Transcript
Announcer:
You’re listening to Advances in Women’s Health on ReachMD. On this episode, we’ll hear from Dr. Monica Christmas, who’s the Associate Medical Director for the Menopause Society, an Associate Professor of Obstetrics and Gynecology, the Director of the Center for Women’s Integrated Health, and the Director of the Menopause Program at the University of Chicago Medicine. She’ll be discussing how to manage mood changes during perimenopause. Here’s Dr. Christmas now.
Dr. Christmas:
People get really frustrated, because they'll say, "I know something's wrong. Please check my hormones." And we'll check them, and their FSH will be normal. Their estradiol might even be high, because during that perimenopause transition, we often get spikes in estrogen.
And that can be extremely frustrating, because they don't know why they're feeling the way that they do. They'll tell you, commonly, "I just don't feel like myself anymore." Or they'll tell you, "I'm yelling at my significant other more. I'm blowing up about things. I know that I overreacted, but I just am not able to control my outburst or what I'm saying in the moment.” It can be extremely challenging too for people in their work or professional setting.
And you can capture those things, certainly, by using a validated questionnaire, but many times, you just need to listen. And for milder symptoms, or especially if there's other exacerbating factors… A real example yesterday in my clinic—I do believe that she had midlife hormonal changes to being in the midlife transition that were impacting her mood symptoms—but she also had really real-life experiences that were going on. She had gone through a divorce. Her daughter was also going through a divorce that was impacted by domestic violence. She had experienced some racial discrimination in her neighborhood that she lived in and ended up needing to move. She also stated that there was lots of stress in her work life. In her career of 27 years, she'd had to make a pretty significant pivot and change. And then, coupled with that, she was the major caregiver for her father, who recently died from terminal cancer. And while her father was sick, she found out that her sister had breast cancer. So there is no way… I can't even make up all those things. I was tearful listening to this woman talk to me.
All of those things in her life were definitely impacting her, and I also do believe that her being in the menopause transition time of life was impacting her as well. And so, in terms of how I supported her and how we talked about managing her other menopause-related symptoms as well as her behavioral health needs, was a multifactorial approach. And there wasn't going to be one single thing I was going to be able to do for that particular person to make everything better.
Sometimes it's not that complicated. It’s an easier thing when somebody tells me, “My job is fine. My children are doing well. I have the most supportive spouse. I don't know why I'm really feeling this way. I’m insecure or feeling imposter syndrome. I'm more tearful than I normally am, and I've got these terrible hot flashes, too." That's somebody that may actually respond to just managing them with hormone therapy, right? They never had depression or anxiety in the past. This all just started with the menopause transition. They may be someone that just responds to that.
Somebody who has a history of anxiety or depression in the past—even if they've been stable for many years—if they're not on medication, they might need to go back to what they were on before, meaning an antidepressant or mood stabilizer. If they're already on something, it might be that we need to adjust the dose or change, either in this menopause timeframe or adding the hormone therapy to their antidepressant regimen.
Announcer:
That was Dr. Monica Christmas talking about mental health considerations during the menopause transition. To access this and other episodes in our series, visit Advances in Women’s Health on ReachMD.com, where you can Be Part of the Knowledge. Thanks for listening!
