Issues Women Struggle With When Going Through Menopause
Many women suffer from depression while going through menopause. antidepressants- SSRI or SNRIs (selective serotonin reuptake inhibitors or serotonin and noradrenaline reuptake inhibitors) are commonly used as the first line response. Unfortunately the treatment has shown only small improvements with troublesome side effect.
Menopause comes from the Greek words mene (month) and pausis (stop). And is defined as the stopping of menstrual periods. Signs and symptoms of this are characterized as the onset of irregular periods, hot flashes, and night sweats. It is known to be associated with changes in biopsychological changes like mood swings, anxiety, sexual dysfunction, stress, forgetfulness, and sleep disturbances.
During menopause estrogen levels decline leading to sleep impairment, depression, cognitive decline and ailments such as osteoporosis, vaginal atrophy, and sexual dysfunction. Sleep disturbances have been ascribed to many things like normal changes due to aging, poor health perception, poor sleep hygiene, nervousness, stress, and chronic health issues. Postmenopausal women may have a number of sleep disorders that include OSA (obstructive sleep apnea) and RLS (restless leg syndrome) to name a few.
Postmenopausal women have also been found to have multiple reasons for sleep disturbances. As women enter the transitional phase of menopause there will be a decr3ease in estrogen leading to a decline in sleep quality and duration. It was also noted to have an increase in restless leg syndrome having an additional difficulty with sleep.
In addition, primary sleep disorders such as OSA, RLS or periodic limb movement disorder are common in postmenopausal women. There were other items noted that could contribute to poor sleep such as gadget addiction, game addiction, excessive caffeine or environmental issues such as snoring or crowded environment. A careful evaluation of the menopausal group of women with sleep issues will throw light on underlying causes and aid in the determination of treatment strategies (Indira & Kasikrishnaraja, 2018).
All women experience menopause regardless of culture, race or social economic background. Natural menopause is part of the aging process that causes a variety of physiological and psychological symptoms. It has been reported that there is an increase in depression and an increase in negative feelings if other life events occur simultaneously. Unfortunately, many early studies produced sometimes conflicting views about symptoms of menopause.
Mental issues are one area that has been consistent through the various recent studies. It was also noted that while every woman goes through menopause, different cultures approach it in different ways. Examples of this; in some African cultures, women think it is a sign of higher social status and an easier future life. On the other hand in the US, Germany, and Italy there are negative attitudes that they feel menopause is equal to getting old/weak. And most women enter menopause without knowing about it and are caught off guard when the symptoms strike.
Most report negative experiences given the fact they are starting to live lonelier lives that can exacerbate the feelings of depression. The psychological experiences of women can greatly vary from person to person. Feelings of anxiety, depression, loneliness, and disability are reported most frequently. Women who receive positive support from families are able to deal with the changes much better. The study did suggest that an area of consultation can help support women during this chaotic time in their lives (Samouei & Valiani, 2017).
Postmenopausal women have an increased risk of a number of health problems like osteoporosis, skin changes, cognition, and heart disease. In order to conduct this study, a group of 431 women was contacted. The study found the level of education, occupational status, marital status, family composition, number of children and income had little influence with the findings.
Most common physical illness noted with menopause was high blood pressure with about one-quarter of them also presenting with respiratory and thyroid problems. One of the most reported symptoms were hot flashes and cognitive difficulties. One finding of the study was that women who complained of hot flashes were part of the group who went through menopause at a later age. This was coupled with lethargy and irritability. It was also noted that there was a high number of women who were experiencing varying degrees of joint pain.
There was also an incidence of urinary disorders bu5t as this study was conducted in India, not enough information was collected due to culture. Two other changes noted was the growth of facial hair and skin changes. This study also noted a few important limitations. First, the questionnaire was not standardized. Second, only subjective assessments were conducted to determine symptoms like memory or sadness-it focused mostly on physical and emotional symptomology (Changulouri & Turedi, 2018).
The climacteric or menopause are defined as a biological phase that comprises transitional between reproductive and nonproductive periods. The association between loss of ovarian function and increase coronary risk been well documented by other studies. It has been found that women develop cardiovascular disease approximately 10 years later than men.
Some cardiovascular disease is due to non-modifiable risk factors such as age, sex, and family history. But there are some risk factors that are modifiable including a sedentary lifestyle, smoking, increased blood pressure, diabetes mellitus, increased cholesterol and metabolic issues such as obesity and dyslipidemia. Overweight especially abdominal obesity correlated with cardiovascular risk factors.
In menopause, change in body fat distribution may increase the risk of cardiovascular disease and metabolic disorders. This study showed postmenopausal women had a higher risk of heart disease and showed a higher abdominal circumference. It was also noted in this study that all women with intermediate risk had metabolic syndrome issues as well. In one study it was reported that ischemic coronary disease or death as a result in 10 years after menopause. There are changes in the body fat distribution and metabolic disorders that can lead to heart problems (Santos Mota, 2018).
Many women with no past psychiatric history experience severe mood symptoms for the first time in their life during the menopause transition. This can lead to debilitating long-term consequences. Women with a history of depression can experience a relapse or worsening of symptoms during this time.
This study took 44 women going through a randomized trial with two groups. One group was given 2.5 mg of tibolone or a placebo. There were 22 in each group and they were studied for 12 weeks. Their depression was monitored for both groups to see if there was any difference. The study found that the tibolone group demonstrated a significant improvement in depression scores when compared with those of the placebo group. There were a few limitations with the study, however. The biggest limitation was the fact it was only monitored for 12 weeks. It is hoped future research would be conducted over a longer timeframe. It should also explore if the benefits of tibolone extend to other symptoms as well. The use of hormonal treatments such as this provides innovations for the treatment of depression during menopausal transitioning (Kulkarni, 2018).
Changelaui, R. & Turedi, A. (2018). A community based study of symptom profile in perimenopausal and menopausal women in India. International Journal of Scientific Research,7(6). https://wwjournals.com/index.php
Indira, M. & Kasikirishnaraja, P. (2018). Patterns of sleep impairments in an epidemiological cohort of postmenopausal women in Perundurai. Journal of Evaluation of Medical and Dental Sciences,7(16). Doi:10.14260/jemds/2018/440
Kaulkarni, J. et al. (2018). Tibolone improves depression in women through the menopause transition: A double-blind randomized controlled trial of adjunctive tibolone. Journal of Affective Disorders,236(15). https://doi.org/10.1016/j.jad.2018.04.103
Samouei, R. & Valiani, M. (2017). Psychological experiences of women regarding menopause. International Journal of Educational and Psychological Researches, 3(1). Doi:10.4103/2395-2296.179065
Santos Mota, M.P. et al (2018). Evaluation of cardiovascular risk in climacteric women: A cross-sectional study. Journal of Mid-Life Health,9. Doi:10.4103/JMH_67_18