Menopause and Mental Health
Whilst having breakfast with my colleague Dr Chi-Chi Obuaya, Consultant Psychiatrist, I mentioned the fact that menopause has been on my mind for quite some time. With a busy life and having a tendency to procrastinate, I have spent the last 15 years meaning to turn my attention to menopause. A subject that had been tiptoed around for many years until NOW! All of a sudden the menopause is the new sexy subject to discuss, magazine articles, books, tweets and an abundance of discussion around a subject that has up till recently been under the radar. It occurred to me that many women of a certain age. present to their doctors with symptoms such as depression, anxiety, loss of libido and weight gain. With further investigation, the presenting problems could be hormone related. Chi-Chi took this on board and we both agreed to pursue the subject further.
In a recent talk he said the following, “I have been in the privileged position of teaching postgraduate students on gender and mental health issues for a number of years. As I return from another stimulating seminar I am forced to reflect on a big gap in my knowledge. Whilst my talk covered areas as diverse as the impact of domestic violence, FGM and trafficking, it really only scratched the surface with regards to the menopause. We do know that some mental health conditions can become pronounced at menopause. For example, there is a second peak in the onset of psychotic disorders in postmenopausal women, suggesting that oestrogen has a protective role up until this point. However, this throws up a few questions: should we, as psychiatrists, be prescribing Hormone Replacement Therapy (HRT) and in what other conditions might oestrogen be implicated? My psychiatric training contained very little about menopause. There is so much more we need to try and understand. Mental health professionals could play a role in helping women understand whether their ‘symptoms’ are related to the “Change” or a sign of a more serious mental health condition. I wonder how many peri-menopausal women might be misdiagnosed as having a depressive illness? Menopause is a significant life event, which brings about uncertainty and lots of time for reflection and questioning. There are issues around sexuality and libido, self-esteem and body image. For women that have not had children, a sense of unfulfillment or loss may come back to the surface.
We should also not forget about the impact menopause has on men. Akin to the arrival of children, men can experience menopause as passive bystanders with little or no control over its impact.
We, as health professionals, ought to do more to understand this area so that we can be better informed to help our patients. Let us not be ashamed of our limited knowledge: our ignorance may spark a greater sense of intrigue in our conversations with peri-menopausal patients, help us to understand their experiences better and ultimately put us in a better position to help them.