Marking the end of the menstrual cycle, menopause is defined as occurring 12 months after a woman's last menstrual period. The five to ten year period before menopause, when estrogen and hormone levels begin to drop, is called perimenopause. Hormones are the messengers in the body that start, stop, speed up or slow down our physical and chemical functions. Ovaries are the source of estrogen and progesterone, the two key hormones that control the reproductive system, including the menstrual cycle and fertility in women. During menopause, estrogen depletion can bring on a combination of hormonal and biochemical fluctuations that can lead to changes in the brain and nervous system.
Studies show that hormonal fluctuations and changes in estrogen levels can interact with chemicals in the brain, affecting mood. Due to depletion in estrogen a woman may experience:. Clinical trials are yet to find a link between depression and menopause. But many women do experience mood swings during perimenopause. Happy highs then teary-eyed lows. Cheerful times followed by crabby days. These mood swings are often linked to fluctuating levels of estrogen. Depression may also be a result of potential physical and emotional effects of menopause such as insomnia ,.
However, research suggests women who had severe PMS in their younger years or postpartum depression may have more severe mood swings during perimenopause.
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Women with a history of clinical depression also seem to be particularly vulnerable to recurrent clinical depression during menopause. I found coping with life and stressors became much harder and I also found it brought to the fore unresolved repressed past hurts that demanded me to deal with them. Menopause has been shown to exacerbate bipolar disorder.
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Although doctors don't completely understand the biochemistry behind the reaction, research suggests that a significant number of women with bipolar disorder are more sensitive to hormonal shifts during menopause. At menopause women living with bipolar disorder report more depressive episodes than those without. This is at least partly due to the normal menopausal decrease in the hormone estrogen.
Menopause and Madness: The Truth about Estrogen and the Mind
Estrogen has been shown to have important neurological and psychological protective activities. A reduction has been shown to potentially trigger or aggravate mental disorders including psychotic ones. This has led researchers to believe there may be a link between estrogen levels and psychosis in women. Women with pre-existing chronic schizophrenia may experience a deterioration of their illness and possible higher demand for medication. It seems perimenopause may enhance the risk of first onset of schizophrenic psychoses.
While schizophrenia typically has its onset in young adulthood, there is a second peak in women around menopause. Researchers have suggested that falling estrogen levels may modulate certain brain neurotransmitters, this may lead to an increase in symptoms of schizophrenia during this hormonal transition.
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Despite the known effect of estrogen levels, other factors can influence a woman's mental health. This phase of life is often burdened with emotional stressors such as ending or starting romantic relationships, grown children leaving or returning home, financial or career changes, concerns about ageing parents, getting older in a society that values youth, worries about the health of a partner and need to reevaluate life expectations. When you look at the potential effects of menopause and societal pressures this period can sound overwhelming. Life circumstances play a part in how we get through this time.
It's possible that your emotional intensity and regulation could go down a notch, but no one can predict that as all women are different. She was no longer working; she broke up with her boyfriend and became suicidal. No one knows exactly how schizophrenia starts — or, for that matter, what it is. Genes definitely play a role. But environment interacts with the genes to turn them on in certain cases, and researchers have sought to pinpoint those triggers — to determine which circumstances or behaviors put a person who is predisposed at increased risk.
Pot smoking in adolescence is thought to be a risk factor; so are head injuries during birth and in early childhood. These are all hypotheses with some data to support them.
Menopause and Madness by Marcia Lawrence
The truth is, for all the codifications of the DSM, science still has an extremely rudimentary and tentative understanding of what actually happens in the brains of people we recognize as mentally ill. And political institutions routinely fail to meaningfully fund that inquiry. The estrogen hypothesis is valuable not because it provides a clear-cut answer as to why some women mentally deteriorate in midlife but because it suggests one way, in the face of a terrifying mystery, to begin exploring it.
Mary Seeman is 83 years old, with cropped white hair and a sharp, wise face. She still lives in Toronto, her sixth-floor apartment a jungle gym of rails and poles to accommodate her husband, Philip, who is 84 and has a degenerative muscle disease. Seeman was one of the first psychiatrists to put forward the estrogen hypothesis, an idea inspired, she told me, by Philip. While Mary was busy training to be a psychiatrist, Philip, a psychopharmocologist, was trying to figure out how antipsychotic drugs worked on the brain.
The first antipsychotic, Thorazine, came on the market in It had the miraculous effect of quieting psych wards overnight, as it switched off the hallucinations and delusions that made patients babble and scream, enabling them to become functional and coherent again. It was also a puzzle. Designed as a companion drug to anesthesia, no one, including its manufacturers, understood why Thorazine also quieted psychosis.
Philip applied himself to finding out. In , he published an extraordinary discovery: All antipsychotic drugs work the same way. This is why people who take antipsychotic drugs say their emotions feel so muted; the medicine interrupts their pleasure mechanism.
He brightens. Taking a pen from his pocket, he leans over the coffee table between us and starts to draw on a pad, making a big triangle. He draws another arrow intercepting his triangle from a different direction. This is estrogen. It also blunts the effect of dopamine and acts as an inhibitor, similar to an antipsychotic. If estrogen modulates psychosis, it might explain why schizophrenic symptoms in menstruating women were less severe than those in men and why these women needed lower doses of antipsychotics to control them.
It might even be protective enough to delay onset for a number of years. Sudden, dramatic fluctuations in estrogen during perimenopause, the months or years before a woman stops menstruating, might explain why a woman with no previous history of mental illness might suddenly come down with a bad case of psychosis. In , Mary Seeman published one of the first papers suggesting the estrogen hypothesis in a small journal connected with the University of Ottawa.
She was the only author, making a mild plea for her psychiatry colleagues to pay more attention to the role of estrogen in schizophrenia. The plea fell on deaf ears. There was no established discipline in reproductive mental health at the time, no association for practitioners with specialized expertise. We were self-taught and formed a coalition.
They found that early puberty seems to correlate to later onset of schizophrenia, positing that the presence of estrogen delays its debut somehow. Among women of childbearing age with an existing schizophrenia diagnosis, a large minority reported an increased severity of symptoms just before menstruation, when estrogen dips.
In , premenstrual dysphoric disorder became an official diagnosis in the new revision of the DSM, an acknowledgment that for 5. Older feminists opposed the classification, arguing that it made a pathology of being female, but younger feminists disagreed. By establishing the category, they said, a group of sufferers could finally be acknowledged and receive the treatment they require and have insurance cover that treatment.
The DSM hardly mentions reproductive hormones, and the doctors who look to hormonal changes for answers or causes remain a tiny minority. Only 59 percent of psychiatry residencies require any training in reproductive psychiatry at all, and far fewer hold residents to a standard of competency. In the meantime, people like Talia continue to suffer. Talia had been diagnosed with bipolar disorder in her 20s but had it under control with medication. Then around Christmas , just after the election of Donald Trump, when she was 42 and beginning to get hot flashes that forced her to keep her bedroom window open even on frigid nights, Talia came down with a terrible cold and cough that led to ten days of insomnia.
At the large midwestern university where she is a professor, Talia had been studying the Nazi program Aktion T4, the wholesale rounding up and extermination of people who were disabled, elderly, or mentally ill, and now she began to fear that she was a Nazi target. It was the worst kind of paranoia, she says, because it was based in her own extensive research. She knew everything about Aktion T4. Pale and wide-eyed, she comes across as delicate, like a person who has survived a wreck or a trauma, which she has. The election of Trump amplified her fears. Her rational mind clearly saw the historical analogies between the nationalistic right of and the Nazi Party.
Her irrational mind turned an academic observation into a full-blown reality. To stop Nazi doctors from spying on her, Talia covered the windows in her front hall with white computer paper and kept the blinds in the living room permanently closed. One afternoon when she was home alone, there was a knock at the door and Talia hid in the closet, so sure was she that the Nazis had come to take her away. It was around this time that Talia started pacing the kitchen ceaselessly, unable to speak.
She plastered every inch of the dining table — the same one where we sit with our coffee mugs — with Post-it reminders of things to do.
Ted remembers wondering throughout that awful time whether this was the new normal, with his wife mute and the shades always drawn. Her psychiatrist has tried to reassure her that the approach of menopause will not necessarily exacerbate her symptoms, because this does not happen in every case.
Imagine a world in which medicine and science really prioritized women, addressing and inquiring into our femaleness, including our menstrual cycles and hormone fluctuations, rather than shoehorning us into categories established by men, substantiated by research on men, and designed to diagnose and treat men? What if practitioners understood how female hormones impaired or enhanced the effectiveness of medicine?
What if women with midlife psychosis formed a recognizable cohort and saw one another as regular travelers through an unmarked and treacherous territory? Imagine if Janet and Talia were visible to one another, and to us. In , an Australian psychiatrist named Jayashri Kulkarni began publishing the results of extraordinary experiments that took the estrogen hypothesis to the next step. In a small trial, Kulkarni administered estrogen along with regularly prescribed antipsychotic medication to a group of women of childbearing age diagnosed with schizophrenia; she found that, compared with a control group, their positive and negative symptoms abated.
She tried again with a larger group and got a similar result.