By Susan Brink
Archie Bunker called it "mental pause," his malapropism in sync with myth and folklore: Women of a certain age turn into shrieking hags or sobbing wimps.
But mood changes don't affect everyone at midlife, and when they do, it often has little to do with hormones and a lot to do with life events. Women in their 50s 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 be secondary effects: Hot flashes and night sweats rob women of sleep, making them crabby.
A factor few people talk about, says Phyllis Kernoff Mansfield, professor of women's studies at Pennsylvania State University, is that at menopause women's bodies begin to change in ways few people enjoy. "Women don't like what they're seeing in the mirror," she says. "There's nothing inherently wrong with a bigger belly or wrinkles or gray hair. But they're scared of the perceived loss of attractiveness and youthfulness."
In a five-year study of women's moods as they approached and experienced menopause, Sonja McKinlay, president of the New England Research Institutes in Watertown, Mass., found that the rate of depression in nearly 2,600 women increased slightly in the year before and the year after menopause. The risk was greatest among women who already had a history of depression, who had hot flashes, who suffered from some other disease, 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 in hormone levels that affect women in different ways. Milder versions of such fluctuations occur during each menstrual cycle and after pregnancy, yet not every woman has premenstrual syndrome or postpartum depression. With perimenopause, "it may be the rapid change in hormones or the frequency of cycles that triggers depression in some women," says Peter Schmidt, chief of the National Institute of Mental Health's unit on reproductive endocrine studies. In one study, Schmidt looked at 34 women who were going through perimenopausal depression. Half of them received a placebo, and half had estrogen treatment in the form of an estradiol patch. Symptoms of depression improved for 80 percent of the women on the patch and for only 22 percent of women with a placebo 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, a year down the road, the estradiol would keep working or start to show ill effects.
For now, treating depression and other mood disorders in women at this point in their lives is like treating anyone else. What's needed is a careful evaluation of each woman's condition and possible use of an antidepressant or other drug and psychotherapy.
Copyright 2002 U.S.News & World Report, L.P. Reprinted with permission.