Am I Losing My Mind - Or Is It My Hormones?
The menopausal transition is fraught with several well-known physical symptoms including hot flashes and skin and hair changes. What are not as well known, but just as problematic, are the psychological symptoms that may manifest during this time. Many are familiar with the hormonal connection in PMS and post-partum, but the same hormone fluctuations that contribute to those issues are at work during perimenopause as well. Depression, anxiety, attention issues, and insomnia are common complaints that may develop for the first time during perimenopause or may be recurrent issues from the past. Maybe you wouldn’t use such clinical terms, but do you find yourself weeping at commercials? Being testy with your partner for no reason? Losing your car in the parking lot? Waking frequently at 1-3am? Feeling tired or anti-social? Many women simply, often tearfully, describe just not feeling like themselves.
There are several possible underlying contributing factors that should be excluded, like frank psychiatric illness, sleep disorders, thyroid disease and nutritional deficiencies. However, there has been research confirming that these naturally occurring changes in hormones during menopause are enough to contribute to psychological symptoms. Though we are in the infancy of understanding the connection between hormones and the brain, there is a relationship between hormone levels and neurotransmitters that play a role in mood disorders. We know that serotonin-reuptake inhibitors like Effexor and Lexapro not only help with the physical symptoms like hot flashes, but also improve mood, sleep and quality of life in some patients. Vyvanse has been shown to help with attention and concentration difficulties during perimenopause. Gabapentin has been shown to help with sleep, depression, pain and hot flashes. The reverse holds as well: Progesterone has well known antianxiety and sleep promoting properties and estrogen can be an effective antidepressant in many women. Decreased levels of both DHEA and testosterone have been noted in women suffering with depression and anxiety.
Depending on the severity of presenting problems and patient preference, several treatment options are available, including diet, exercise and lifestyle changes, herbal and nutrition supplements, acupuncture, as well as the aforementioned hormones and medications. Research supports the role of alcohol and sugar avoidance in attention issues, depression, anxiety and insomnia at all life stages. Acupuncture, exercise, and yoga have been shown to improve mood, sleep and hot flashes. Chinese herbal medicine, Black Cohosh, St. John’s Wort, Maca, Magnolia and soy isoflavones have been shown to help decrease anxiety, depression, insomnia and hot flashes in some women. Research shows that cognitive behavioral therapy and meditation are effective treatments for anxiety, depression, and insomnia from any cause and may have a role in a comprehensive treatment plan.
The take-home message is that psychological symptoms are common in the menopausal transition and may be more severe than the physical symptoms in some women. There is no right answer in terms of treatment and like many medical therapies, a few may need to be tried before finding the right one for each individual. With the help of a skilled practitioner, you can find the right combination of treatments that will help you get started on the road to wellness today.