Here’s another Change One Thing Challenge -- where we provide simple suggestions for positive changes and you choose one change and make it. Our suggestions and survival techniques for menopause and mental health are a great place to start.

Survival Technique 1: Blame your hormones anyway.

Few scientific studies demonstrate that menopause contributes to true clinical depression, severe anxiety, or erratic behavior. However, some perimenopausal women report symptoms of tearfulness, mood swings, and feeling blue or discouraged. It is unclear whether these mood symptoms are related to a decline in ovarian hormone levels, but sleep deprivation due to menopause-related night sweats often results in fatigue, irritability, and moodiness. Abrupt hormonal fluctuations during perimenopause may have an impact on these symptoms as well.

Depressed mood during perimenopause is associated with a history of depressed mood earlier in life (including PMS), a longer menopause transition, or severe menopausal symptoms such as hot flashes. Other causes of mood disturbance during perimenopause include:

• Thyroid disorders -- fatigue, depression, mood swings, and sleep disturbances are frequently associated with menopause, but they may also be signs of hypothyroidism. The thyroid helps regulate metabolism and influences the heart, brain, kidneys, and reproductive system.
• Medication side effects -- some menopause-like symptoms may be side effects of medication a woman is taking for a different problem.
• Midlife stresses -- floundering relationships, undesired childlessness, divorce or widowhood, struggles with adolescents, return of grown children to the home, empty nest, concerns about aging parents, elder caregiving responsibilities, and career and financial issues.
• Difficulty aging -- changes in self-concept, self-esteem, and body image. Women may begin to contemplate their own mortality and become introspective about the meaning or purpose of their lives.

Survival Technique 2: Repeat after us: Change is good, change is good, change is …

During the menopause transition, women may feel overwhelmed, out of control, angry, or numb. They may seek refuge in alcohol or drugs and thus compound their problems. In fact, women are more likely than men to drink alcohol as a way of dealing with blue moods, loss, divorce, or children leaving home. Although psychological problems are not caused by menopause, they can begin or become worse at this time. Support and encouragement can help women thrive once again during what can be the best years of their lives.

Emotional health during perimenopause requires a balance between self-nurturing and the obligations of work and caring for others. Many women are able to identify and describe sources of tension and symptoms of stress but find it difficult to take time for themselves. Recognizing a problem is the first step to coping. Although many stressors cannot be altered, coping skills enable women to meet life’s challenges and create a renewed sense of self-confidence and balance.

Survival Technique 3: Don’t worry, get happy.

Sometimes, coping skills and lifestyle changes are not sufficient to relieve symptoms of stress. These symptoms may be a side effect of medication, a symptom of a medical condition, or the result of clinical depression or anxiety. A healthcare provider can help determine the cause of mental health stressors, assess options, and prescribe appropriate treatment.

For example, mood disturbances brought on by sleep deprivation resulting from nighttime hot flashes (night sweats) usually improve when hot flashes are treated.
During perimenopause, hormone drugs such as low-dose oral contraceptives may help stabilize mood by controlling hormone fluctuations. This may be particularly true for women who suffered from postpartum depression or PMS. However, no hormone drug is government approved for the relief of psychological symptoms.

Some women use nonprescription remedies to improve mood and mild depression. Supplements containing the herb St. John’s wort may be helpful. Side effects include gastrointestinal upset, fatigue, and increased sensitivity to sunlight (so it is advisable to wear sunscreen, a hat, and wraparound sunglasses when outdoors; and sunbathing must be avoided). Women should not use this herb with drugs that alter blood clotting, such as aspirin or warfarin (Coumadin). Consultation and follow-up with a healthcare provider is important to evaluate symptoms and the effectiveness of the supplements, and to determine the length of treatment. Many practitioners advise using this herb for no more than 2 years.

Another nutrient, omega-3 fatty acid, may also improve mood. Food sources include fatty fish (such as salmon, tuna, herring, and sardines); supplements are also available. More research is needed to determine their effects on mood.

Survival Technique 4: If you notice your menopause “blues” getting darker, seek expert advice.

More severe depression and anxiety require special attention. Clinical depression is one example. Often a perimenopausal woman will say she feels “depressed.” It’s important that a healthcare provider distinguish whether she is feeling blue or if she is actually “clinically depressed,” a condition associated with a chemical imbalance in the brain. The following symptoms, lasting for more than 2 weeks, can indicate this condition:

• Prolonged tiredness/lack of energy
• Loss of interest in normal activities
• Sadness/depressed mood
• Irritability/tension/nervousness
• Physical symptoms of anxiety (diarrhea, indigestion, heart palpitations, headaches, hyperventilation, sweating)
• Decreased sex drive
• Feelings of guilt

Clinical depression is not caused by menopause, but women who have had depression in the past are vulnerable to recurrent depression during perimenopause. For severe depression, prescription antidepressant medications can be given to help correct the chemical imbalance. Although several weeks are usually needed to experience a drug’s full effect, most women show a marked improvement with these medications with relatively few side effects. Antidepressant medication is most effective when used in combination with counseling or psychotherapy. Although proven effective for mild depression, St. John’s wort is not effective for clinical depression.

Anxiety is another condition that goes beyond the blues. Anxiety is an agitated sense of anticipation, dread, or fear experienced by everyone at one time or another. Menopause does not cause anxiety, but women may experience more anxiety because of how they react to physical and psychological changes during perimenopause, coupled with other midlife stressors. Although anxiety usually resolves without treatment, it may accompany or be a warning sign of a panic disorder. Symptoms of a “panic attack” include shortness of breath, chest pain, dizziness, heart palpitations, and/or feelings of being out of control or “going crazy.” Sometimes the unsettling feelings that precede a hot flash can trigger such an attack. Anxiety can be related to depression. Severe symptoms of anxiety can usually be relieved through one of several therapeutic approaches including:

• Relaxation techniques
• Stress reduction techniques
• Counseling
• Psychotherapy
• Prescription drug treatment

Survival Technique 5: Lie down on their couch.

Although some individuals feel embarrassed or ashamed about discussing their mental health concerns, no one should suffer in silence. Healthcare providers are better able to help when given as much information as possible about personal and family history. Most primary care providers are not extensively trained in the management of mental health disorders, but they are often knowledgeable and helpful. The next step might be consultation with a mental health professional -- an expert opinion can be reassuring. Treatment for a specific problem, such as marital difficulties or an eating disorder, is best provided by a counselor with expertise in those areas.