Menopause symptoms: Psychological

Psychological symptoms of menopause

Psychological and emotional symptoms are common around the menopause, but the causes are complex. Anxiety, depression, sadness, difficulty concentrating, overreacting to minor upsets, anger and irritability, forgetfulness and mood swings are all typical psychological problems. Hormonal changes are thought to be responsible for a proportion of these symptoms, but it is hard to be certain which symptoms are hormonal in origin, and which are due to other changes in a woman’s life around that time. Studies indicate that many cases of depression, for example, relate more to personal circumstances than to the menopause itself. Studies have also indicated that women who are generally happy with their lives experience fewer problems during menopause.

Situations and life events that tend to crowd into women’s lives when in their late forties and fifties include:

• Children leaving home
• Divorce
• Retirement (of self or partner)
• Widowhood
• Illness or death of parents
• Physical ageing

Other psychological challenges can include beliefs about no longer being useful, distorted body image, fear of death, insomnia, feeling ‘unemployable’, low self worth, and of course, the physical symptoms of the menopause itself.

While hot flushes are physical symptoms, much of the distress that women experience due to hot flushes is caused by the negative thoughts that they engender. Whenever a person experiences a physical symptom, they do so at two levels: the actual experience of the symptom, and their thoughts about it.  Although up to 85% of women experience hot flushes during menopause, the degree of distress experienced varies considerably from woman to woman, and this variation cannot all be put down to symptom severity. While one woman may consider hot flushes to be a relatively minor inconvenience and an unfortunate consequence of menopause, another may associate them with growing old, being out of control, or even shame. The first kind of woman will find it easier to live with the symptoms, while the other will tend to fight and resent the symptoms and as a result suffer terribly. These complex relationships between body and mind make it very difficult to assign causes of psychological distress. 

Management and treatment of psychological symptoms

Whatever the psychological symptoms and whatever the cause of those symptoms, the important thing to realise is that they are real.  There is a tendency in our culture to give credence to problems where a physical cause can be found, but to dismiss those which seem to be purely psychological in origin. In reality, distress is distress, whether physical or psychological, and needs management and care.
 
Because of the lack of clarity about the cause of psychological symptoms, choice of treatment is not always easy and will always be a very individual decision.
Possible approaches to treatment include:

• Antidepressants. These can be effective in treating depression, insomnia and some forms of anxiety, and some may help with hot flushes as well, although evidence for the latter is more variable (and HRT is much more effective).
  
  
• HRT. Evidence of the effectiveness of HRT in treating psychological symptoms is inconclusive, but suggests that small amounts of estrogen may be beneficial in improving mood. A trial of treatment may help to distinguish between symptoms caused by hormones and symptoms caused by other factors, although there is likely to be a significant placebo effect.
  
  
• Cognitive Behavioural Therapy (CBT).  CBT is known to be as effective in treating depression and anxiety as anti-depressants, and has the additional value of providing people with skills to manage their mood after treatment has stopped.  It is now increasingly being used to help women to cope with the physical symptoms of menopause, and early results suggest that it is effective in reducing symptoms and increasing well-being.
  
  
• Counselling and problem-solving.  When symptoms can clearly be related to personal circumstances, talking problems through with a counsellor, life coach or therapist can be very helpful, especially when there is a focus on coping with day to day realities and finding practical solutions to problems.
  
  
• Mindfulness.  Psychological problems are caused and/or maintained by distressing thoughts. When people are sad they spend a lot of time ruminating about the past and feeling despondent about the future. When they are anxious they focus on dreadful things that might happen. Mindfulness is a technique for bringing a person’s attention to the present. Traditionally practised by Buddhists, it now has much credibility in modern psychology in the treatment of depression and anxiety and generally increasing well-being.

Suggested reading
There is an excellent series of books based on cognitive behavioural techniques, including:
Overcoming Depression by Paul Gilbert
Overcoming Anxiety by Helen Kennerley
Overcoming Low Self Esteem by Melanie Fennell
Overcoming Anger and Irritability by William Davies
Overcoming Insomnia and sleep problems by Colin Espie
Also:
I Had a Black Dog by Matthew Johnson
The Worry Cure by Robert Leahy
Wherever You Go, There You are: Mindfulness Meditation for Everyday Life by Jon Kabat-Zinn
The Mindful Way Through Depression by Mark Williams and colleagues.

Dr Anita Houghton is a doctor, career coach and CBT therapist, and author of Finding Square Holes, a self help book for reviewing your working life and planning careers. 
Visit her website: www.workinglives.co.uk.
She also produces regular free tips on life and work.

Stress
For a simple guide to stressing less and enjoying life more, visit: www.stepsforstress.org