There have always been negative associations with menopause. One
concern I hear repeatedly is that depression is a fact of life once a
woman makes the transition into menopause. As you will learn from Dr.
Meisler's article, other factors can influence mental health. The
changes in hormones that occur with menopause are not the only
cause of changes in mood and a woman's sense of well being. — Beverly
Vaughn, MD, Medical Coordinator, Menopause and You Program
Myth vs. Reality
Menopause is an emotionally charged word, and some would say
menopause is an emotionally charged time during a woman’s life. There
are a number of myths surrounding menopause, and I will try to help
distinguish myth from reality.
First of all, it is a myth that women inevitably become depressed,
irritable and/or forgetful at this time. The reality is that some women
may experience all or some of these symptoms, but others may experience
none of them.
Women have a wide range of emotional responses to menopause, based on
their individual physiology, general health, past mental health, and
familial and cultural factors. No two women will bring the same set of
contributing factors, let alone the same attitudes, fears, and
fantasies, to this watershed life event.
Certainly, women who have experienced episodes of depression earlier in
life may be at risk for developing depression with menopause, but not
necessarily. If a woman has had recurrent episodes of depression
earlier, she may be on a maintenance regimen of antidepressant treatment
(medication, which may or may not be combined with psychotherapy) which
may protect her from becoming depressed.
A Time of Change
Many factors can affect a woman’s emotional response to menopause. For
women whose main identity has been as a wife, menopause may bring an
unprecedented sense of freedom, in which they see themselves as “freed
up” to pursue other aspects of their lives.
Familial and cultural factors play a role here, as well. If a woman
experienced/observed her mother’s menopause as a neutral, or positive
event, she may be more likely to have that expectation for herself. The
opposite, of course, is also true.
Similarly, in a culture such as ours, which puts a high priority on
youth and youthful beauty, this may imply to some women that after
menopause, they won’t be valued as highly as before. Conversely, in
cultures in which age is respected, indeed venerated, such as in China
and Japan, women may look forward to this stage of life, when they can
take their place among the highly respected elders.
Menopause is also a time of multiple life changes for many women.
Children may be leaving home, for college or work, resulting in
so-called “empty-nest” syndrome. Simultaneously, elderly parents may be
developing age-related illnesses and infirmities, leaving women in the
middle—the filling in the so-called “sandwich generation”.
Also, at this time, marriages may be ending, either by divorce or by the
death of the middle-aged husband. All of these are significant losses,
and loss is a major predisposing factor to depression.
Not all women, though, may experience the time of menopause as one of
loss; for some women, there is a sense of liberation. A woman may see
herself as finally free of the responsibility of daily, nurturing
motherhood. If she’s been working, she may find herself with more time
and energy to devote to her career. If she’s not worked outside the
home, she may now find freedom to start a career or devote time to other
interests and pursuits.
Finally, for women who never had children, for whatever reason,
menopause may bring mourning for the mother role that now will never
In short, there are a variety of psychosocial, as well as physical,
factors which may come to the fore in menopause. A key point to
remember, from a psychiatric point of view, is that depression is not
inevitable part of menopause. Of course, if depressive symptoms do
develop, professional help should be obtained.
When to Seek Professional Attention
Basically, there are some symptoms that occur with any depression:
First, depressive mood most of the day, nearly every day, and/or
significantly decreased interest or pleasure in all, or almost all,
activities most of the day, nearly every day, for at least two weeks.
One or both of these symptoms must be present along with three or more
of the following:
significant weight loss, when not dieting, or weight
gain (e.g., a change of more than 5% of body weight in a
month), or decrease or increase in appetite nearly every
insomnia or excessive sleep nearly every day
feelings of restlessness or being slowed down nearly
fatigue or loss of energy nearly every day
feelings of worthlessness or excessive or inappropriate
guilt nearly every day
diminished ability to think or concentrate, or
indecisiveness nearly every day
recurrent thoughts of death or suicide, with or without
a specific plan
These are the hallmark symptoms of depression and any woman experiencing
the first and/or second, along with at least three of the others for
more than two weeks should seek psychiatric help.
For the majority of women, however, menopause is either a neutral or
positive milestone. Given current life expectations, for most
women, if they take care of themselves in terms of basic healthy
lifestyle (diet, sleep, exercise, etc.) and keep their minds challenged
(with paid careers, volunteer work, active social lives, etc.), the
decades of menopause can be a challenging, fulfilling part of
This article is part of the Menopause and You library,
a Web-based program sponsored by Women’s Health Source.
It is intended as an information resource providing guidelines for
women. As always, check with your own healthcare practitioner with your
specific concerns and questions.
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