Mental Health and Menopause

It has been on my mind for a while to write this post.  This morning, I was reading multiple studies, and I’d like to start out with some thoughts from Mood and Menopause: Findings from the Study of Women’s Health Across the Nation (SWAN) over ten years.  

Women have a two-fold greater risk for depression than men. These sex differences have been found for both major depressive disorder as well as depressive symptoms in a large European study (DEPRES; Depressive Research in European Society³).

For decades, a controversy has existed regarding the extent to which, if at all, the menopausal transition or postmenopause (author’s note, we now just call it menopause for after…there is no post) increases the risk for elevated depressive symptoms and/or disorders. In 1995, when SWAN began, the state of knowledge about this issue was unclear and confusing, based largely on a cycle of “beliefs” and inconsistent findings from predominantly cross-sectional and small clinical studies that used varied measures of depressive symptoms. 

Depression has been variously defined across a spectrum ranging from a relatively brief negative mood state that includes feeling sad or being “blue” to a medically defined syndrome called Major Depressive Disorder/Minor Depression (a subthreshold depressive disorder that has fewer symptoms than major) or “clinical depression.” The criteria for clinical depression include the duration of symptoms for a minimum of 2 weeks and symptoms that cause significant distress or impairment in functioning. 

What factors contribute to risk for high depressive symptoms among midlife women, what is the relative importance of menopausal status, and do hormone levels or changes or VMS account for association of menopausal status with depression?

Numerous factors were independently associated with high CES-D over the first five and eight years of SWAN. The models for the two sets of analyses varied somewhat, but the results were similar. The significant predictors included VMS, being a current smoker, low social support, very stressful events,^22;24 financial strain,²² having less than a college education and higher body mass index (BMI).²⁴ For example, having less than a college education was associated with an increased odds ratios of 1.5 to 2 times compared to having a college education or more; vasomotor symptoms increased the odds by 62% – 77% and reporting two or more life events increase the odds by more than 5 times. For every 1 unit increase in BMI, the odds of high depressive symptoms increased by 1%. High social support was protective and reduced the odds by nearly 20%.²⁴ 

I am going to stop here with the findings, and I have linked it, but I would like the above to sink in.  There are predictors like “VMS” which are the vasomotor symptoms of hot flashes and night sweats.  I haven’t met many women who do NOT experience that.  Financial strain?  I am also going to note that as we age, we are always concerned with finances unless you have some kind of family money and/or are very smart with money and perhaps don’t have multiple kids in college at the same time, weddings to plan and pay for or whatever happens as we age.  BMI- body mass index.  I absolutely can NOT stand this particular thing, but I can tell you this.  Exercise in perimenopause saves you on many levels.  If you knew my height and weight, and the fact that I teach yoga 4 days a week and am not considered “big” by society’s size in clothes standards; however, at the doctor’s office the BMI would indicate I might be risk if I don’t “watch it” for pre-obesity, well then I would say you have found why I do not like that as a measurement.  NONE of those are what I actually want you to look at though.  It’s the last line.

High social support was protective and reduced the odds by nearly 20%.  

The paper went on to say this:  Using repeated measures logistic regression, we found that women were two to four times more likely to experience a major depressive episode when they were perimenopausal (OR=2.27) or postmenopausal (OR=3.57), even after controlling for a variety of factors associated with depression, including a history of major depression at baseline, annual psychotropic medication use, higher BMI, very upsetting life events and frequent VMS. 

My question to you is this my women friends and even my men friends who support women during this time…what is your workplace doing to address this?  How are we being supported?  Why is it I am finding so much information for pre- and post-natal healthcare, but we are leaving this time out in society?

Where is our high social support?  Well, I can tell you that here in my area and online through my teachings I am supporting women during this time.  All it takes is for one person to start a movement and to ask your workplace what is being provided during this transition that is just as important (if not more) than just slapping on a May is Mental Health month and then carrying on with your normal procedures at work.

Janet is over there in her cubicle crying up a storm, then the next day she is smiling, and the following she is about to cut you.  Not to mention she is trying to get through a meeting and sweat pops out all over her and not one colleague has checked on her.

What do we need our workplaces, friends and family to be aware of during this time?

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