Life stresses and depression in the menopause

Sexuality in Perimenopausal and Postmenopausal Women

This article reviews psychosocial and biological aspects of the effects of menopause on sexuality. Sexuality is conceptualized as having multiple dimensions including desire, arousal, and orgasm. Population studies have revealed that postmenopausal status is associated with decline in these components of sexual functioning. While it is probable that psychological response to menopause affects sexual functioning, little research has addressed this issue. Considerable research has addressed the possible relationship between sexuality and menopausal hormone changes. Some research shows that low estrogen levels are associated with diminished sexual response and that estrogen replacement produces enhanced sexual response. Other studies, however, do not show this. Testosterone level is more clearly related to at least some measures of sexuality. Issues for future research are discussed.

Reproductive aging, sex steroids, and mood disorders

Epidemiologic studies have documented that the majority of women do not become depressed during the menopause transition. However, recent longitudinal studies suggest that in some women, the events related to the menopause transition could play a role in the onset of depression. In this article we review evidence suggesting a relationship between the menopause transition and depression. Additionally, we describe several findings that suggest a role of ovarian hormones in the onset of these depressions, including the clustering of episodes of depression during the stage of the menopause transition that is accompanied by estradiol withdrawal, and the therapeutic effects of short-term estradiol in depressed perimenopausal women. Finally, we discuss possible causes of affective disturbances during the menopause transition.

Study of psychosocial factors in Japanese patients suffering from menopausal disorders

AIM

Psychosocial elements are often found in the background of patients with menopausal disorders, and counseling based on these elements is essential for effective treatment. In the study presented here an attempt was made to extract psychosocial factors from Japanese cases of menopausal disorders in which the patients exhibited the impact of psychiatric elements and required counseling.

METHODS

A total of 97 cases in which the patients received counseling for the treatment of undefined complaints at our menopause clinic were analyzed. During counseling the patients were interviewed in regard to psychosocial factors and underwent psychological tests.

RESULTS

About half of them were found to have experienced various interpersonal problems as well as health-related problems. The frequency of problems such as empty nest syndrome and loss of relatives or friends was relatively low. Work-related anxiety or hardships of life were frequent among the premenopausal patients, while concern about aging was often noted in their postmenopausal counterparts. The incidence of empty nest syndrome was high among the ovariectomized women, but worry about aging was frequently reported by those undergoing natural menopause.

CONCLUSION

This preliminary study revealed that problems related to families and the patient's health account for a large part of the psychosocial factors affecting the development of menopausal disorders in Japan. Incorporating these findings into counseling will make outpatient clinics services more acceptable to such patients.

The menopause transition and the aging process: a population perspective

The menopause transition period, extending from active reproductive capacity with well-characterized hormone profiles through reproductive senescence, has been less well studied than any other period of the life span except extreme old age. Yet, for the gerontologist, this is an important period to understand for at least two reasons. First, during this period changes in the neuroendocrine system and ovary may provide a model for the study of other aging-related processes. Second, specific characteristics of this transitional period (including duration, intensity, and age at menopause) may be considered "aging", and influence short-term health and quality-of-life status, as well as life expectancy. In addition to discussing the menopause transition in terms of age and culture, we include some of the theories and conceptual models that can influence the nature and interpretation of information from this time period, and its ultimate impact on health and health practice.

Predictors of menopausal symptoms: psychosocial aspects

The most relevant factors influencing a woman's quality of life during the menopausal transition appear to be her previous emotional and physical health, her social situation, her experience of stressful life events (particularly bereavements and separations), as well as her beliefs about the menopause. Specific predictors of vasomotor symptoms include surgical menopause and possibly current cigarette smoking. The role of stress, past menstrual problems and reports of hot flushes earlier in life as predictors requires further study. There are considerable cultural differences in the reporting of vasomotor symptoms which may be explained by the meaning ascribed to them and the value of older women in societies, as well as possible dietary, lifestyle and genetic differences. Those who seek medical help for menopausal problems tend to report more physical and psychological problems in general. They are more likely to be under stress and to hold particular beliefs about the menopause. These personal and social issues need to be addressed in their own right and should not be automatically attributed to the menopause. Clinical psychologists and counsellors, ideally working as part of the team, can help women and couples to clarify the nature of the problems and to help them to explore solutions. In contrast to childbirth, preparation for the menopause has been neglected in the development of services, as well as in research (Notelovitz, 1988; Hunter, 1990c). The studies reviewed here do suggest some pointers for health promotion; these are being evaluated in a current study by Hunter and Liao and can be summarized as follows: 1. Providing balanced information about the menopause, to women and their families. 2. Discussion of attitudes towards the menopause, with reassurance of overly pessimistic beliefs. 3. Health promotion sessions focusing upon diet, exercise and smoking (factors which are associated with general health and the development of osteoporosis). 4. Stress management sessions. 5. Group discussion of personal, health and social issues met by women during midlife.

Relations between fertility, body shape and menopause in Austrian women

The influence of number and date of pregnancies, births, and spontaneous and induced abortions on body shape, age at menopause and menopausal symptoms have been studied for 110 postmenopausal Viennese women. A significant correlation between fertility and age at menopause was not found, but several menopausal symptoms showed statistically significant correlations with fertility. With a higher number of pregnancies the individual symptoms became more severe.

Emotional well-being, sexual behaviour and hormone replacement therapy

Improvements in the design of epidemiological studies of the climacteric and postmenopause have been made in the past 25 years. But more complex theoretical models are necessary if we are to give due emphasis to the influence of psychological, social, cultural and hormonal factors and their interactions. The majority of studies show that emotional problems are not more prevalent during the climacteric and postmenopause and that psychosocial factors, such as stressful life-events, are more likely causes of emotional distress during mid-life. Vaginal dryness increases in postmenopausal women but there are varied reasons for changes in other aspects of sexual behaviour which require further research. While estrogen may have a "mental tonic" effect when prescribed in high doses, HRT does not appear to have a significant effect upon mood or sexual behaviour over and above placebo effects and the relief from vasomotor and vaginal symptoms.

The menopause viewed in relation to other life events--a study performed in Belgium

In order to study the impact of the menopause and hysterectomy in relation to other life events, a study was carried out in Belgium in a random sample of 510 women over 18 yr of age. It was found that these 2 life events are not perceived as being important. Comparison of the findings with those of an earlier unpublished study performed by the International Health Foundation on the same subject indicates that there has been a decrease in the perceived severity of the 2 life events. This could mean that, in the intervening period, socioeconomic status and emotional problems have acquired greater importance, although the change in attitudes might also be partly explained by the fact that the respondents were younger.