By: Jean Johnson for Uterus1“Mood and depression,” said Heidi Nelson, M.D., medical director of Portland, Oregon’s Providence Women’s Health, “that’s the hot button. There are some studies out there that show a link between emotional health and menopause, but if you look carefully, most of them do not.” Indeed, of 14 studies focused on the topic that Nelson’s team assessed from the 1960s to the present, only two associated mood and depression with menopause. Many of these research projects were completed by male physicians before sufficient numbers of women were represented in the medical research field.
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Symptoms of menopause:
Early onset menopause symptoms include:
irregular vaginal bleeding
Hot flashes
Night sweats
Late onset menopause symptoms include:
Vaginal dryness
Vaginal irritation
Osteoporosis
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Nelson’s work was part of a larger project sponsored by the federal Agency of Healthcare Research and Quality. Her charge was to review and analyze existing evidence about menopause-related symptoms, as well as draw conclusions about the risks and benefits of treatments for those symptoms. Her report in turn will be assessed alongside a number of others and will influence how future research dollars are spent. While hope that future studies will operate from perspectives that allow for links between depression and menopause, at this point, the news is not especially encouraging – especially for those currently suffering from mood changes and depression related to menopause.
“If a physician understands that menopause and depression don’t go hand in hand,” said Nelson, “then the physician will appropriately treat the woman for depression and not assume that hormonal therapy will solve the problem.”
That’s an understatement said Norrine Vickers formerly a resident of the rural town, LaGrande, in eastern Oregon’s agricultural and ranching country.
“There was no talk at all of using estrogen to manage the depression that menopause brought out in me. In fact, all my physician did – and she was a woman – was ship me off to the psychiatrist. That was the beginning of the worst year of my life. He started in with first this drug and then the next, trying to find something that would work. He’d ask me things like did I see flashes of light when I drove down the road. ‘No’ was my answer until I started taking the first bottle of pills he suggested. Then low and behold, there were the lights, my blood pressure went crazy, and by the end of the year I did too. Changed my name, sold off my whole library of books to the second hand dealer, and finally ended up so lethargic I couldn’t manage my own grooming. It was a nightmare I wish on no one. Even talking about it now, it doesn’t seem possible that something like that could happen in modern America.”
Vickers’ family finally moved, and eventually she found a female psychologist who supported her interest in trying life without all the anti-depression drugs. “By then, I was coming through menopause a bit more I think so I was able to manage even though I wasn’t taking estrogen,” Vickers said. “What I found was that I just needed to get involved in something that made me feel like my life was worthwhile. I did that – dropped the drugs and never looked back.”
Unfortunate experiences like Vickers are precisely what Nelson’s team hopes their findings will begin to change. “A lot of women are very distressed by their symptoms,” Nelson said. “It’s not trivial.”
That said, Nelson points out that with depression and anxiety more common to women than men, figuring out these emotional states’ relationship to menopause is not all that easy.
Nonetheless, Nelson speculates that some cases of depression in menopausal women might be treated by low-level doses of estrogen prescribed over relatively short periods of time. Using high doses of estrogen over extended periods were contraindicated by the Women’s Health Initiative study in 2002 that linked artificial estrogen to heart disease and breast cancer. Still, more modest regimes can help control symptoms of menopause including clinical depression that is not so severe that it needs a more careful evaluation by a mental health practitioner.
In the meantime, expect the powers-that-be to proceed apace to try and unravel the confusion. “What we found is that everyone’s measuring differently and using different definitions, so research methods could improve so we know we’re talking about the same thing,” said Nelson. Also, if anything she said her team’s results are simply the beginning. “Although there’s no evidence supporting the link between menopause and depression to date, there is still a lot of room to study this dynamic, so it’s not over by any means.”
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Menopause Management (Parts 1-4)
The Lady Has the Blues – Women and Depression (Part 1 and 2)
Perimenopause and Depression: Risks and Symptoms
