In the past, menopaue research has primarily focused on the physiological and biological changes during a woman's life. However, clinical studies in menopause and neuropsychology have become more popular with fascinating results surfacing over the past few years.

It is now widely accepted that menopause is linked to certain psychological and behavioral changes. Thinking, speech, short- and long-term memory, spatial and time changes are all relevant changes that many women may experience. Various treatment options have recently become available for these symptoms including estrogen therapy, dietary and behavioral changes, and techniques for improving memory.

Symptoms of Mental Changes at Menopause

• Irritability
• Tearfulness not caused by a sad event
• Excessive worry
• Anxiety
• Diminished energy
• Problems in concentrating
• Feelings of low self-esteem
• Loss of memory

Feeling the mentalpause changes? If so, you're not alone! Many women (but not all women) encounter these noticeable changes during their perimenopausal and menopausal years. Women are commonly surprised when they find out their symptoms are associated with their hormonal changes. If any of this sounds familiar to you, I encourage you to learn more about the psychological aspects of menopause.

Be sure to inform your doctor about any mental or emotional symptoms your may be experiencing. They symptoms may be associated with fluctuating hormonal changes or another medical reason.

0.1. Causes of Psychological Changes at Menopause

I’m always moody and irritable.

I'm flipping out.

I feel like I'm going crazy.

I'm just not myself.

I’m having fuzzy thinking and memory malfunctions.

While these may be regular statements for some, they are usually periodic feelings for a lot of perimenopausal or menopausal women. Although "menopausal depression" is a common term, there is currently no scientific evidence that supports the belief that natural menopause contributes to true clinical depression, anxiety, severe memory lapses or erratic behavior (NAMS, 2003).

Statistically speaking, most women do not suffer from depression as they pass through menopause*. However, many women notice a change in their emotions and feelings during midlife for various reasons (i.e., changes in self-concept, body image, stress, relationship issues, cultural reasons, etc.). Professionals do not yet agree upon a single underlying reason for the causes of the psychological unsteadiness.

Different stresses around the time of menopause may be attributed to psychological changes. Frequently, women in their midlife face many challenging stresses including divorce, having grown children leave the house, concerns about aging and widowing, and caring for older parents. This may be overwhelming for women and psychological problems can develop concurrently with menopause.

Changes in ovarian hormone levels (declining estrogen and progesterone levels) may also explain the emotional inconsistencies women face at this time. Some experts believe the loss in estrogen in relation to glucose levels may affect cognition. More research needs to be examined but oral contraceptives and estrogen therapy may help stabilize some cognitive disorders including Alzheimer's (Warga, 1999).

Sleep depravation can also cause emotional and behavioral changes. Sleep changes can occur for various reasons including disruption caused by hot flashes and hormonal changes. Refer to the September issue of the Menopause Minute to review how sleep and menopause are related. If one suffers from insomnia, it could affect cognitive function.

0.2. Ways to Improve Mood

Support groups are an excellent source and can be extremely beneficial. They help reduce feelings of isolation. Engage in pleasurable activities and include companions in your activities. Exercise helps your moods. When you exercise, short-term changes in brain chemistry occur which make improvements to your mood. Also, talk to your doctor about any menopause and your moods, evaluation and treatment is very important. And, both medication and psychotherapy may be recommended which can be extremely helpful.

0.3. Depression Checklist

Use this list to help determine whether you are suffering from a depressive episode

1. Depressed mood most of the day, nearly every day
2. Significant loss of interest or pleasure in all, or almost all, activities most of the day, nearly every day
3. Significant weight loss (when not dieting) or weight gain
4. Too little or too much sleep nearly every day
5. Noticeable slowing or restlessness nearly every day
6. Fatigue or loss of energy nearly every day
7. Feelings of worthlessness, or excessive or inappropriate guilt nearly every day
8. Difficulty thinking, concentrating, or making decisions nearly everyday
9. Recurrent thoughts of death (not just fear of dying), recurrent suicidal ideas without a specific plan, or a suicide attempt or specific plan

If you checked either item “1” or “2”, and at least five symptoms altogether (including “1” and/or “2”), you may be suffering from a serious depression and should seek professional help.

Source: Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition. Copyright 1994 American Psychiatric Association.

0.4. Coping with Cognitive changes

Changes in estrogen levels can be controlled by estrogen therapy ( ET). Various studies have suggested that replacing estrogen levels can reverse cognitive changes and ultimately improve memory. Statistically significant studies find ET helps verbal memory, verbal learning and spatial memory skills**.

Contact your doctor and thoroughly discuss your options if you think you may be a candidate for ET. Other non-hormonal treatments are also available including varying your intake of vitamins and minerals with different diets, herbal remedies and stress-relieving tactics. To control insomnia, NAMS, 2003 suggests several ways to improve your sleep routine. Refer to our September issue to review them.

Nutritional inadequacy is commonly linked to psychological irregularity. Substances in the brain (known as neurotransmitters) control proper brain function. Nutrients play a large role in controlling mental problems. Emotional distress may be a function of an inadequate supply of a certain vitamin or mineral. Below is a list of common nutrient deficiencies and related mental symptoms adapted from Ojeda, 1995:

• Vitamin B-1 (thiamin): Loss of appetite, depression, irritability, memory loss, sensitivity to noise, inability to concentrate, fatigue, reduced attention span
• Vitamin B-3 (niacin): Insomnia, nervousness, irritability, confusion, depression, hallucination, loss of memory
• Vitamin B-6: Anxiety, depression, irritability, insomnia
• Vitamin B-12 (cobalamine): Difficulty concentrating and remembering, depression, severe agitation, hallucinations, manic behavior
• Folic Acid: Irritability, weakness, apathy, hostility, anemia
• Vitamin C: Increased stress, fatigue
• Vitamin E: Depression, lethargy
• Potassium: Nervousness, irritability, mental disorientation
• Magnesium: Paranoid psychosis
• Calcium: Anxiety, neurosis, fatigue, insomnia, tension
• Zinc: Anemia, poor mental function
• Iron: Depression, lethargy, poor concentration, irritability, decreased attention span
• Essential Fatty Acids: Anxiety, irritability, insomnia

Herbal remedies have also been known to reduce anxiety and tension. Herbal remedies are popular solutions for women in European countries. It should be strongly noted that alternative or natural herbal remedies are not under the guidance of the Food and Drug Administration (FDA) and are not publicly controlled. Some include valerian, kava, Ginkgo biloba, passion flower, skullcap, chaste tree, oat straw, Siberian ginseng, dandelion root, garden sage and chamomile.

Stress relieving tactics can also be used to ensure strong mental health. These include (but are not limited to) the following list taken from NAMS, 2003:

• Participate in pleasurable activities
• Talk with friends
• Eat three nutritious meals a day; focus on a diet that is low in fat, alcohol and caffeine
• Snack on healthful, crunchy foods such as apples and raw carrots
• Make time for regular, daily exercise
• Find or renew a creative outlet or activity that fulfills mental and spiritual needs
• Enjoy self-care activities such as a massage or manicure
• Try stress reduction and relaxation techniques, such as deep breathing and meditation
• Get adequate sleep each night
• Laugh as much as possible
• Consider joining a support group or seeking therapy if necessary

For menopausal or perimenopausal women who experience cognitive difficulties, they are usually periodic. These common feelings usually occur intermittently and can be controlled with the proper treatments. Each woman is wired differently. One treatment may work flawlessly on your friend but doesn't necessarily work great in your personal situation.

Most importantly, keep challenging yourself to maintain a healthy cognitive state. Enhance your brain's ability to handle complexity and coordination skills over time. By keeping your brain busy and finding new challenges, it will not get tired! Here are some new learning techniques adapted from Warga, 1999:

• Consider taking a continuing education course
• Learn a new complex skill
• Crossword puzzles
• Join an online chat group
• Attend weekend seminars at a museum or educational center
• Pick up some new area that interests you and read as much about it as you can
• Create or join a monthly reading group

Challenge yourself to learn new material and your mind will thank you.

* "While statistical studies have long shown that women are at least twice as likely as men to become depressed (or to seek help for it), recent epidemiological studies have suggested that women are no more depressed during their forties and fifties than they are at any other time in life. There is no increase in the number of women hospitalized for mental illness during these years, nor do suicide rates, generally taken as an index of severe depression, rise for women during these decades of life. As a group, women are much more likely to be depressed in their twenties and thirties, when the life stresses they face are entirely different." (Minkin and Wright, 1996)

** Dr. Barbara Sherwin, professor of psychology and obstetrics and gynecology at McGill University in Montreal has studied the connection between estrogen and cognition. Her results all point to a very plausible correlation, "...in three different studies of premenopausal women who have had to have complete hysterectomies with ovary removal. Estrogen loss consistently led to reduced scores on verbal learning and memory measures compared with baseline measures—having to remember a paragraph or paired sets of words immediately afterward, or after a delay—and a return to baseline levels when estrogen-replacement therapy was given—sometimes to better than baseline levels." (Warga, 1999)

References:

NAMS 1993: The Menopause Guidebook (http://www.menopause.org/edumaterials/guidebook/guidebook.htm)

Minkin, M. J., and Wright, C. V., 1996, What Every Woman Needs to Know About Menopause: Yale University Press, New Haven and London, p. 62.

Ojeda, L., 1995, Menopause without Medicine: Hunter House Inc., Alameda CA, pp79-92.

Warga, C. L., 1999, Menopause and the Mind: The Free Press, New York, 388pp.