The topic of menopause may be trending, but healthcare professionals may not be taking changes to hormones seriously enough.
Last summer, Vanessa McGrady developed bloating and other digestive problems, her hair began falling out, and she found herself tossing and turning at night. She knew these symptoms stemmed from menopause, especially since her menstrual cycle had also become irregular, but the onslaught overwhelmed her. “I felt like I’d lost control of my body and its functions,” says McGrady, 55 from Burbank, California and author of the memoir Rock Needs River.
The hot flushes, combined with the hot outside temperatures, made McGrady feel even more out of sorts. And she felt alone in her experience because her husband and daughter couldn’t relate.
McGrady’s hope for reassurance and effective medical treatment was dashed when she saw her general practitioner. As she ticked through her symptoms, she felt so overwhelmed that she started to cry. Her doctor – a younger woman – coldly asked why she was upset.
“She had no empathy,” McGrady recalls. She also had no medical advice to offer. After informing McGrady that she didn’t prescribe hormones, the doctor suggested seeking out herbal medicine at a health food store. McGrady left feeling dismissed and even more adrift.
Many Doctors Still Don’t Understand Menopause
According to the National Institute on Aging in the U.S., more than one million American women experience menopause each year, defined as passing 12 months without a period.
While McGrady isn’t yet among them (she is considered perimenopausal, with irregular but still occasional menstruation), her encounter with her physician is unfortunately common.
At least McGrady’s physician recognised that her symptoms were from menopause.
Other women say their healthcare practitioners don’t even make the connection, chalking up their symptoms to things like stress or even hypochondria.
Women are regularly gaslighted about the way that fluctuating hormones related to menopause affect their physical and mental health, says Maya Dusenbery, the author of Doing Harm: The Truth About How Bad Medicine and Lazy Science Leave Women Dismissed, Misdiagnosed, and Sick.
Women’s normal hormonal levels, including during puberty, still don’t receive sufficient attention by the medical community, Dusenbery says.
A survey published in 2019 in Mayo Clinic Proceedings found that just 7 percent of new physicians in family medicine and gynaecology felt adequately prepared to deal with patients’ menopause, with 20 percent reporting they had not received a single lecture on the topic during residency.
“This has led to women who experience symptoms being told their symptoms are either all in their heads or nothing to complain about,” she explains.
Mental health symptoms, including depression, anxiety, or brain fog, worsen the odds of being dismissed, Dusenbery says. “It’s all too easy for medical providers to see middle-aged women struggling with anxiety and depression as just stressed by the everyday challenges of midlife.”
Hormone Fluctuations Can Cause Anxiety and Depression
The shifting hormones during the years leading up to and following the ending of periods cause a wide range of scientifically documented symptoms.
Common physical issues include hot flushes, night sweats, hair loss, weight gain, vaginal dryness, and urinary issues known as the genitourinary syndrome of menopause.
Before the 1990s, there was debate about whether shifting hormones also caused mental health problems in some women, says Nanette Santoro, MD, the chair of obstetrics and gynaecology at the University of Colorado and a prolific menopause researcher.
But several high-quality studies after that time, including the famed Study of Women’s Health Across the Nation, conclusively proved that mental health issues may arise during the menopause transition.
“Women without preexisting anxiety or depression can in fact be hit very hard at this time,” Dr. Santoro says, although she notes that women with a history of these conditions are at the highest risk.
Other women develop brain fog, a type of sluggish thinking that impacts life and work. Studies confirming the link between brain fog and menopause include one reported in April 2023 in the journal Maturitas. In a survey of nearly 2,000 women, those in perimenopause or who had surgical menopause were more likely than premenopausal women to cite issues with executive function (the term used to describe working memory, flexible thinking, and other mental processes).
“There is clear evidence” that mood is related to the menopausal transition, Santoro says.
The menopause transition is a process that generally starts in a person’s forties and continues into their fifties. Women in the throes of it are not mentally unstable. They’re simply dealing with the physical or mental symptoms that result when reproductive hormones fluctuate, Dusenbery says.
“Any woman of perimenopausal age who is experiencing new mental health issues – or symptoms of any kind – should consider that the menopausal transition could be the cause,” she says.
Women Experiencing Menopause Often Feel Alone
When Amanda Thebe entered perimenopause several years ago, she developed severe depression along with physical symptoms, including bouts of nausea, dizziness, and vertigo.
During two years of visits to the emergency room and numerous doctors, no one connected her experience to perimenopause.
Thebe, a fitness and nutrition coach from Houston, clearly remembers the day a gynaecologist finally told her that her symptoms were caused by perimenopause. “This was a huge relief to me because I literally thought I was going crazy,” Thebe recalls.
The experience prompted her to start a Facebook support group, Menopausing So Hard, which now has more than 18,000 members, and to write the book Menopocalypse so others wouldn’t feel as isolated as she did.
“Women [in the Facebook group] often post saying they really don’t recognise themselves anymore, that they aren’t in control of their body or moods,” Thebe says.
This community has helped her and many others learn from one another, even when the medical community fails them. “The power of the group is that women speak up and share their own experiences, therefore helping others feel less isolated in their despair,” she says.
Menopause Treatments Can Help Mental Health Symptoms Too
Fortunately, despite what McGrady’s physician told her, effective treatments are available. Hormone therapy is the standard of care for many people experiencing hot flushes and other types of symptoms, according to the North American Menopause Society. “For women aged younger than 60 years or who are within 10 years of menopause onset and have no contraindications, the benefit-risk ratio is favourable for treatment,” the group stated in a position paper.
Cognitive behavioural therapy and clinical hypnosis are also supported by evidence, per the North American Menopause Society.
Mental health symptoms may be improved with hormone therapy. Santoro suggests trying it for several months.
“Seeking help from a clinical psychologist or psychiatrist who can evaluate your situation more formally may also be helpful,” she says.
Of course, this requires having a practitioner who takes these symptoms seriously. If yours does not, Dusenbery suggests that you seek out someone who does.
SOURCE: Everyday Health
