Menopause
Women with mental health conditions may struggle with menopause transition
Many women struggle to find resources to help manage their menopause symptoms. For women living with a serious mental illness, the need for additional support and education during the menopause transition is even greater.
A new scoping review has confirmed this research and suggested a need for more psychoeducation programmes. Serious mental illnesses are a group of mental health conditions often characterised by their chronicity and severity of symptoms that lead to significant functional impairment.
Although definitions may vary, conditions that are usually assessed include conditions such as schizophrenia, schizoaffective disorder, bipolar disorder, recurrent depression, severe anxiety and eating disorders, personality disorders, and post-traumatic stress disorder.
These conditions may be associated with a range of poorer physical health outcomes and higher mortality rates, with a lack of proper healthcare being a contributing factor to poorer outcomes.
The menopause transition can be a time of increased risk of depression and anxiety symptoms in nonpsychiatric people. Despite major advances in education around the menopause transition, this period in a woman’s life can often be filled with frustration over the lack of resources. For women also struggling with a mental health problem, the questions are often more numerous and the frustration more debilitating.
Although there has been considerable interest in understanding the effect of the menopause transition on mental health problems overall, little research has been undertaken to assess the effect of menopause on those living with a diagnosed chronic mental health condition. Earlier research had suggested that women with compromised mental health were more likely to report more significant menopause symptoms as well as more exaggerated mental health problems.
For example, a woman diagnosed with schizophrenia may have worse psychotic symptoms during the transition. Eating disorders may also worsen because of disturbances to body image during this transitional phase.
Despite the limited number of applicable studies identified, there seems to be consensus around the idea that women living with a serious mental health condition may be ill-equipped for the menopause transition. That is why the goal of this latest review was to assess the research literature regarding psychoeducation programs in the management of menopause symptoms for women living with a mental illness.
“Overall, we have improved our understanding of the menopause transition and its potential effect on women’s wellbeing and overall functioning. However, this study is confirming what we know from other areas in medicine and public health – that we need to do a better job in providing persons with severe mental illnesses with the information, resources, and care they need to manage their health throughout their lifespans – including their midlife years,” said Dr. Claudio Soares, a psychiatrist and president of The Menopause Society.
Abdominal obesity may lead to worse menopause symptoms, including forgetfulness, irritability and night sweats, a new study suggests.
The findings point to a possible link between fat stored around the waist and more severe midlife symptoms.
Researchers said waist-to-height ratio could help identify women who may benefit from more targeted support.
Dr Monica Christmas is associate medical director for The Menopause Society.
Christmas said: “Unintended weight gain during the menopause transition, especially in the midsection, is one of the most commonly reported complaints, with the most significant gains experienced in the years leading up to the final menstrual period and a couple of years after.
“This not only affects self-image but also imposes negative health risks and, as the study highlights, is associated with higher prevalence and severity of menopause symptoms.”
The study used data from more than 1,100 women who took part in the Study of Women’s Health Across the Nation.
Abdominal obesity is a build-up of fat around the waist. It often includes visceral fat, which is deep, active fat surrounding internal organs.
This type of fat releases inflammatory proteins and toxic fatty acids that can contribute to insulin resistance, cardiovascular disease, high blood pressure and a higher risk of some cancers.
Insulin resistance means the body does not respond properly to insulin, the hormone that helps control blood sugar.
The Menopause Society said abdominal obesity is estimated to affect more than 60 per cent of menopausal women.
As oestrogen levels fall during menopause, women tend to store more fat around the waist rather than the hips, even if their overall weight does not change.
The researchers noted that obesity patterns and menopause symptom burden can vary by region, but research into the effect of abdominal obesity on these symptoms remains limited.
They also said earlier studies have mainly looked at single symptoms, rather than how symptoms connect with each other.
In this study, researchers used network analysis, a method that looks at how symptoms are linked, to compare symptom patterns in women with and without abdominal obesity.
They identified abdominal obesity using waist-to-height ratios, which compare waist size with height and can be used as a simple measure of health risk linked to body fat around the middle.
The researchers concluded that women with abdominal obesity had both a higher prevalence and greater severity of a range of symptoms, as well as a distinct symptom network structure.
In particular, women with abdominal obesity reported a higher prevalence and greater severity of dizziness, hot flashes and night sweats than women without abdominal obesity.
Sleep disturbances and palpitations were also reported more often in women with abdominal obesity. Palpitations are feelings of a fast, fluttering or pounding heartbeat.
The researchers said assessment of abdominal obesity using waist-to-height ratios may help stratify women who are likely to benefit from targeted, network-based interventions rather than isolated symptom management.
Christmas said: “Educating women early about healthy lifestyle interventions to prevent midlife weight gain is key to improving mental and physical well-being during a tumultuous time frame.”
Perimenopause may offer a key window to spot heart disease risk earlier, with women in the transition twice as likely to have low heart health scores, new research suggests.
The findings suggest the transition to menopause could be an important time to reassess risk and prompt lifestyle changes.
Garima Arora is senior author of the study and professor of medicine in the division of cardiovascular disease at the University of Alabama at Birmingham.
Arora said: “Mid-life women should think of the perimenopausal period as a ‘window of opportunity.’
They should be proactive and not wait until they reach menopause to start checking their blood pressure, cholesterol and blood sugar levels.
“Women should talk with their health care team about their reproductive status and any changes they are experiencing. It may be the perfect time to get a baseline for their heart health.”
The analysis included 9,248 women aged 18 to 80 who took part in the National Health and Nutrition Examination Survey between 2007 and 2020.
Researchers used Life’s Essential 8, a heart health score developed by the American Heart Association. It measures diet, physical activity, tobacco use, sleep, blood pressure, cholesterol, body weight and blood sugar on a 100-point scale.
Median scores fell as women moved through reproductive stages, from 73.3 out of 100 in premenopausal women to 69.1 in perimenopausal women and 63.9 in postmenopausal women.
Among the individual Life’s Essential 8 measures, diet consistently had the lowest scores and continued to decline across all reproductive stages.
After accounting for age, perimenopausal women were twice as likely to have a low overall score as premenopausal women.
They were also 76 per cent more likely to have a low cholesterol score and 83 per cent more likely to have a low blood sugar score.
The researchers said fluctuations in oestrogen levels during perimenopause may contribute to lower cardiovascular health because they may affect cholesterol, insulin resistance, blood pressure and weight management.
Insulin resistance means the body does not respond properly to insulin, the hormone that helps control blood sugar.
Sleep duration scores remained high across all reproductive stages, despite perimenopausal women reporting difficulty sleeping, suggesting sleep quality may be more affected than sleep length.
Amrita Nayak, lead author of the study and research fellow in the division of cardiovascular disease at the University of Alabama at Birmingham, said the findings highlight a point where risk may begin to rise.
She said: “Our analysis highlights that perimenopause, women’s reproductive transition period to menopause, is the critical time when the increase in cardiovascular risk seems magnified.
“When we compared women’s LE8 scores to the premenopausal baseline, the perimenopausal group was the first to show a significant jump in the odds of having low heart health.”
Arora added that nutrition could be an important area for early intervention.
“Nutrition can be a central factor for early and proactive intervention.
“Focusing on heart-healthy habits early, especially getting regular exercise and following a healthy eating plan like the DASH diet with a focus on lowering salt can help improve cardiovascular health for perimenopausal women in the years to come.”
Stacey E. Rosen, volunteer president of the American Heart Association, who was not involved in the study, said the findings underline the need to consider women-specific risk factors across life stages.
“This research highlights yet another aspect of the unique factors that increase a woman’s risk of cardiovascular disease throughout the stages of her lifespan.
“Significant health changes during pregnancy, perimenopause and menopause make it particularly important to pay close attention to increases in health risk factors during those times.
“I encourage women to talk with their primary care and specialty health care teams to learn about early detection and modification of traditional and ‘female-specific’ risk factors.
“Women can take proven steps to improve their cardiovascular health at all ages.”
The researchers said the next step is to follow women over several years to track hormone levels and heart health, which may help clarify the long-term impact of perimenopause and how lifestyle changes could reduce risk.
Osteoporosis may raise the risk of death in postmenopausal women by up to 47 per cent, a new study suggests.
The findings point to an inverse relationship between femoral bone mineral density and mortality risk, especially within certain ranges.
Femoral bone mineral density is the amount of mineral in the thigh bone, which is often measured to assess bone strength and osteoporosis risk.
Dr Monica Christmas is associate medical director for The Menopause Society.
She said: “Osteoporosis often remains a silent threat after menopause, despite its profound effect on women’s lives—from loss of height, poor balance, and reduced mobility to disfigurement, pain, and even premature death.
“Early screening and preventive measures, including a calcium-rich diet (preferably from food sources), regular weight-bearing exercise, and hormone therapy when appropriate, can significantly improve bone health and reduce risks not only of fractures but also cardiovascular disease, certain cancers, and dementia.
“It’s time we bring this conversation to the forefront.”
In the study involving nearly 3,000 postmenopausal women, bone mineral density at four femoral sites was assessed using dual-energy x-ray absorptiometry, a scan commonly used to measure bone strength and fracture risk.
The analysis found that mortality risk was significantly higher when femoral bone mineral density reached the osteoporotic threshold or when osteoporotic fractures were present.
After full adjustment, osteoporosis was associated with a 47 per cent increased risk of mortality.
A stronger inverse association between increased bone mineral density and mortality risk was seen within specific ranges, suggesting bone mineral density could serve as a prognostic marker of wider health.
The relationship appeared especially notable within the range of 0.46 to 0.71 g/cm² for total femur bone mineral density.
Previous research has shown that postmenopausal women face a significantly higher risk of death within one year of hip or vertebral fractures.
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