Mental Well-being in Menopause

The menopause transition is widely variable in its duration and symptomatology. Clinical surveillance is critical to helping to recognize symptoms of depression-both recurrent and new onset-and anxiety, as these are extremely common in the general population and may worsen as women traverse menopause. Treatments for depression and anxiety are similar for perimenopausal women as they are for women and men at other times of life, except for the role of estrogen therapy in alleviating depression prior to menopause and in some cases, preventing depression. Although cognition does not generally decline significantly with progress through the menopause transition, executive function can be compromised, especially in women with a history of adverse childhood experiences. A history of trauma puts women at exceptional risk. Comorbid psychiatric conditions such as bipolar disease and schizophrenia also require attention during the menopause transition, as efficacy of antipsychotic medications may vary, requiring dosing adjustments. Collaboration between the OB/GYN and psychology or psychiatry colleagues can be greatly beneficial in individual patient management. Of note, research among heterosexual couples indicate that male spouses can also be influential in their partner's decision to pursue treatment or make lifestyle changes in response to menopausal transition symptoms.78 An educational intervention for male spouses suggested positive impact through increasing men's knowledge of menopausal health as well as female spouse's marital satisfaction.79 Education for women, their social support system, and their medical team about the menopause transition, its impact on well-being, and treatment options are essential to improve quality of life for this population.