Perimenopausal Women Essay
The purpose of this paper is to discuss the onset of depression in women during the peri-menopausal stage of menopause. The paper begins by discussing the stages of menopause and the life changing events that come along with it and is followed by the definition of peri-menopause and depression. Sections that follow discuss the physical and psychological symptoms of peri-menopause. The paper will also discuss various studies and research into the onset of depression during the peri-menopausal stage. The paper concludes with treatment options both medical and spiritually for a woman facing peri-menopause.
Depression in Peri-Menopausal Women There are many transitions that all women face in their lifetime and one of the most stressful, confusing, and emotional transitions are entering peri-menopause. Menopause, to many women, is a symbol of becoming older, less desirable, loss of social role, an empty nest, and other insecure stages of life. These life-changing stages and the experience of hormonal ups and downs cause peri-menopause to seem like childhood puberty (Ballinger, Cobbin, Krivanek, & Saunders, 1979, p. 192). Peri-menopause, or menopause transition, is the stage of a woman’s reproductive life that begins several years before menopause, when the ovaries gradually begin to produce less estrogen”(WebMD, 2012).
The average age, according to a study conducted by Treolar, “for entry into the peri-menopausal transition was 45. 1, and the age range that included 95% of the women was 39-51”(as cited in Speroff, 2000,p. 376-377). The transition into peri-menopause subjects a woman to fluctuations in reproductive hormones and is characterized by but not limited to irregular menstrual cycles, insomnia, hot flashes, and mood swings. According to Sichel and Driscoll (1999), this time of life may last as long as seven to ten years, or longer although some women may also have shorter peri-menopausal transitions”(as cited in McGonagle, 2005, p. 9). Symptoms Symptoms for peri-menopausal depression are similar to those of general depression symptoms. These symptoms include loss of interest or pleasure, low self-esteem, insomnia, fatigue, and difficulty in concentrating. “During peri-menopause, several symptoms may arise and can prevail until post-menopause”(Pimenta, Leal, Maroco, & Rams, 2011, p. 1).
Not only does a woman in peri-menopause have physical symptoms she may also be affected psychologically Women in the peri-menopausal stage of menopause will also experience psychological symptoms due to the hormonal ups and downs. These psychological symptoms include depression, anxiety, mood swings, and irritability and memory loss. Mood change is the most common symptom for which women in menopause transition seek treatment. According to Parry (2010), almost fifty percent of those women seeking treatment are clinically depressed and over one third experience their first episode of depression during peri-menopause (p. 4). This paper will discuss the aspect of depression in women in the peri-menopausal stage of menopause.
Depression is defined as a “mood disorder that presents with depressed mood, loss of interest or pleasure, feelings of guilt or low self-esteem, disturbed sleep or appetite, low energy, and poor concentration” (WHO, 2012). According to Schmidt, Roca, and Rubinow (1998), “the term peri-menopausal depression is used to describe the onset of depression, either major or minor, in association with a change in menstrual cycle function or endocrine evidence of the peri-menopausal (i. . elevated FSH)”(as cited in McGonagle, 2005, p. 42). “The estrogen withdrawal theory explains depressive symptoms as resulting from a sustained decline in ovarian estrogen in tandem with spiking secretions of follicle-stimulating hormones (FSH) by the pituitary gland” (Brandon, Shivakumar, & Freeman, 2008, p. 41). Risk Factors Women that have experienced clinical depression are more vulnerable to recurrent clinical depression during the peri-menopausal stage (NAMS, 2012).
According to Parry (2008), peri-menopausal women are especially at risk for experiencing new onset and recurrence of major depression, and women who have history of premenstrual syndrome or have experienced postpartum depression are at even greater risk (p. 24). Also according to Parry (2008), women with bi-polar illness are more likely to have recurrence of depressive episodes and the risk of suicide increases in women age 45 to 64 (p. 24). Other risk factors include: * Premature or surgical menopause Lengthy menopausal transition (> 27 months) * Persistent and/or vasomotor symptoms * Negative attitude toward menopause and aging (Brandon et al. 2008, p. 40). Causes Although the exact cause for peri-menopausal depression is not known it is likely that hormonal fluctuation, the experience of menopause, and the psychosocial factors work together to increase a woman’s vulnerability for depressive symptoms (Brandon et al. 2008, p. 41). The causes for peri-menopausal depression can be physical, psychological or psychosocial.
According to The Harvard Medical School Family Health Guide on-line, “In addition to hormonal fluctuations, researchers have explored the possible influence of psychosocial factors, hot flashes, and their impact on sleep, and genetic vulnerabilities”(2006, par 2). The physical cause for peri-menopausal depression can be attributed to the fluctuations in a woman’s hormonal imbalance that occurs during the onset of menopause and continues for a long period of time (Brandon et. al 2008, p. 39). The psychological causes include daily stressors, hereditary diseases triggered by the chemical or hormonal imbalance.
A 2006 Seattle Midlife Women’s Study results confirmed the correlation of depressive symptoms with stress, disruption of sleep, hot flashes, and later stage peri-menopause (Woods, Mariella, & Mitchell, 2006, p. 200-202). The emotional stability of a woman experiencing peri-menopause can become upset due to the disruption of sleep patterns caused by hot flashes. Although hot flashes may be experienced at any time, peri-menopausal women who are experiencing depression reports an increase in the severity of hot flashes during sleep (Speroff, 2000, p. 383). These somatic symptoms of peri-menopause lead to the secondhand symptoms of depression.
Researchers call this the domino theory. Night sweats and hot flashes lead to sleep disruption, which may cause a woman to experience fatigue, the inability to concentrate, and feelings of being overwhelmed, which leads to feelings of depression (Brandon et al. 2008, p. 42) “Depression and anxiety, two major health issues, whose incidence tend to increase throughout the menopausal transition are associated with sleep disturbances”(Terauchi et al. 2011, p. 64). Psychosocial theory refers to depression being the result of the increase of stress or unfavorable or detrimental life events. For example, more undesirable life-events were recently found to be related to worse menopause symptom severity”(Bauld & Brown, 2009, p. 160-161). A woman faces many forms of stress, a demanding career, family responsibilities, low socioeconomic status, insomnia, divorce or other relationship issues, and just not making enough time for her needs (Brandon et al. 2008, p. 42). “Many women suffer increased stress around the time of the menopause”(Ballinger et al. 1979, p. 192). If a woman had an unfavorable view of menopause she may be prone to depression and worsened menopausal symptoms.
Recent research has proven that the attitude a woman has about menopause the more likely she is to have less depression than those women who have a negative expectation about menopause. In a recent study, attitudes to menopause and expectation of somatic symptoms were assessed in 541 premenopausal women. Women who expected to experience worse symptoms (e. g. more hot flashes) later reported higher levels of depression, whereas women who expected menopause to be a positive an/or beneficial experience reported less depression and fewer somatic symptoms (Ballinger et al. 008, p. 161). Treatment Treatment of peri-menopausal depression is based on whether the symptoms are physical or psychological. It is important to look at all available approaches to treating peri-menopausal depression. “To determine the optimal treatment for peri-menopausal depression, clinicians must weigh the risks of untreated depression and the benefits of treatment” (Barry, 2010, p. 145). Some approaches to treatment include life style changes, herbal and alternative methods, and pharmacological and medial alternatives. Life Style Changes
Life style changes are the first basic form of treatment of depression. Although life style changes are not as risky as hormone replacement therapy or surgery, they do require a lot of discipline. Even the smallest or simplest change in a woman’s life style can be quite beneficial in relieving the symptoms of depression (34-Menopause Symptoms, 2012, par 4). One form of life style change a woman can make is getting regular exercise. “The physiological and physical benefits of regular exercise will help ease the symptoms of depression”(34-menopause Symptoms, 2012, par 5).
Exercising can aid a woman in the reduction of stress, in increasing self-esteem, and aid in restoring the sleep disturbances caused by the symptoms of menopause. Not only is exercise a factor in treating depression but also a change in diet is also a way to relieve the symptoms of depression. “Studies have shown that diets rich in foods that promote estrogen production (such as soy, apples, alfalfa, cherries, potatoes, rice, wheat, and yams) go a long way in treating symptoms of depression”(34-Menopause Symptoms, 2012 par 9).
Alcohol, sugar, and caffeine should be avoided. Many individuals experiencing depression will turn to alcohol to make themselves feel better. Although alcohol can temporarily make an individual feel “better” it usually makes the depression worsen. Along with alcohol many will turn to sugary snacks and caffeine products such as soda or coffee to fight the fatigue, but his is only a temporary fix also. Once the “high” from sugar and caffeine wears off the individual id back to feeling depressed. Alternative Methods
There are many alternative methods for treating depression available to women. “Defined as treatment not taught in medical school nor generally found in U. S. hospitals, unconventional medicine included acupuncture, herbals, diet, spirituality, folk remedies, megavitamins, homeopathy, and self-help groups”(Gingrich & Fogel, 2003, p. 182). All of these forms of treatment can be valid options for treating depression. Herbal supplements are a very popular form of treatment and have begun to overlap with conventional medicine.
It is important to discuss any alternative method with a physician, as there are possibilities of drug interactions with conventional medications. Pharmacological “Hormone replacement therapy, which is now used primarily for the short-term treatment of hot flashed and night sweats, has been shown in some studies to improve depressive symptoms in some women approaching menopause”(WebMD, 2012). Hormone replacement therapy has been the most conventional method prescribed for the relief of peri-menopausal symptoms such as vasomotor and vaginal changes.
There are side effects and risks involved with using hormone replacement therapy such as increased risk of breast cancer (Gingrich & Fogel, 2003, p. 182). There is also the use of antidepressant such as fluoxetine (Prozac) to relieve the symptoms of depression. Antidepressants also have side effects that can imitate the symptoms of mood disorders and hormonal imbalance. While each of these therapies is a viable method, using a combination of these therapies is essentially the best and most effective way to treat the symptoms of depression.
Again it is essential to discuss these methods with a physician. Conclusion Women face many life transitions, menopause is one that can be traumatic for a woman. Peri-menopause can be stressful, emotional, and confusing for any woman. Hormonal imbalance and lower production of estrogen are the signs of per-menopause. Menopause, to many women is a sign that she is getting older, losing her beauty, an empty nest, and a los of social status. Symptoms of menopause include loss of interest or pleasure, low self-esteem, insomnia, fatigue, and difficulty in concentrating.
Women that have a past history of depression, have surgical menopause; lengthy vasomotor symptoms, and a negative view of menopause are at great risk of depression. There are many treatment options for the treatment of peri-menopausal depression. It is important to discuss all options with a physician before beginning any treatment.
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