Tonya Arends, a nursing assistant at Stanford Hospital, began to feel upset to the point of tears over mundane events and feared something was wrong.
“I've always been a very calm, consistent person,” Allens, 53, said, adding that she has never been diagnosed with depression and has always calmly gotten through difficult times.
“Over the past two years, I’ve noticed a change in that,” she said. “I used to be more sensitive to things, and it just kept escalating. It ended up getting so bad that I was crying in the bathroom at work. That's not like me.”
Ahrens decided to change her career from corporate management to nursing after joining her mother's journey as a cancer patient at Stanford Medicine. Her unexpected tears at work upset her because she enjoyed interacting with her patients, even though they were having difficult days. .
Karen Adams
Concerned, Ahrens immediately made an appointment with Dr. Karen Adams, a clinical professor of obstetrics and gynecology and director of the Menopause and Healthy Aging Program at Stanford University. Adams is a board-certified menopause specialist, and her team treats many patients in perimenopause, the three- to four-year stage of hormonal changes before a woman stops menstruating.
Dr. Adams had a reassuring message for new patients whose age and symptoms indicate they are experiencing perimenopause. Changes in mental health, including mood swings, are common during perimenopause. While this is a normal occurrence for half of the world's population and can cause a lot of discomfort, women like Ahrens are entitled to proper medical care to relieve their symptoms. Also, the lack of properly trained doctors makes finding appropriate treatment difficult, but effective treatments are available.
“Dr. Adams told me, 'You're not crazy. This is a hormonal imbalance. This is something that's going on in your body, and it's common during perimenopause.'” he recalls. “She made me feel safe and she made me feel so hopeful.”
Dr. Adams told me, “You're not crazy.'' This is a hormonal imbalance. This is something that happens inside your body and is common during perimenopause. ” She reassured me and made me feel so hopeful.
Tonya Ahrens
unpredictable hormones
A woman reaches menopause when she has not had a menstrual period for one year. Menopause occurs at the average age of 51. The period before this milestone, perimenopause, is characterized by irregular menstrual periods and large fluctuations in the reproductive hormones estrogen and progesterone. Hormonal changes can affect mental health.
“The reason it's so devastating is because it's 100 percent unpredictable,” Adams said. Unlike premenstrual syndrome, which causes some women to feel cranky before the start of their period, perimenopausal mood symptoms don't follow a predictable timeline.
“Your highs are higher and your lows are lower because your hormones are out of control,” Adams says. “A woman literally wakes up in the morning not knowing how she's going to feel. People feel out of control and think something really terrible is happening.”
That's why knowledge is key, Adams says. The sense of relief Ahrens felt when she learned of the connection between her mental health and her perimenopause is common among her patients. “When I tell people about this, they cry with great relief because there's a reason this is happening and it's not just in their head,” she said.
Ahrens said Adams told her, “'You're not hurt, you're not weak.'” I think I really needed to hear that. ”
[She said] “You are not hurt and you are not weak.” I think I really needed to hear that.
Tonya Ahrens
Common mental health symptoms
Everyone who menstruates eventually reaches menopause, but most women experience some unpleasant side effects during this transition. The most common menopausal symptoms after menstruation stops are hot flashes and night sweats, which affect about 80% of women, and erratic mood, which affects 68% of women. 60% of women experience sleep disturbances, and about half experience vaginal symptoms or joint or musculoskeletal pain.
But in people with a history of mental health conditions such as major depression, premenstrual syndrome, and postpartum depression, such fluctuations are even more common than in the general population of perimenopausal women, Adams said. noted that the severity of mood symptoms varies from person to person. In person.
“For some people, it's just a little bit frustrating and feeling like the fuse has been cut short,” she says. “Some people may also feel tearful or feel like they can no longer enjoy things they used to enjoy.”
Fluctuations in reproductive hormones may be the sole cause of perimenopausal mood changes, but doctors must rule out other causes such as major depression, anxiety, and panic disorder. Adams said people who were previously diagnosed with bipolar disorder or schizophrenia should also be tested for relapse.
Patients may also need to be tested for thyroid dysfunction, which can cause symptoms like depression, as well as long-term coronavirus infections and rheumatic diseases such as arthritis. This is because the patient's symptoms often overlap with those of perimenopause.
“It's really important for women to recognize that this is a particularly unwell time in their lives and that they need to seek care,” Adams said.
simple treatment options
For patients without other medical conditions, the first-line treatment for perimenopausal symptoms, including unstable mood, is menopausal hormone therapy, formerly known as hormone replacement therapy.
MHT has been proven to have many benefits for women's physical and mental health if started at the right time and used correctly, Adams said. However, there remains confusion among many physicians about whether MHT is safe.
“Back in 2002, the Women's Health Initiative (a large trial of MHT) found that women receiving combined hormone therapy containing estrogen and progesterone together had lower rates of heart attacks, strokes, clotting events, and breast cancer. ,” she said.
However, further research has revealed that these harmful effects are primarily seen in women who begin hormone replacement therapy more than 10 years after menopause.
“We know that starting hormones in people in their 70s destabilizes plaques in their coronary arteries and heart, increasing their risk rather than decreasing it,” Adams said.
The good news is that women who begin hormone therapy during perimenopause or within 10 years of their last menstrual period can experience a variety of health benefits from MHT. These include reducing heart risks. Lower incidence of lung and colon cancer. Bone density improves and hip fracture rates decrease. And it may be possible to prevent dementia.
Some hormone treatments further reduce the risk of breast cancer. A new study published this month in the journal Menopause finds that if women start MHT at the right time, their benefits persist even when women continue hormone therapy past age 65. Ta.
As Ahrens has learned from experience, hormone replacement therapy also has a great effect on stabilizing a patient's mood.
“Simple and life-changing”
At Arends' initial consultation, Adams explained that she was a good candidate for MHT and suggested a variety of treatment options. Ahrens chose a combination of progesterone from an intrauterine device, which can help stop periods, and estradiol, a bioidentical estrogen delivered through a skin patch. After Ahrens took hormones for several months, she scheduled a follow-up appointment.
“By the end of the first month, I felt like myself,” Ahrens said. “I didn't notice any major mood changes. I didn't suddenly cry. I felt great.”
She was surprised by the frankness of the treatment. “I thought this was going to be a more difficult process with a lot of trial and error,” she said. “It was simple, but the impact was life-changing.”
In contrast to patients with major depression, who often have to try a variety of antidepressants to find the right drug and dose, “If you experience mood symptoms during perimenopause or early menopause, most often “Estrogen comes into play,” Adams said.
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lack of care
Adams and her team are expanding access to evidence-based menopause treatments.
“The reality is that most people go through menopause without medical care, and it's not because they don't want or don't seek treatment,” Adams says. “That's because professional menopause care is not available in many areas.”
A 2019 study found that historically physicians have received little or no training in menopause care, with most residents reporting receiving less than one lecture on the topic during their training. are doing.
“When a woman goes to the doctor, she might be told, 'Well, it's just aging, get used to it, it's your new normal,' and when she asks about hormones, she might be told, 'Oh, that's impossible.' “It's dangerous,” Adams said, noting that evidence on how to safely use MHT is not yet widely disseminated among health care providers.
When a woman goes to the doctor, she might be told, “Well, this is just aging, this is the new normal, so get used to it,'' or when she asks about hormones, she might be told, “Oh, that's impossible.'' That's dangerous. '
Karen Adams
The Stanford Menopause and Healthy Aging Program brings together experts from a variety of fields to provide care for premenopausal, menopausal, and postmenopausal women. In addition to treating individual patients, they aim to lead the field of menopause research and advocacy. We offer conferences, webinars, and podcasts to update your knowledge of current providers. We are also focusing on training the next generation of medical professionals. Their overarching goal is to put Stanford Medicine at the forefront of precision menopause care in the United States and around the world.
“We are expanding our expertise,” Adams said, noting that there are currently only 1,800 certified menopause specialists, or clinicians who have completed specialized training in menopause care and passed the certification exam, worldwide. pointed out. (Many certified health care providers offer services through telehealth, but Adams recommends this option for women seeking menopause care in rural areas where there are no local specialists.)
“Menopause is a normal human experience, but it is also a time when multiple organ systems become dysregulated, leading to significant symptoms and increased vulnerability to chronic disease,” she says. “By intervening in a very simple, targeted and effective way, we can have a positive impact on women's long-term health, not to mention their immediate quality of life.”
Photo: Emily Moskal
