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Psychological aspects of menopause management

https://doi.org/10.1016/S1521-690X(02)00077-5Get rights and content

Abstract

The influence of endocrine function on the mood of the menopausal woman continues to be debated and researched. While many women present at the menopause with depression and anxiety, the reasons for these mood disorders cannot be attributed to menopause status alone. The influence of psychological factors, lifestyle, body image, interpersonal relationships, role, and sociocultural factors in predicting levels of depression and anxiety in the menopausal patient cannot be ignored. This chapter discusses the research to date on menopause and depression and anxiety. Included is a discussion of the role of psychosocial factors in the symptomatology of perimenopausal, post-menopausal and prematurely menopausal women. The importance of understanding the individual menopausal experiences of women within the context of their lives while offering support, education, and validation is highlighted. The need for a multidimensional approach to treating the menopausal woman who presents with mood disorders is examined. Finally, this chapter makes it clear that psychosocial aspects of menopause management require further research, particularly on the experiences of women who enter menopause prematurely.

Section snippets

Case one

‘Joanne’, aged 51 years, presents with hot flushes and vaginal atrophy. She would also like to tell you she feels: depressed, anxious, irritable, fatigued, and not as confident in herself as she once was. Somehow she feels out of control. Her body is doing things which are unpredictable, and she does not know when her next hot flush is coming or how to control the fat which is somehow shifting up towards her waist. Joanne experienced depression after the birth of her first child, but thought it

Psychological factors

In general, women have been found to be twice as likely as men to experience an affective disorder and anxiety disorder.1., 2. Many clinicians are quick to point the finger at hormones and biological factors, such as menopause in the increased incidence of mood disorders in women. Interestingly, however, researchers have found that the prevalence of depression decreases with age and was experienced more by women in the childbearing years.3., 4., 5. For example, in a large Australian population

Psychological and social mechanisms and their role in menopause management

The following sections discuss the role of psychosocial factors on mood and menopause management. This includes an understanding of personal psychological history and vulnerability, the secondary effects of menopause, lifestyle issues, body image, interpersonal relationships, role and sociocultural influences.

Relationship with a partner

Whether women are in a relationship with a partner, heterosexual or homosexual, or whether they are single, widowed or divorced may also influence the experience of menopause. It is not clear whether the quality of a woman's relationship with her partner changes during the menopausal transition, or whether her feelings about her interpersonal relationships influence the experience of menopause.55 Very little research has been performed on the influence of relationships and menopause and most of

Role

Research on the importance of having a role to fulfil for midlife women has provided mixed findings. While multiple roles were associated with higher life satisfaction and well-being it is difficult to know whether more roles resulted in greater satisfaction—or being more satisfied with life made people want to perform more roles.66., 67. Vandewater et al found that the quality of the role a woman had in midlife, particularly in relation to her family, and her capacity to care for people,

Summary

It would appear that at the same time women experience changes to their body associated with physiological aspects of menopause it is also important to account for the psychological and social influences on their lives. Endocrine status cannot be used to predict whether women will experience negative psychological functioning; rather psychological morbidity is influenced by many factors and requires a multifaceted approach to its treatment.

Taking time to establish a therapeutic relationship

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