What is postmenopausal depression?

It's all in the hormones

Technically, 'menopause' comes from the Greek words 'menos' and 'pausos' - your periods stop. But there are lots of other changes, including hot flushes, vaginal dryness, a tendency to put on weight around your tummy and mood swings.

Most of the physical changes of the menopause are due to changes in levels of the female hormone oestrogen, which naturally go up and down during your menstrual cycle. Your oestrogen levels drop after the menopause and come down to a constant low level, usually within a couple of years of your periods stopping. It's these changes that cause hot flushes and vaginal dryness. Your natural levels of another female hormone, progesterone, also change with the menopause, and this hormone is thought to be mainly to blame for premenstrual syndrome (PMS).

However, if you've suffered from PMS it doesn't necessarily mean your menopausal symptoms will be bad too.

It's well recognised that major life changes can bring on depression. Unfortunately, many women are going through just such changes (children leaving home, divorce, etc) around the time of the menopause. At the same time, you're up half the night with hot flushes, and sex may become uncomfortable because of vaginal dryness, possibly causing friction with your husband. Going through 'the change' also means you can't have more children - and even if you didn't want to, the fact that you now have no choice can take a toll.

Interestingly, in cultures where having a period makes women 'untouchable' and childbirth is a dangerous business because of lack of medical facilities, fewer women report depression or mood swings around the menopause. They are free from the monthly social restrictions, and many report that they feel more happy, not less.

Your attitude to the menopause really does seem to make a difference, too. Several studies have shown that a negative attitude towards impending menopause makes you more likely to suffer mood changes as well as hot flushes.

Interestingly, there is also increasing evidence that your lifestyle can have a major impact on the symptoms you get around the menopause. For instance, smoking and gaining weight around the menopause are linked to more hot flushes; and lack of regular exercise can increase your risk of hot flushes as well as being linked with an increased risk of depression at any age.

Mood swings - feeling angry, irritable or upset easily - are common with the menopause. To recognise if you are really depressed, see below. If you're not, there are lots of ways you can minimise the impact of the menopause and get your life back on track.

My top tips for mood swings at the menopause:

• Think positive. This could be the start of a new and exciting chapter in your life - no more worrying about contraception, more time for yourself after years of putting the children first.

• Watch your diet. Sugary foods cause your blood sugar levels to rise and then fall rapidly. This can make you irritable.

• Consider adding more soya-containing foods to your diet (soya beans, tofu, soya milk all count). Japanese women, who have a diet high in soya, which contains 'phyto-oestrogens', appear to have fewer problems around the menopause.

• Exercise regularly. This raises natural body levels of endorphins, a 'feelgood' chemical.

• Celebrate you! You are still yourself, and you're beautiful. You have a wealth of experience and wisdom you never had in your youth.

We use the term 'it's really depressing' a lot, but in medical terms, depression is more than just having a bad day. For a doctor to diagnose depression, you need to have symptoms on several days a week for some weeks. They include:

• Little interest or pleasure in doing things.

• Feeling low or hopeless.

• Changes in sleep (not just caused by hot flushes and sweats).

• تغيرات في الشهية.

• Feeling that you have let others down or are a failure.

• Problems concentrating.

• Being so sluggish or nervy that others have noticed.

• At worst, thoughts that you'd be better off dead.

If you suspect you may be depressed, do talk to your GP. There is a wide range of really effective treatments, including talking therapy, available.

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