change, and feminist research has highlighted social contexts for menopause. Results from interviews with a snowball sample of 61 women in 2001 illustrate how a change discourse on menopause and gendered beauty ideals combine to create a context within which some women believe that changes in their physical appearances can be attributed to menopause and that bodily change is problematic. In addition, during focus groups and in-depth interviews, women suggested that, in the face of these discourses or ideologies and changing external bodies, they face a “category crisis.’’ Interviewees also discussed how they attempt to prevent/mask bodily change in order to remain attractive, visibly feminine, and desirable in the eyes of men. Findings from this qualitative study illustrate that we must continue to explore women’s perceptions and experiences of bodily change during menopause, as we lack a full understanding of this developmental transition and its biosocial contexts.     

女性绝经进程与抑郁易感性

采用系统论观点对女性围绝经期的生物学改变进行分析,并在此基础上对该时期抑郁症易感性增加的原因进行探讨,指出绝经进程的系统性特征,对大脑皮层、下丘脑、垂体等中枢神经系统结构和卵巢等外周器官的功能改变和失调进行多层次、关联性、动态性分析,对围绝经期抑郁症病因的进一步研究具有重要意义。     

Sleep in Women: A Review

Sleep complaints are common in women, and women are more likely to suffer from insomnia than men. Multiple factors across a woman's lifespan, including hormonal changes, age‐related physiological changes, psychosocial factors, the presence of sleep disorders, and physical and mental health conditions, can contribute to complaints of poor sleep in women. This article reviews the literature on the characteristics of, and contributing factors to, subjectively and objectively measured sleep during the menstrual cycle, pregnancy, and post‐partum period, as well as the menopausal transition and postmenopause. Evidence from both subjective and objective measurements supports the presence of chronic sleep fragmentation associated with pregnancy, acute sleep deprivation during labour and the immediate post‐partum periods, as well as disrupted sleep during the first few months after childbirth. While there is evidence for menstrual cycle and menopause related sleep disturbance based on women's self report, findings from objectively measured sleep have been mixed. Observational and intervention studies on the relationship between sleep and women's psychological well‐being suggest that underlying causes of sleep disturbance across a woman's lifespan are often multi‐factorial. Comprehensive assessments and targeted interventions are needed in managing sleep problems in women. Cognitive behavioural interventions have been shown to reduce sleep complaints during the perinatal and menopausal periods, and improvements in sleep are likely to lead to improvements in women's overall well‐being.     

Depression and immunocompetence: a review of the literature.

Recent evidence suggests that there is a relationship between depression and immunity. On the basis of these studies, it has been argued that depressed mood may increase susceptibility to disease by means of aberrations occurring within the immune system. Empirical research investigating the relationship between depression and immunity is reviewed here. Studies examining both clinical and nonclinical manifestations of depression are discussed and evaluated. This review reveals that indexes of immunocompetence are lower among people exhibiting depressive symptomology and suggests that immune alterations may be more related to dysphoric mood than to specific situations or events. Alternative hypotheses accounting for links between depressed affect and altered immune states are provided, and suggestions for future research are offered.     

The association of perimenopausal mood disorders with other reproductive-related disorders

Data regarding the increased incidence of psychiatric illness during midlife in women are still conflicting. However, there is a growing consensus that certain groups of women may in fact be at higher risk for mood symptoms and psychiatric disorders during the perimenopausal transition. Mood symptoms during the perimenopause may be related to mood disorders during other periods of hormonal fluctuation throughout a woman's reproductive lifecycle. Elucidating these associations may advance the understanding of mood disorders during the perimenopausal transition. The epidemiology and treatment of perimenopausal mood symptoms compared with the epidemiology and treatment of mood disorders during the late luteal phase of the menstrual cycle, pregnancy, and postpartum. Common risk factors associated with mood disorders during these periods of hormonal changes or instability include poor lifestyle habits, a history of hormonally related mood disorders, stress and negative life events, ethnicity, and comorbidity. Reproductive-related mood disorders also are subject to an improvement in symptoms in response to treatment with selective serotonin reuptake inhibitors. As the morbidity associated with mood disorders during midlife may be quite significant, and as life expectancy continues to increase, recognition, prevention, and treatment of perimenopausal affective illness is becoming increasingly essential.     

Relation of perceived emotional intelligence and health-related quality of life of middle-aged women

This study examined the relationship between perceived emotional intelligence and health-related quality of life in middle-aged women. 99 middle-aged Spanish women, who studied in two adult schools, volunteered to participate. 49 were premenopausal and 45 were postmenopausal. These women completed the Trait Meta-Mood Scale and Health Survey SF-36. Scores were analyzed according to social, physical, and mental health, menopausal status, and scores on perceived emotional intelligence. Then, the data regarding the mental and physical health of the premenopausal and postmenopausal women were compared after controlling for age. No associations between menopausal status and health-related quality of life were found. Perceived skill at mood repair was significantly associated with scores on health-related quality of life in these middle-aged women. These findings provide empirical evidence that aspects of perceived emotional intelligence may account for the health-related quality of life in midlife including social, physical, and psychological symptoms.