Many women find the onset of menopause a difficult time; fraught with distressing feelings about the loss of their fertility, a feeling of redundancy, social stigma, and the passing of their youth. Unpleasant symptoms like headaches, hot flushes, sleepless nights, and unforeseen effects on libido all add to the emotional upheaval. This can leave you feeling depressed, tired and irritable, but don't despair: you aren’t alone in what you’re feeling.
It's completely natural to feel sad when you realise that your child-bearing years may be over. It feels very final, especially for those who have never raised a family. The sense of loss, bereavement, and disappointment left by an unmet maternal instinct can be overwhelming. But menopause doesn't have to be the end of the road.
Another thing to remember is that you're more likely to conceive if you're happy and relaxed. A study by Haimovici, in 1998, showed that stress and depression can suppress your immune system and make it more difficult to conceive, so making changes to manage feelings of depression can be a help in this respect, too.
The role of chemicals and menopausal depression
In 2014, a study in JAMA Psychiatry showed that perimenopausal women had much higher levels of the brain chemical, monoamine oxidase-A (MAO-A), which is linked to depression, than younger women. As oestrogen levels stabilised upon entering menopause, levels of MAO-A trailed off, so menopausal women weren't as badly affected, but were still affected to some degree. MAO-A is a pro-oxidant, a type of chemical which can damage cells and tissues, and breaks down the brain's feel-good chemicals, such as serotonin and dopamine. You'd think then that antioxidant-rich foods could quash this chemical's pro-oxidant effects, and indeed, researchers are looking into dietary supplements as a possible treatment. In the meantime, an antioxidant-rich diet of fresh fruit and vegetables certainly won't do you any harm, and might just boost your mood!
A small study conducted by Meller in 1997 compared women experiencing depression with those who were not, and concluded that depression may be associated with an abnormal regulation of luteinising hormone, which at high levels, triggers ovulation. As hormone levels change during menopause, it's possible that this affects luteinising hormone in a way that causes depression. This supports Meller’s suggestion that there is "a hormonal link between major depressive disorders and impaired fertility".
Patricia Harteneck, PhD, senior psychologist at The Seleni Institute for mental health and wellbeing, specializes in infertility, and says that support from your partner or loved ones is very important at this difficult time. If you've been trying to get pregnant for years, and are now facing the prospect of menopause, then having loved ones available to help you explore treatment options is invaluable. Their understanding and support can help to boost your mood, by making you feel secure and loved.
A number of studies have shown the benefits of cognitive behavioural therapy (CBT), or support groups in reducing the symptoms of anxiety and depression, as well as increasing fertility. A study by Domar (2000) showed that among a group of women undertaking reproductive treatment, 55% fell pregnant within a year of attending a course of CBT, and 54% fell pregnant after attending a support group, but only 20% of the control group (who attended neither CBT nor the support group) fell pregnant.
In 2001, Terzioglu published a study where couples attending counselling sessions aimed at reducing stress levels during their IVF treatment experienced lower anxiety and depression, and significantly higher pregnancy rates.
There are also a number of natural changes to diet and lifestyle that may help with feelings of depression and stress. Deborah Nelson, Ph.D, from Temple University recommends a brisk walk to alleviate menopausal anxiety and depression. She says: "Physical activity represents one way for women to stay mentally healthy. Physical activity can help throughout the menopausal transition and afterwards... You don’t have to run 20 miles a week to reap the benefits of exercise. If you stick to a moderate-paced walking schedule, it can keep your body mass index down and lower the risk of stress, anxiety and depression.”
Marilyn Glenville PhD, author of Natural Alternatives to HRT, writes: "What we eat and drink can determine whether we feel happy or depressed." Carbohydrates make us feel good, calm us down, and relax us, because they trigger the release of the feel-good chemical, serotonin. In turn, eating protein helps to keep us alert and focused.
Kate Neil and Patrick Holford, authors of Balancing Hormones Naturally, say: "The causes of depression are many, and some of them can be helped by nutrition. Causes can include vitamin B deficiency, stress, imbalance between calcium and magnesium, allergies..." The list goes on. The bottom line is that you need to eat a healthy diet that is rich in fresh plant produce, and avoid any nutritional deficiencies that might cause depression. A good quality multivitamin and mineral supplement should help to correct any possible nutrient deficiencies. A diet abundant in fresh fruits and vegetables is the best diet for good mental and physical health.
A positive perspective
If you're feeling blue about entering this stage of life, try to see the positive side of it. You have freedom from painful periods, the risk of an unplanned pregnancy is reduced, you hopefully have fewer financial worries, and can plan your time free from the constraints of childcare. You can see the world, make new friends, and spend more time doing what you want to do.
Menopause doesn't have to mark a slow descent into old age. Look after yourself, pay attention to healthy living, embrace new goals, stay fit and active, draw support from your loved ones, think positive, and you'll have many happy and fulfilling years ahead of you.