A Pitfall and Challenge: Women with Pre and Post Menopause-Spectrum of Psychiatric changes and Balance of Health

A world without women is impossible to dream of. Throughout history, the central role of women in society has ensured stability, progress and long-term development of various nations. A woman is a caretaker, educator, a potential catalyst of the workforce and a developing phenomenon in families and nations worldwide. According to UN Womenwatch Organisation, “Rural women play a key role in supporting their households and communities in achieving food and nutrition security, generating income, and improving rural livelihoods and overall well-being.”

Women play a different and significant role in the social life of a human being, despite the hidden mental stress and psychiatric illness that they go through due to physical and hormonal neuronal changes. In India, women are there in every field, beginning at home to being doctors, engineers, constructors, lawyers and many more. They go through many physical and mental changes, but due to a lack of awareness and lack of knowledge, they suffer from a psychiatric mental spectrum with variants. As women play a potential role in the balancing of Nation and Society, women being educated towards their mental health is a potential challenge to avoid pitfall!

Women during the later stages of their life face the maternal physical change called Menopause. There are many steps along the way to menopause, while each phase of the process has characteristics and symptoms. Perimenopause describes the period when estrogen levels in the body start to drop. Some women start noticing symptoms such as menopausal mood swings and hot flashes at this time. Menopause takes place, technically, after a woman has not had her period for 12 months. After this, she is considered postmenopausal and many women see differences in their emotional symptoms. From start to finish, the process can take 2-10 years. Even though menopause is a natural phenomenon, it causes symptoms ranging from vasomotor symptoms to sleep disturbance, mood disorders, loss of sexual desire and vaginal dryness. During the menopausal transition, women may experience a variety of symptoms. Many a time women are unaware of these symptoms and they do not seek treatment for the same.

Most women go through menopause without developing a significant mood disorder. Menopause is a time of change, however, and emotional reactions are part of that.

According to the recently published cross-section study in the Research Journal “Int J Med Sci Public Health 2018;7(1):48-52” on Indian women, the results were very shocking and unexpected. Women who suffer from different psychiatric illness found are much more than expected and most of them were unaware. The analysis of the study explains how crucial attention is required for mental health education and awareness for women in India. The applied research data for various psychiatric symptoms in women associated with menopause is noted below:-

 The data is taken from one cross sectional study: Patel M, Shah V, Kamani H, Sonaliya K. Current scenario of menopause-related symptoms using menopause rating scale among middle-aged women of Western India: A cross-sectional study. Int J Med Sci Public Health 2018;7(1):48-52.

The study was concluded in a minimal number of women, but this short study gave shocking results, leading to a focus on the actual urge for mental education in women, especially. They feel the symptoms and changes they feel or observe are a part of a natural phenomenon, but it’s really a progressive psychological change leading to a spectrum of difficulties and disorders.

Some of the most widespread aspects of menopause mood swings include:

• Irritability: Up to 70 percent of women describe irritability as their main emotional problem during the early stages of the menopausal transition. They find themselves less tolerant and more easily annoyed at things that did not bother them before.
• Depression: Depression is the most common and serious emotional side effect of menopause. It affects up to 1 out of every 5 women as they progress through menopause.
• Anxiety: Many women experience tension, nervousness, worry and panic attacks during menopause. Some may find their anxiety getting worse, while others may develop it for the first time.
• Crying episodes and feeling weepy: This tendency can become more pronounced in menopausal women as they find themselves weeping over incidents that might not have mattered much before. However, tears can reduce stress as they allow people to release pent-up feelings.
• Insomnia: Insomnia can contribute to mood swings, as it interferes with day-to-day functioning. It is common during menopause, affecting 40-50 percent of women.

[Figure 1 is taken from Wikipedia: Source https://en.wikipedia.org/wiki/Menopause; Figure 2 and Figure 3 are taken from the Drjockers.com blog: Source https://drjockers.com/perimenopause-natural-solutions/]

The drop in estrogen is thought to affect the way the body manages serotonin and norepinephrine levels, two substances that have been linked to depression. Lower levels of estrogen have been linked to irritability, fatigue, stress, forgetfulness, anxiety and difficulty in concentrating. The impact of these changing hormone levels may not be limited to a direct cause-and-effect relationship with depression, anger and anxiety. Hormone shifts may also intensify these feelings.

Researchers have found higher levels of a brain protein known as monoamine oxidase A (MAO-A), which is linked to depression in women entering perimenopause. Sometimes, the reactions build on each other, such as with night sweats. These are hot flashes that take place when someone is asleep. Night sweats can be so intense that a woman is woken and sleep is disrupted. Several nights of disrupted sleep can result in foggy thinking, irritability, and other characteristics associated with menopausal mood swings.

Medication, therapy, and Alternatives:

Hormone therapy was once a widely recommended treatment for the symptoms of menopause, but it was later found to increase some health risks. While it is still prescribed today, it is used cautiously, and doctors are exploring other treatment options, including lifestyle changes. Bioidentical hormones are also used to address menopausal mood swings and symptoms. They are made from plants by pharmacists based on instructions from a doctor and are not regulated by the United States Food and Drug Administration (FDA) for quality, purity or dosage. They appear to have the same risks and benefits as conventional hormone therapy. Some types of antidepressants may be helpful for women who have trouble with hot flashes in addition to depression.

Lifestyle changes

Experts from all around the world have found that exercise, diet, getting enough sleep and supportive relationships help women with the emotional aspects of the transition into menopause. Regular exercise is a great way to promote both mental and physical health. Being active helps relieve stress, improves mood and makes it easier to put problems in perspective. Many women wonder if lifestyle and behaviour changes can help with menopausal symptoms. Studies have shown mixed results for lifestyle changes; hence, speak to your doctor if you have any queries. Maintaining a healthy weight might be helpful, as there is evidence that weight gain can increase the severity of menopausal symptoms.

Some evidences suggest that yoga can help menopausal symptoms. Other activities such as exercising, breathing and relaxation practices or controlling environmental temperature might not necessarily help your symptoms, but they can help with your overall sense of wellbeing. Cognitive behaviour therapy (CBT) can improve well-being and decrease the impact of menopausal symptoms. Hypnosis might give you some benefit, but there is no evidence that acupuncture, magnetic therapy, reflexology or chiropractic interventions help menopausal symptoms.

The Centre for Disease Control and Prevention (CDC) recommend 2.5 hours a week of moderately intense aerobic exercise, such as a fast walk and 2 days a week of muscle strengthening. Diet can also help individuals reduce menopausal mood swings, especially one rich in protein and omega-3 fatty acids. Researchers have also found that practices such as tai chi, yoga and meditation can help them to overcome the stress, irritability and other symptoms of menopause.

Read More: 10 Meditation Techniques Everyone can (and should) Explore

Hopes and Hypes of Complementary Medicine: Factsheet

Complementary medicine is used to describe a wide range of health care medicines, therapies (forms of treatment that do not involve medicines) and other products that are not generally considered part of conventional medicine. Some complementary medicines may help with mild symptoms, but there is little evidence that many popular complementary medicines help with symptoms or are safe. Speak to your doctor before using complementary medicine because it might affect other medications. Avoid buying online products – their safety cannot be guaranteed. You should not use soy/ phytoestrogen products if you can’t take prescribed hormone therapy for safety reasons, such as breast cancer. Bio-identical compounded hormone therapy cannot be recommended because its safety is unknown. No complementary medicine is as effective as estrogen therapy for menopausal symptoms.

A common question most women have is…

Will Menopause affect my Sex life?

• The most likely advice to be had for any woman entering and at the end-stage of menopause is to consult a Gynaecologist for better physical, maternal and mental health. The changes can be new for you, but a well-qualified Gynaecologist can help you reduce the symptoms and improve the quality of life with minor lifestyle changes and a few medications if required. 
• If your sex life is good before menopause, it is likely to remain good after menopause. Sexual well-being is complex, and many other personal factors in your life could be involved. Vaginal dryness can be treated with creams and lubricant; Hormonal treatments include estrogen or testosterone therapy but only use testosterone designed for women which are generally prescribed by the Gynaecologist after proper counseling.
• Your doctor, a Gynaecologist, may need to work with you to look at the many factors that might be affecting your sexual wellbeing and to improve the quality of life, affecting mental health.

Thus, the best way to deal with the Menopause symptoms and associated psychiatric disorders is to consult your doctor without hesitation and speak out about the issues you are facing or changes you are experiencing in your body. Women should become aware and consult a Gynaecologist or Psychotherapist to improve their mental health. Awareness and proper counselling can help to reduce future comorbid psychiatric complications. A women’s health campaign should be conducted as a recommended project by NGOs and the Government too in where everybody can contribute to create more awareness among people towards this pandemic, as women are the base of a Developing Nation! Women should be respected, loved and cared for throughout their lives as they face so many unsolved challenges like psychiatric and neurological issues associated with their menstruation cycle, yet give their lives for the benefit of others!

The deteriorating mental health of Women in Developing Nation like INDIA is really a PITFALL and Challenge!