Midlife Mental Health

On the heels of World Menopause Day October 18^th, I want to acknowledge this pivotal transition during the reproductive life cycle and the significant impact it can have on an individual’s mental health. The journey to menopause and how one experiences it can greatly vary and is often influenced by a complex interplay of biological, psychological and social factors. This is similar to other significant transitions in the reproductive life cycle including the onset of puberty and the perinatal period. However, menopause is often stigmatized, associated with aging and individuals may feel ashamed and isolated by their symptoms or situation.  In the past this period was referred to as a “midlife crisis”.  Navigating through the many uncertainties that come with midlife can often feel very daunting and without the proper support it certainly feels like a crisis.

This is especially true for those individuals who experience an array of symptoms associated with the transition leading up to menopause aka (peri)menopause – back to those symptoms in a minute. Menopause, is marked by the day of the final menstrual period which is often determined retrospectively after an entire 12 months passes in absence of menstrual bleeding. On average, an individual will approach menopause by age 52 but it may happen as early as in your 30’s or as late as in your 60’s, occurring either naturally or as a result of medical or surgical reasons.

Regardless of the cause, you may notice a syndrome of symptoms including hot flashes, night sweats, inflammation, joint pain, weight gain, muscle wasting, sexual dysfunction, pelvic floor weakness, genitourinary symptoms, cognitive changes, sleep disturbances, loss of skin elasticity and dryness, hair thinning on the scalp and excessive hair growth on the face, acne, increased headaches, elevated blood pressure, mood changes and more. Many of these symptoms contribute to lost wages, missed work days and employee resignations costing employers $1.8 billion annually.

Mood changes can look like anxiety, depression or a mixture of both. Many of these symptoms can be a result of hormonal changes, significant life events, relationship issues, caretaker fatigue, financial stress and limitations in physical health. While not a lot of research has been conducted on this important topic, two pivotal studies offer some insight on how to support individuals during this time. The Women’s Health Initiative (WHI) and the  Study of Women’s Health Across the Nation (SWAN) both have provided important findings to help frame evidence-based approaches throughout midlife and menopause to improve an individual’s physical, social, psychological and mental well-being.

In the SWAN, depending on ethnicity, 20 to 70 percent of participants reported using some form of complementary and alternative therapy (CAM) during the menopausal transition phase to manage symptoms.  Adopting healthy lifestyle behaviors focused on eating a healthy diet, regular exercise, quality sleep, mindfulness practices and socializing with friends can help to reduce stress and depressive symptoms.  Reduce the use of substances that may also impact your sleep, stress levels and overall health. Evidence suggests hormone replacement therapy can help to manage some of the myriad of symptoms including balancing mood but it may not be safe or appropriate for everyone. Psychiatric medications may also help to reduce anxiety and depressive symptoms, reduce hot flashes and improve sleep quality.

Finding a provider who can help navigate the constellation of symptoms that present during this midlife transition may feel impossible and often does require a collaboration of specialists. At Flourish, we commit to supporting your midlife mental health needs and validate your experiences so you don’t feel alone on this journey.

Here are a few of my favorite resources to help you start learning more about this important milestone:

• The Menopause Society Website: https://menopause.org
• The Vajenda Website: https://vajenda.substack.com
• The ‘Pause Life Website: https://thepauselife.com
• You Are Not Broke Podcast: https://kellycaspersonmd.com/you-are-not-broken-podcast/

References:

• Faubion S. et al. (2023) Impact of Menopause Symptoms on Women in the Workplace. Mayo Clin Proc; 98:833-845. doi: 10.1016/j.mayocp.2023.02.025.pubmed.ncbi.nlm.nih.gov/37115119/
• Study of Women’s Health Across the Lifespan Website https://www.swanstudy.org/
• Women’s Health Initiative Website  https://www.whi.org/