It’s a cliché that women express their feelings more than men do. We’re thought to be born communicators who are comfortable sharing our innermost thoughts and feelings. There’s even data to back this up.1,2 So, why is it so hard for us to talk about our experience of menopause?
It may be that many women don’t know how to talk about menopause comfortably, even with friends who are also going through it.
To find out why menopause is such a difficult topic for women to broach, we reached out to Dr. Jennifer Payne to learn more.
Dr. Payne is Director of Women’s Mood Disorders Center and Associate Professor of Psychiatry and Behavioral Sciences at Johns Hopkins Medicine. Her research interests include menopause, perimenopause, and hormonal influences on mood and mood disorders. She’s also in perimenopause herself. In addition to seeing patients and researching these topics, Dr. Payne actively talks with her friends about their collective symptoms, a lot of the time with laughter, over breakfasts together. Here’s what she had to say about the importance of talking about your menopause experience.
Q – Why did you choose to focus on women’s mental health?
A – I consider myself to be a reproduction psychiatrist. I’m interested in times of reproductive change in women’s lives; these include perimenopause and menopause. Managing psychiatric and mental disorders in women is complicated and I believe the emotional issues which arise during perimenopause deserve more attention than they get.
Q – The 10-year study of Women’s Health Across the Nation (SWAN) found that women are at increased risk for depressive moods during menopause.3 Which emotional disorders are the most common for your patients during this timeframe?
A – Menopause is technically only one day. Most people, when they talk about menopause, are really referring to the symptomatic period leading up to it, known as perimenopause. We know that women can develop depressive episodes in mood as well as common physical symptoms during perimenopause, and it’s a time when women are at risk for developing depression. Hot flashes and night sweats are a big physical symptom that women have emotional reactions to and often need help coping with.
We also know that when women have a preexisting mood disorder, such as bipolar disorder, they can destabilize during perimenopause. We think this may be related to hormonal fluctuations.
Q – Bonafide’s recent State of Menopause survey found that less than half of all women talk about menopausal symptoms or their feelings about what they’re going through. What are the most common emotional perimenopause symptoms your patients are dealing with?
A – Most of the time it’s mood swings and mood instability, which almost all women experience during perimenopause. Many women describe mood instability during perimenopause as feeling like unpredictable PMS. Some report random arguments, followed by hot flashes. Others feel irritable, tearful, and unable to let things go as easily as they did before.
A big issue for women is thinking that mood instability and menopausal emotional symptoms are all in their head. Sometimes they blame themselves for not being patient enough. This is a catalyst for self-blame and shame, which makes communication with others even harder.
Q – Does stress play a role?
A – Stress can absolutely play a role. We know that women are at an increased risk for high levels of anxiety during perimenopause. I’m in perimenopause myself, and one of the things I’ve found interesting is – when I first started having hot flashes, I woke up, realized I was having a hot flash, and thought to myself, ‘this is interesting, I’m sweating and have a very rapid heartbeat’. If I was prone to anxiety that would have made me very anxious.
Physical symptoms can also trigger symptoms related to mental health. And on top of that, perimenopausal women are usually going through a time of change in their lives. Kids are leaving the house. Parents are older. Responsibilities are shifting. I’m having a change in my own career so I know that even positive changes can generate stress.
Stress can also be a trigger for mood changes and anxiety disorders during and after menopause. Like most things, there are multiple factors and stressors at play.
Q – Do hormonal therapies help address symptoms related to mental health during menopause?
A – Hormonal therapies can absolutely help; however, every case is different. In [perimenopausal] women with mood disorders, I’m going to work on stabilizing the mood disorder first, before we talk about prescription hormones.
Studies have shown that prescribed estrogen taken during perimenopause can be helpful for managing mood symptoms, and possibly can be used as an adjunct for treating major depression.4 Once you hit menopause, it’s no longer helpful for mood disorders or depression, however, we also know that the risk for depressed moods seems to settle down after menopause. When hormonal fluctuations cease, depression risk tends to settle back down to the baseline level of risk each individual woman had prior to perimenopause. If you have a preexisting mood disorder it may also settle down.
Some of the thought behind prescribing a hormonal treatment [during menopause] is to get rid of those hormonal fluctuations, as for the most part the fluctuations that are the problem, not the low level of hormones. The brain likes steady levels. That’s where taking birth control pills without placebo pills, or using an estrogen patch, can be helpful. It helps to smooth out estrogen levels and the brain reacts well to that.
Q – What are some of the negatives that can occur when women don’t talk about their menopause experience?
A – There’s so many! When women don’t talk about their emotions, they feel all alone. They feel greater amounts of stress. They feel shame and shame is a horrible emotion. I think there’s a lot of negative self-talk and beating yourself up that can lead to depressive episodes. You can feel like you have no control.
Q – What’s your best advice for women who tend to bottle up their feelings during menopause?
A – If you can, talk to friends, laugh about it, and don’t beat yourself up. If possible, don’t try to keep it all in – as depression can be thought of as anger and hatred turned inwards.
It’s important that you avoid doing nothing. If you don’t have a friend you can talk to, make a plan to make a friend. Explore interests you have that others may also share. Go to an art festival, join a perimenopause group, or take some educational courses. Volunteer in your community and try to meet people.
I’ve even written prescriptions before for perimenopausal and menopausal women to go get a pet. My cat has been a huge comfort. He drapes himself on my shoulder and just purrs. Taking care of another creature can be heartwarming.
It’s also important to exercise. This helps to calm the nervous system down. And, if you feel out of control, always be sure to reach out to a mental health professional.
Q – What should menopausal women avoid to improve their mental health?
A – It’s easy to reach for alcohol, cigarettes, or food, however, when you reach for substances, you may end up feeling out of control. And what you’re really craving is control. So, this behavior is self-defeating. Exercising, talking to friends or to your healthcare provider, even using online groups or self-help apps are all better choices.
Most importantly, remember that menopause is natural. Reach out to your friends and say, ‘let’s talk about menopause.’ If they’re looking for support and wondering how to talk about menopause with others, they’ll be relieved you took the lead. Don’t isolate, and don’t go it alone. You really don’t have to.