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Perimenopausal depression: the symptoms to look out for and how to help employees

By Dr Haleema Sheikh, specialist in integrative women’s health and bioidentical hormone balancing, Marion Gluck Clinic

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Dr Haleema Sheikh

When the orchestra of hormones is not balanced, mood can be severely impacted. Dr Haleema Sheikh goes through everything you need to know about perimenopause.

Perimenopause is the lead up to menopause when the effects of hormonal changes start to become evident.

It refers to the menopausal transition phase when the levels of reproductive hormones become more variable, and the effects of these fluctuations are felt throughout the body including the brain.

Interestingly, perimenopause can last for 10 years or more, ending one year after the last menstrual cycle – which is the official date of menopause.

Thus, it is useful for women to know what to expect and equip themselves with knowledge and tools to empower themselves to navigate a path through.

Hormones are chemicals produced by your body’s glands, which signal the body to initiate certain physical processes like ovulation as well as mental functions such as mood regulation.

We have receptors in the brain for reproductive hormones and thus fluctuations and hormonal imbalances can have a profound impact on our mood and also through their impact on neurotransmitters

There are four main hormones that have a significant effect on mood: oestrogen, progesterone, testosterone and cortisol.

  • Oestrogen can improve mood by supporting serotonin – the happy neurotransmitter – and noradrenaline levels in the brain.
  • Progesterone is our soothing calming and sleep-inducing hormone which can alleviate mood swings, irritability, and depression.
  • Testosterone is an uplifting hormone and helps with a sense of wellbeing, focus and confidence.
  • Cortisol is a released as a stress response from the adrenal glands and when stress is chronic remains elevated at the expense of sex hormones, which in turn creates further imbalances. It can cause irritability, anxiety, and low moods when over or under produced – adrenal dysfunction.

When the orchestra of hormones is not balanced with glands producing too much or not enough of a particular hormone, mood can be severely impacted and, in some cases, lead to depression.

Women during perimenopause can be vulnerable to such mood issues with the fluctuations and dropping hormones.

Symptoms of depression may include fatigue and lack of energy, feeling restless or slowed down, struggles with focus and remembering things, apathy and lack of interest in activities previously enjoyed as well as feelings of helplessness, hopelessness or worthlessness.

Reduced levels of female hormones during perimenopause may also cause additional depressive symptoms such as mood swings, sleep problems, hot flashes, irritability and feeling profound despair and tearful.

Premenopausal depression may present somewhat differently than classical depression with more irritability and more frequent mood changes, while feeling sad and tearful are less often experienced.

There are additional risk factors associated with perimenopausal depression which include family history of depression, prior history of sexual abuse or violence, having a sedentary lifestyle, smoking, being socially isolated, struggling with self-esteem, having negative feelings about ageing and feeling disappointed about not being able to have children.

Awareness of these can be helpful to identify those women who are more vulnerable and may have difficulty adapting to the fluctuating levels of oestrogen and progesterone during the menopause transition.

A significant percentage of women going through perimenopause and menopause are prescribed medication such as antidepressants by their GP or a mental health specialist.

However, low mood around the time of menopause is very likely to have hormonal imbalance as a root cause and in women where there is no prior history of depression antidepressants may not be the most effective treatment.

A lot of women going through perimenopause are misdiagnosed with depression and can feel a lot better with lifestyle changes and bioidentical progesterone treatment especially early on in perimenopause.

Antidepressants regulate certain neurotransmitters like serotonin and noradrenaline that can affect mood but they do not address the underlying hormones imbalances associated with perimenopause or menopause which are often the important root causes.

There are a number of lifestyle factors that can help improve hormone balance and thus improve mood during perimenopause. And it would be ideal to work on these before accessing pharmaceutical medication.

Working on lifestyle to optimise hormonal balance and brain health will in turn help improve mood and emotional health:

  1. ‘When the body moves the brain grooves.’ Movement and exercise help the body release natural endorphins and BDNF (brain derived neurotrophic factor) that lifts our mood.
  2. B vitamins can be important to the mental and emotional well-being of perimenopausal women as they improve hormonal balance and support progesterone production
  3. Mindful breathing can help reduce anxiety. A common technique involves paying attention to your body’s response to natural relaxation as you slowly breathe in — from the abdomen — and then exhale. Doing this for 10-15 minutes a day will help bring down stress and cortisol levels which in turn improves reproductive hormone production
  4. Proper sleep-adopting good sleep habits such as going to bed at the same time every night in a quiet, dark, cool room and avoiding using electronics in bed.
  5. Valerian is an herb which has been shown to help perimenopausal depresstion and contains a number of compounds that may help promote calmness by increasing GABA (neurotransmitter) availability in the body and interacting with certain receptors involved in mood and sleep.

It is important for employers to understand the impact of hormonal fluctuations during perimenopause on mood, as it can have a profound effect.

Building awareness in the workplace and a having a framework to support women is essential to ensure the expertise and wisdom of this demographic is retained.

Open communication with sensitivity empathy and active listening as well as careful consideration of how employees can have access to high quality information and education about perimenopause/menopause are key.

This will encourage women to talk with honesty and engender self-compassion and agency.

It would be worth considering hosting an organisational campaign on the perimenopause to break taboos and to raise awareness.

This could be as simple as putting up posters or hosting a talk which could fit into a wider organizational well-being week.

Developing a healthy lifestyle culture within the workplace will mitigate a lot of the troublesome mood issues during perimenopause/ menopause.

It is important to lead by example and consider how to incentivise employees to look after themselves which will in turn lead to improved productivity.

Ensuring a balanced timetable for staff with breaks for movement and access to healthy protein-based snacks to balance blood glucose is helpful. A simple 10-minute walk can alleviate anxiety and improve mood

Hormone replacement therapy can certainly help alleviate the hormone fluctuations and help women rebalance their mood especially if there is significant flux.

HRT will work better with a good foundational lifestyle, and this is an important message to share.

Bioidentical hormone prescribing allows for a personalised approach to check hormone levels and ensure a balanced prescription is issued for each woman according to where they are in their perimenopausal journey.

 

Dr Haleema Sheikh is certified in functional medicine and uses her knowledge to complement hormone balancing. She has joined the Marion Gluck Clinic last year and is particularly well versed in women’s health issues including PCOS, PMS, perimenopause and menopause.

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Cultural stigma is a barrier to menopause help, black women say

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Cultural stigma and a lack of education are making it harder to get menopause help, ethnic minority women in Jersey have said.

The women came together to share their stories at an event in St Helier hosted by Eve Studios and Liberty Underwear.

Participants were encouraged to speak openly about the symptoms they had experienced.

Angela Mowanga, from Jersey, told ITV Channel: “I became dismissive about signs and symptoms. From our parents and our grandparents, they just carried on.

“I hardly heard the word menopause spoken about in my household. We never had things like hot flushes, itchy skin and tiredness.

“So for us to start talking about menopause, there is a taboo around it. A taboo that comes from ignorance but also not being willing to educate ourselves.

“We as women of colour, societies of colour, we have a lot of taboo subjects, which now have to be highlighted with the generation today.

“However, with the modern day, society is changing. And we hope programmes like this can actually be well received.”

Daisy Ayebale, from Jersey, added: “I think it’s important we are listened to. We need the right information from the experts, but we have also been overlooked when it comes to the healthcare system.

“We need to know this information before it’s too late, before you’re gambling with your health. We are glad to be changing the narrative, we are glad to be changing things right now. We are very hopeful.”

Research shows that black women are more likely to experience menopausal symptoms earlier, more intensely and for longer.

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Women urged to be wary of menopause misinformation on social media

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Women are being urged to seek evidence-based advice and avoid menopause misinformation shared on social media.

A seminar co-hosted by the World Health Organization (WHO) mainly examined what is known about the cognitive effects of menopause and current research in the field worldwide.

Dr Nicole Jaff, a South African academic and certified menopause practitioner, said research into menopause and its effects was now at a peak.

She said: “There’s a lot of information out there.

“But I would say please look for the evidence-based information, not for the influencers and the misinformation, but those who are giving guidelines, who are giving information.”

Jaff highlighted research into cognitive changes during menopause and how some women experience brain fog, a term for difficulties with memory, concentration and clear thinking.

She said: “I’m very excited about the non-hormonal treatments that are now available, especially for women who could never take hormone therapy because of breast cancers and various cancers, who can now take it.

“I’m extremely excited about people who are standing up for evidence-based medicine, for science, who are actually fighting back against a lot of the social media and influencers who are not giving evidence-based information and making life very difficult for women because they think they should be forever young or buying this or buying that.”

Jaff advised women and healthcare workers to read new guidelines recently issued by the International Menopause Society. They are available free to download from its website.

The seminar also heard from Professor Aimee Spector, professor of clinical psychology of ageing at University College London.

She raised similar concerns about misinformation, particularly claims linking hormone replacement therapy, known as HRT, to dementia. Some claims suggest HRT reduces dementia risk, while others suggest it increases the risk.

Spector said: “I think there’s also lots of misinformation.

“And I think that there’s huge variations in how even professionals and doctors interpret this information.”

She was part of an international research team commissioned by the WHO last year to assess published studies on the issue.

The institutions involved also included the Global Brain Health Institute at Trinity College Dublin.

Spector said: “The first thing to say is that the quality of evidence was very low.

“Nine out of the 10 studies we looked at were observational, which means that you’re observing patterns over time. But you don’t necessarily know whether that’s due to the hormone therapy or not.

“Our overall recommendation was that there’s insufficient evidence for menopause hormone therapy in terms of either increasing or reducing the risk of dementia. In other words, we don’t know either way.”

Spector said women should therefore decide whether to use HRT to treat menopause symptoms rather than based on concerns about dementia.

She said: “It’s recommended for menopause symptoms, but it’s not recommended to reduce dementia. And I think a lot of people are saying that.”

The Menopause on the Brain webinar was part of an ongoing series hosted by the WHO and other global health agencies.

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Premature menopause is a high blood pressure risk, study finds

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Premature menopause is linked to a higher risk of developing high blood pressure, according to a study of more than 107,000 women.

The risk was highest among women who reached menopause between the ages of 25 and 35.

Researchers said the findings support earlier cardiovascular screening for women who reach menopause before the age of 40.

Dr Stephanie Faubion, medical director for The Menopause Society, said: “The results of this study highlight the potential adverse long-term health outcomes associated with premature menopause, and in particular, the need to regularly screen for cardiovascular risk factors such as hypertension.

“Use of hormone therapy is also routinely recommended in women with premature menopause at least until the natural age of menopause unless contraindications exist.”

Hormonal changes during menopause are known to affect women’s wider health, while earlier menopause has previously been linked to coronary heart disease and stroke.

Coronary heart disease develops when the blood vessels supplying the heart become narrowed or blocked.

However, previous evidence directly linking the timing of menopause to high blood pressure has been mixed.

High blood pressure, also known as hypertension, puts extra strain on the heart and blood vessels and can increase the risk of heart disease and stroke.

Researchers said it can be difficult to separate the direct effects of hormonal changes from factors that often accompany menopause, including weight gain, metabolic changes and other cardiovascular risks.

Metabolic changes affect how the body processes and uses energy, including sugar and fat.

The study analysed data from 107,836 postmenopausal women who joined the UK Biobank between 2006 and 2010. They were followed for a median of almost 15 years.

Researchers divided the women into three groups based on their age at menopause: after 45, between 40 and 45, or before 40.

They also examined whether menopause occurred naturally or followed surgery.

During the follow-up period, 18,508 women, or 17.2 per cent, were diagnosed with high blood pressure.

The proportion increased as the age at menopause fell. Hypertension developed in 16.6 per cent of women who experienced menopause after 45, compared with 18.8 per cent of those who reached menopause between 40 and 45.

Among women who experienced menopause before 40, 22.6 per cent developed the condition.

After taking account of more than 50 factors, including weight, lifestyle habits, family history and laboratory results, premature menopause remained linked to a 12.3 per cent higher risk of hypertension than menopause after age 45.

Further analysis suggested the risk peaked among women who reached menopause between the ages of 25 and 35.

The researchers said this may mean that the cardiovascular risk associated with premature menopause is concentrated among a younger group than the conventional under-40 definition suggests.

Surgical menopause was initially linked to higher rates of hypertension, but the association was no longer significant after other risk factors were taken into account.

The authors said clinicians should consider age at menopause as a distinct cardiovascular risk factor, particularly for women who experience it before 40.

They also called for earlier detection and management of hypertension, alongside individual discussions about hormone therapy.

Hormone therapy replaces hormones that decline during menopause and may be recommended for some women, depending on their individual health and medical history.

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