Menopausal Depression: Hormonal, Or Circumstantial?

Janice is an attractive, happily married 48 year old woman who has developed chronic migraines. Colleen, a 52 year old successful business owner, comes in to her physician’s office complaining of constant low energy and insomnia. Judith is a 54 year old artist, who weeps as she confesses to her therapist that she no longer loves her husband of 22 years. Menopausal depression: is it hormonal, or due to changing life circumstances?

What’s different hormonally?

“The Change of Life unhinges the female nervous system and deprives women of their personal charm.”
(excerpt from the documentary “Victorian Women”)

Sounds like a good argument for hormone replacement therapy (HRT), huh? So, what does happen hormonally at menopause that impacts our moods? In a nutshell; there is a significant drop in estrogen, which can contribute to general malaise (the Blues). Night sweats interrupt REM sleep, and sleep deprivation is a major contributor to depression. Progesterone, which evokes calmness and aids sleep, is waning.

Is it the Change of Life? Or Life’s Changing?

In my own darkest hour I sought help from my OB/GYN, a highly respected male physician who specializes in treating menopausal women. He is a vocal proponent for HRT, and several months earlier had convinced me that HRT was safe for someone with my history, the benefits far outweighing the risks. I should confess to you that what really sold me was when he played the Vanity Card; he told me that he could walk into a room of menopausal women, and know exactly who were on hormones and who weren’t. So, I (with some trepidation), started with a Vivelle patch, which provided estrogen, and oral doses of a plant-based progesterone. Fast forward a few months. I am no longer suffering from night sweats and insomnia, but the low level depression and bouts of anxiety still haunt me. My doctor spent the entire allotted time we had together droning on about all the stressors we encounter in middle age; care of aging parents, dealing with teenagers and/or empty nest issues, physical deterioration, etc., etc. He viewed HRT as the panacea; any other disturbing symptoms beyond hot flashes were not in the scope of his expertise.

Actually, I didn’t struggle with any of the issues he brought up. My parents are healthy (and living in another state!), my kids (at least at that point in time) were not troublesome, and my physical health was quite good. I was overwhelmed with all of the responsibility and commitment that starting a new practice entails. But in the past I’d sailed through stressful times like this. What was different?

The Body Rebels

Deciding to stick with HRT for the time being, I found myself a good therapist, and began exploring what are known as our “core beliefs;” those defenses we’ve developed, often as children, to cope with what life presented us with. As a therapist, I look at menopause as a time when “the chickens come home to roost.” What has worked for us for many, many years, suddenly isn’t working anymore. Protecting ourselves from being hurt by becoming ’stoic.’ Staying busy all the time, to avoid looking too closely at our pain. Avoiding conflict, remaining silent, swallowing anger…the list goes on. Often, this is manifested in physical ailments; headaches, abdominal distress, neck and jaw pain, back problems, and a compromised immune system. Kids move out, and our roles change. Marriages are put to the test, with the distraction of children out of the picture. Some women question their partnership with this man they’ve “gone through the motions” with for the past 20 or 30 years.

Taking a healthy step forward

So, what can you do to help yourself? First of all, access all the information you can on the benefits versus the risks of HRT. Research the possibility of bioidentical hormones, which most resemble that which your body produces. Look at alte
ative therapies, such as acupuncture, and herbal supplements. Be prepared to be overwhelmed. For every study that you read on the risks of HRT, you can also find a study that refutes the results of that study. Look into saliva tests, which can provide information on your current hormone levels to be used to custom tailor your hormonal needs. I’m currently weaning myself off bioidentical hormones, getting myself a saliva test, and looking at “compounded” hormonal creams. I also highly recommend Christiane Northrup’s book, “The Wisdom of Menopause,” an excellent resource. Be an informed consumer when you visit your doctor’s office.

Consider counseling, to examine those long held beliefs and patterns that aren’t working for you anymore, and are making you miserable, both emotionally and physically. Think of being in therapy as nurturing yourself, striving to be healthy. Caring for your self esteem translates into being good to your body.

Take a walk every day. Look into yoga, to learn to love your body. Relaxation techniques and meditation really do work; a therapist can help you with this. Splurge on massages. And, as your mama would say, eat right! If you do nothing more than make sure to eat 4-5 servings of fruits and vegetables a day, you will vastly improve your nutrition.

Attitude is everything!

Lastly, how about an attitude adjustment? Why can’t we celebrate menopause as a Rite of Passage? Gail Sheehy, in her book “The Silent Passage: Menopause” suggests that first we consider the time we have left to live: one half of our adult lives. Do we look at entering this phase as the slow road downhill? Or is it the opportunity to re-create ourselves? What would light your fire? A dance class? Voice lessons? Pursuing that degree you never finished? Take a step right now, and do something that takes you out of your comfort zone this week! n