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Hormones and Emotions
Susan Brink
18 Nov 2002

Archie Bunker called it "mental pause," his malapropism in sync withmyth and folklore: Women of a certain age turn into shrieking hags or sobbingwimps.

But mood changes don't affect everyone at midlife, and when they do, it oftenhas little to do with hormones and a lot to do with life events. Women in their50s may have children who are leaving the nest, parents who are sick or dying,or their own chronic health problems. And mood changes tied to menopause may besecondary effects: Hot flashes and night sweats rob women of sleep, making themcrabby.

A factor few people talk about, says Phyllis KernoffMansfield, professor of women's studies at PennsylvaniaStateUniversity
, is that atmenopause women's bodies begin to change in ways few people enjoy. "Womendon't like what they're seeing in the mirror," she says. "There'snothing inherently wrong with a bigger belly or wrinkles or gray hair. Butthey're scared of the perceived loss of attractiveness and youthfulness."

In a five-year study of women's moods as they approached and experiencedmenopause, Sonja McKinlay, president of the NewEngland Research Institutes in Watertown, Mass., found that the rate ofdepression in nearly 2,600 women increased slightly in the year before and theyear after menopause. The risk was greatest among women who already had ahistory of depression, who had hot flashes, who suffered from some otherdisease, or who were under significant stress. It had nothing, absolutely nothing,to do with estrogen levels in the blood.

But for some women, hormonal changes may play a role in mood. Perimenopause is a time of unparalleled fluctuations inhormone levels that affect women in different ways. Milder versions of suchfluctuations occur during each menstrual cycle and after pregnancy, yet notevery woman has premenstrual syndrome or postpartum depression. With perimenopause
, "it may be the rapid change in hormonesor the frequency of cycles that triggers depression in some women," saysPeter Schmidt, chief of the National Institute of Mental Health's unit onreproductive endocrine studies. In one study, Schmidt looked at 34 women whowere going through perimenopausal depression. Half ofthem received a placebo, and half had estrogen treatment in the form of an estradiol patch. Symptoms of depression improved for 80percent of the women on the patch and for only 22 percent of women with aplacebo patch.

Managing mood. But there are unknowns. The study,published in the August 2000 American Journal of Obstetrics and Gynecology,lasted six weeks--long enough to show improvement. But no one knows if, say ayear down the road, the estradiol would keep workingor start to show ill effects.

For now, treating depression and other mood disorders in women at this point intheir lives is like treating anyone else. What's needed is a careful evaluationof each woman's condition and possible use of an antidepressant or other drugand psychotherapy.

Copyright 2002 U.S.News & World Report, L.P. Reprinted with permission.

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