Menopause

Menopause is officially defined as a permanent cessation of menstruation when the ovary stops producing egg cells and female sex hormones (estrogens). Many women use the term menopause to define a time period before the cessation of menses whereby they experience a host of new and uncomfortable symptoms. This is often termed as perimenopause which is the time before menopause and the first year of amenorrhea. Physically, women experience hot flashes, a combination of feeling hot and sweating profusely. These symptoms are due mainly to decreasing levels of the female hormone, estrogen. Other symptoms include vaginal dryness, bladder problems, difficulty with intercourse, and increased risk of heart disease, stroke, and osteoporosis.

Studies remain mixed with respect to their stance on the association between menopause and psychiatric illness. The majority of researchers find that psychological symptoms occurring during the menopausal years are unrelated to the cessation of menses in and of itself. Instead, these researchers argue that life events that happen to occur typically in that part of a woman’s life cycle, such as being divorced, not having conceived children, and not having a suitable socioeconomic status that was expected for this late phase of life, are more responsible as triggers of psychiatric illness, such as depression. "Empty nest syndrome" is often a contributing factor. Also, mood disorders are more likely to occur in women experiencing menopause early due to surgical reasons. Women with a history of psychiatric illness often show a reappearance of their illness during this vulnerable time in their life cycle. Other studies do find an association between menopause and psychiatric symptoms such as depression, hypochondriasis and insomnia. In conclusion, there is no evidence supporting menopause as a cause of psychiatric illness.

Treatment intervention during the menopausal years depends on the extent to which physical and psychological symptoms manifest themselves. Treatment is often similar to treatment of psychiatric illness in the woman experiencing pre-menstrual syndrome. Individual and supportive psychotherapy, as well as group, family and marital therapy is often warranted for a menopausal woman who is in a new life transition. Hormone replacement therapy is prescribed to treat the vasomotor symptoms, atrophy of the genital mucosa and to prevent the worsening of osteoporosis. Psychologically, estrogen-replacement therapy may ameliorate some symptoms by improving a woman’s sense of well-being. In women with depressive illness during menopause, a course of SSRI’s is an effective treatment intervention. Currently, research is being conducted in the area of combining hormone replacement therapy with antidepressants in the treatment of depression experienced during menopause.