This is the first blog post in a series of four articles to spotlight mental health issues that arise in connection to the perimenopausal, menopausal, and post-menopausal phases of a woman’s life. Menopause typically occurs around 50-52 years old preceded by 4-8 perimenopausal years. It stretches across 33% of a woman’s lifespan on average but receives very little research funding and attention. This is not an anecdotal statement. Experts in women’s reproductive health estimate that 1.1 million academic medical articles exist on trying to conceive (TTC) and pregnancy, 97,000 studies on menopause, and only 6,500 on perimenopause. This is striking considering that a significant portion of women (around 15% in the US) will never have children, yet every biological woman will navigate the process of perimenopause to menopause. In 2024, only 31% of ob/gyn residencies reportedly have curriculum that includes perimenopause and menopause. This truly is the wild, wild west of women’s health.
To be clear, menopause isn’t simply about saying goodbye to one’s reproductive years. Menstruation is an output marker of ovarian functioning and health as coordinated by your neuroimmunoendocrine system. Let’s pause to appreciate this complexity – (1) neuro meaning nervous system (brain) involvement, which encompasses your biology intersecting with your psychology; (2) immuno meaning the status of your immune and digestive health; and (3) endocrine meaning the multiple structures and pathways in your body involved in hormone production, modulation, communication and function.
Several hormones are involved in the process of menstruating, perhaps most notably is estrogen. Estrogen transforms from a very active and dynamic hormone from the time that women are in their teens to forties to a very passive and static hormone from 50s until the time of death. We are learning each year how protective estrogen is to a woman’s health. Estrogen is involved in brain health, mental health, cardiac health, metabolic health, digestive health, and bone health. A very broad but science-backed finding is that the further away from high estrogen levels a woman is, higher levels of chronic illness are found. However, chronic illness or frailty is not an inevitable outcome of going through menopause. There are several behavioral and lifestyle interventions that mitigate the effects of the unavoidable biological process of menopause so that cognitive, physical, and psychological health can be stabilized and preserved.
This series will identify the risk factors women should be aware of and also the specific behavioral and lifestyle changes that are currently recommended by experts in women’s health. All of this information should be discussed with your personal doctors — generalizations do not necessarily apply across the board and the best medicine is personalized medicine that is delivered in a supportive, informed doctor-patient relationship.
Sources:
Cleveland Clinic
https://my.clevelandclinic.org/health/diseases/21841-menopause
Landry, A. (May 2024)
https://www.forbes.com/sites/adairalandry/2024/05/31/menopause-impacts-33-of-a-womans-life-its-time-to-stop-the-stigma/
Russell, Jones, & Newhouse (2019). “The role of estrogen in brain and cognitive aging”, Neurotherapeutics, 16, 649-665.