Hannah Yoon for NPR
Teri Hines was around 40 when he began to notice that his body was changing.
His period became irregular and more intense. “It increased in frequency, increased in intensity and increased in duration,” she says.
He began to have hot flashes, gained weight and his energy levels plummeted.
“I just didn’t have the energy to do the things I wanted to do,” she says, like the long morning walks she loved to do with her dogs or planning a solo trip.
At that time, Hines lived alone in Philadelphia, where she worked as an assistant principal at a school. He struggled to get out of bed and go to work, and began withdrawing from his friends.
Looking back, remember feeling isolated and unbound. “It was a mist about who he was, what he wanted, where he was going, what he was able to achieve,” she says. “I just couldn’t find my balance.”
Hines knew that he was probably going through perimenopause, which are the years before menopause, when women’s monthly hormonal cycles become erratic as their bodies prepare to stop menstruating.
What he didn’t realize, and many women don’t know, is that hormonal changes in perimenopause can cause mood changes and, for some, an increased risk of anxiety and depression.
“Women who have a previous diagnosis of major depression or anxiety disorder will be at greater risk during the perimenopausal time,” says Jennifer Payne, who runs the Center for Women’s Mood Disorders at Johns Hopkins University.
And he warns that for these women, it is something that should be taken seriously. “If you have severe depression and your functioning is affected, if you have suicidal thoughts or feel completely desperate, that is a major depressive episode that absolutely needs treatment,” he says.
A vulnerable time
Perimenopausal mood swings often resemble the symptoms of premenstrual syndrome; Women may feel sad, slow or irritable.
“I’ve had people who say they feel they have PMS all the time,” says psychiatrist Hadine Joffe, who runs the Connors Center for Women’s Health and Gender Biology at Brigham and Women’s Hospital in Boston. “They just don’t feel they are in control of their mood and they feel nervous.”
However, in general, these mood swings are manageable, he adds. “The good news is that most women will navigate their perimenopause without serious mental health problems.”
But a significant number of women, approximately 18% among women in early perimenopause and 38% of women in late perimenopause, experience symptoms of depression. And anxiety symptoms seem to be more common during this time before menopause, including panic attacks.
The people most at risk are women with a history of mental illness, as well as women whose mood is particularly sensitive to hormonal fluctuations.
“Women who had postpartum depression or who have always had significant mood changes premenstrually will be at risk of having more symptoms,” says Payne.
It is not that women who develop severe anxiety or depression have abnormal or abnormal changes in hormones, she says. Rather, “your brain is likely to be sensitive to normal and natural hormonal fluctuations.”
“We know that in psychiatric illnesses, in general, the environment definitely plays a role,” adds Payne. And during this period of time, he says, there are often major changes in the lives of women that can exacerbate their risk of having mental health symptoms.
“Some women go through divorces, children go to school or leave the house, parents are getting older and need more care,” says Payne. “There are changes in the race, etc.”
“There is a lot of specific stress in middle age that occurs due to the situation of people in your life,” Joffe adds.
When doctors don’t pay attention
Hines was familiar with depression. She had been depressed several times before and had been proactive in seeking treatment.
“I had been an advocate for myself in depression and self-care and I got the right help, I got advice,” says Hines. “Sometimes when I needed [it], using medications. ”
And over the years, he had learned to recognize his symptoms and triggers, often major changes in life, whether professional or personal.
However, this time, he says, he was too focused on how he was changing his body and omitted the symptoms of depression.
“The physical nature of menopause consumes you and that is what we are taught to pay attention to,” she says.
She did not know that her past history of depression put her at greater risk of becoming depressed during perimenopause. But she mentioned her physical symptoms and energy levels to her doctor from the beginning during a regular appointment. But the conversation was disappointing, she says.
“I think she could have said ‘you are about the age at which you will begin to have these symptoms, you will begin to be perimenopausal,'” Hines recalls.
The doctor did not offer advice to help her with her symptoms or even any information about perimenopause, she says, not even the fact that, on average, it lasts about four years, and for some women up to 10 years.
This is not uncommon. More than 1,000 women wrote to NPR with their own stories about the struggles during perimenopause. And most said they had received little information or help from their doctors, especially for mental health symptoms.
“It’s a very common situation for women, and doctors aren’t up to date with that,” says Payne.
This is partly because most doctors, including obstetric gynecologists, get little education about perimenopause, says Joffe.
Hines and many other women who wrote to NPR said they found they had to be in the driver’s seat when it comes to finding and finding the right help or treatment.
Women need to be direct with their doctors about their mental health symptoms, says Joffe.
“Just as they would if they had a rash,” she says. “They would make an extra date and that’s the first thing they say, I have a rash.”
Payne agrees. “The most important thing women can do is be honest with their doctors about their symptoms and what symptoms they have and how severe they are,” he says.
Treatments that work
Hines finally got his doctor to pay attention to him and treat his mental health symptoms.
But it took several years, even before he realized that he could be depressed.
“It was then that I made an appointment with my doctor and said: this is what I am thinking, this is what I feel, I think I could be depressed.”
This time, your doctor prescribed an antidepressant. “The moment I started, I felt I had the energy to face those other things that were under way,” says Hines.
“Antidepressants can help a woman get out of her major depressive episodes,” says Payne. “They can also be useful for anxiety symptoms.”
Research also shows that they can relieve some of the physical symptoms of perimenopause, such as hot flashes and insomnia.
Hines also benefited from talk therapy, which studies say is also useful for treating depression.
“I took antidepressants and then started getting advice,” she says. “Once I had it under control with the advice, I was able to stop using the pharmaceutical products, so I could use the advice.”
Joffe suggests that women who are at this stage of life take steps to strengthen themselves. They should monitor the symptoms carefully in order to have an informed discussion with their doctors.
Most of the time women simply try to resist, says Joffe. “Women are tough. Women are used to having to deal with physical discomfort and life’s challenges,” she says. “And I think many middle-aged women expect this to be a time of anguish, discomfort and discomfort, and that is normative.”
But, he adds, it doesn’t have to be that way. He points to resources such as the website of the North American Menopause Society, for example, which has useful information about menopause, as well as a tool to help women find local providers specializing in perimenopause.
“I want [women] have permission, “she says,” I want [women] to feel that they owe it to themselves and to the people around them, who are not suffering. ”