Menopause, which is literally the cessation of menses, is the stage in a woman's life when her reproductive capacity is brought to an end. The main cause of this is a drop in the essential hormone oestrogen, but there are complex changes in other hormone levels as well.
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For a variety of reasons, it has been assumed that depression and other psychological symptoms are a standard accompaniment of menopause, but recent studies have actually refuted this study. Some researchers have found a rise in the incidence of depression in women, beginning at about age 35 and peaking at about 43 or 44, which is well before the menopause.
Most women begin menopause between 49 and 51, although a small percentage, approximately 8%, experience menopause before the age of 40, which is referred to by physicians as premature menopause.
The few years before menopause actually begins is known as the perimenopausal stage, which is a time that is marked by fluxes of hormones. According to Johannesburg psychiatrist, Dr Dora Wynchank, "The irregularities in these hormone levels have been found to have an effect on the production of serotonin, the chemical in the brain that is closely linked to depression, so mood swings are to be expected at this stage. On the other hand though, oestrogen which has been shown to be a protective factor against schizophrenia, has been implicated as one of the causal factors in depression."
Psychological impact
Oestrogen being linked to depression would explain why depression statistics are higher in women than in men, but then surely as oestrogen levels decrease during menopause, the risk of depression should decrease.
Physiologically, this is true, but it is more the psychological impact of menopause that causes problems. Dr Wynchank states: "The psychological change in status and fertility can have adverse effects and can affect a variety of aspects in a woman's life, including how she views herself sexually."
The hormonal changes are also accompanied by changes in other tissues. Some loss of tissue occurs in the genitals and the breasts, and breast tissue becomes less dense and firm. The ovaries and uterus become smaller, the vagina becomes shorter and smaller in diameter, with thinner and less elastic walls, and less lubrication is produced during intercourse - this being a direct result of insufficient oestrogen. Between 50 and 75% of women have "hot flushes", which are brief, abrupt rises in body temperature that may be accompanied by sudden sweating and skin flushing. Besides the obvious physical discomfort these hot flashes cause, there is also the occasional social discomfort and, when frequent and severe, they can interfere with sleep patterns and cause chronic fatigue.
Attitude not chemistry
Dealing with these physical changes and the psychological implications they carry, it is easy to see how some women can become depressed. But there is good news. According to Dr Joan Borysenko, author of A Woman's Book of Life, depression during this time is more a matter of attitude than chemistry.
She states: "The physiological changes that occur in a woman's forties prime her for the next stage of life, which is characterised as coming more fully into her creativity and making an expanded social contribution. Unfortunately these physiological changes have been cast in a negative light that cause women to fear midlife rather than to look forward to it…The perimenopausal years are considered a negative time of change because they herald the end of our reproductive years. While being freed from the fear of pregnancy has the potential to rejuvenate a woman's sex life, allowing her to become more sensuous than before, many women have equated the end of fertility with the end of their sexuality."
Dr Borysenko continues: "Many years in clinical practice have convinced me of the fact that how we fare during menopause is largely a matter of attitude. Women who feel as if they are coming into their power are likely to have an increased interest in and appreciation of sex. They look vital and healthy, and they feel in the prime of their lives. Many of my patients commented that they felt as though they were becoming women, just entering the fullness, with the advent of midlife. In contrast, women who buy into the myth that menopause is the end of their womanhood, the beginning of a rapid decline into aging and loss of attractiveness, start to lose their vitality. They look and feel old. Research studies indicate that negative views of menopause also increase the number of unpleasant symptoms associated with the change of life including hot flashes, night sweats, fatigue, achiness and sleep disturbance."
Where to go for help
Contact the Depression and Anxiety Group for the number of a support group near you (011) 783 1474/6.
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