In our fourth and final blog post on the menopause transition (MT), we focus on the emotional well-being challenges – specifically, depression, anxiety, and low stress tolerance – that can show up during this time period. An estimated 4 of 10 women report mood symptoms such as tearfulness, low self-worth, feeling hopeless or numb, losing interest in formerly pleasurable activities, worry, and irritability. A changing hormonal landscape means unpredictable cycles – there’s no clear-cut “PMS days” and many women struggle to know whether or not depression, anxiety, or stress symptoms are connected to their hormones. In modern day medicine and psychology, we generally believe that there are three contributing factors of any emergence of symptoms or conditions: (1) biology/genetics; (2) social/environmental; and (3) psychological/personality. With that said, let’s breakdown how menopause and emotions intersect:
(1) Biological factors: Hormones are messengers. Some hormones steer the course of reproduction, some direct the physical growth of the body and cells, and some produce neurotransmitters which influence how you think and feel. Estrogen (a hormone) regulates serotonin (a neurotransmitter). As estrogen changes, serotonin receptors become less responsive and effective. Brain regions that are serotonin dominant (like the hippocampus, the brain’s memory center) will struggle the function the same way they did when estrogen was at it’s peak.
(2) Social factors: These decades of life (40-50s) are like a stress squeeze point – aging and/or dying parents, raising and launching kids, trying to maximize career earnings and promotions, dealing with new age-related health issues or crises (like increasing cancer rates, chronic pain), potential of divorce or marriage difficulties, etc. All contribute to high baseline levels of stress, sleep disruption, more emotional eating, and sedentary lifestyles that are not conducive to emotional well-being.
(3) Psychological factors: Having a history of depression, premenstrual dysphoria disorder (PMDD), trauma, poor coping mechanisms, fixed mindset, and low stress tolerance are risk factors for a poor adjustment to menopause. “The window of vulnerability” model suggests that certain women are predisposed to hormonally-driven mood symptoms in connection with “sensitive” periods of fluctuations, notably the onset of menarche (puberty), in the perinatal and postnatal phases, and menopause transition.
With this information in mind, what are some tips to navigating emotional changes that can accompany menopause?
(1) Be proactive versus reactive. Attend doctors appointments, start asking for hormone bloodwork panels in your late 30s-early 40s to identify baseline levels and changes. Let your doctor know if you had depression or anxiety that started around puberty and/or prenatal or postpartum depression/anxiety/OCD/etc. so that it can be monitored as you enter into perimenopause and menopause.
(2) Get serious about healthy lifestyle routines. Sleep is paramount in steadying emotions and optimizing stress tolerance. Taking control of controllable factors (like, how much time do I spend on my phone before bed? Can I start lifting weights instead of just doing cardio only?) related to sleep hygiene, eating habits, physical activity, and quality of relationships can offset hormonally-driven emotional changes.
(3) Alter the mindset towards menopause. We have other messengers inside our brains besides hormones. Our own narrative (aka, “self-talk”) about menopause and beyond influences health behavior, mood, and biology. For instance, scenario A: “I’m a captain of a ship sailing in stormy waters but I know the waters will calm and I know the route I have to take to get there quicker” versus scenario B: “I’m a passenger of a boat sailing into a storm and I can’t control the weather so it’s just going to be what it is and I hope I survive.” Those statements hit differently, right? Choose your mindset and the behaviors follow.
If you are concerned that the menopause transition is harming your emotional well-being and would like strategies to manage symptoms of depression, anxiety, and stress with support, contact this office at 732-988-3441 to schedule a consultation with a clinical health psychologist.
Lauren Gashlin, PsyD
Clinical Health Psychologist