Nerlandes’ Story

Nerlandes Themistocle is a pharmacist and Pharmacy Manager at CVS Caremark, having worked in pharmaceuticals for over 25 years. She is a wife and a mother of two, currently residing in Rhode Island and finds joy with her family, listening to music, dancing, traveling, and exploring new foods. Nelandes Themistocle shares her truth about menopause, from what she experienced to what she wishes she knew about this important part of the reproductive health journey.

Can you tell us a little bit about your menopause experience?

I didn’t experience symptoms or body changes during the perimenopause stage as many others have. All of the symptoms started once my periods stopped very suddenly at the age of 50. What I’ve learned throughout this process and when talking with others is that not everyone experiences menopause in the same ways. Some may experience vaginal dryness, while others may feel more irritable or depressed. No experiences are one and the same.

What symptoms did you experience?

My symptoms were mainly hot flashes and night sweats, as well as trouble sleeping. The hot flashes, however, were pretty severe for me. I’d have to have fans on me at all times at work and when I go to bed.

Were there any other symptoms that caught you by surprise?

The symptom that really caught me by surprise was anxiety. I started to feel anxious about things I normally wouldn’t. For instance, I never felt or experienced anxiousness when it came to my work, especially because I have worked at the same place for years, however, one day I had such an overwhelming experience I had to call my husband. The palpitations were very intense, and this lasted for an entire week. I still feel anxiety from time to time, but I find ways to manage.

Did you feel prepared going into menopause?

Going into menopause is not something any woman can ever be fully prepared for. It took me an entire year to realize that I was going through the change . I definitely was not prepared. I did not have any idea what to expect or even how to identify if I was really experiencing it.

What do you wish more people knew about menopause?

Menopause is not as simple as people think. It is a very complex process that can be long and at times frustrating. The symptoms can last several years after your period stops and can be disruptive to your everyday life. Everyone experiences menopause differently, like I mentioned earlier, no experience is one and the same, so be patient with yourselves.

What do you think is the biggest misconception about menopause?

Menopause is still considered a very sensitive topic. I think that a lot of women struggle with this idea that once they go into menopause, their womanhood is stripped away. They may feel life is going to change forever, and people, including their spouses, will not look at them the same way. I felt that at one point, but my husband still treats me the same. Life may change in some ways, but the most important things don’t. People, not just women, need to be more educated about menopause to help with these feelings.

Is there any message you’d like to give to someone going through or preparing for menopause — maybe someone experiencing the same symptoms as you?

Menopause is not a medical condition but a natural process that will become a part of your life. Our bodies go through a lot of changes during this time, but there are so many ways to manage it. Don’t be afraid of talking about your symptoms; there is absolutely nothing to be ashamed of. Challenge yourself, change your lifestyle, exercise, keep yourself hydrated, lastly and most importantly, seek medical advice or talk to your provider. There are also so many drugs on the market that can help with the symptoms. I have learned to live with it and be happy.

Learn more about menopause

Menopause

Menopause 101

Menopause symptoms

• Peer support groups (such as Alcoholics Anonymous (AA), Narcotics Anonymous (NA), etc.)
• Therapy and Psychiatry
• Inpatient detox/residential drug or alcohol treatment
• Medication-assisted treatments
• And more

You can visit the online SAMHSA treatment locator, or send your zip code via text message: 435748 (HELP4U) to find help near you. Read more about the HELP4U text messaging service.

The lists below are not all-encompassing, but they should help you get started with your goals. 

Substance Use Resources

Alcohol Resources

Opioid Resources

Smoking/Tobacco Resources

Mental Health Providers

To Learn More About Substance Use and Health 

Next Steps

Reducing or eliminating substances is not always easy! It can certainly be a challenge, but with the proper support, you can be on your way towards achieving your goals.   

The first step is connecting with a resource that is right for you. You can also speak with your primary care provider to discuss any concerns you may have. Your insurance company should be able to provide you with guidance on inpatient and outpatient treatment when needed.  

There is hope.  Reach out and allow yourself to receive support because you deserve to be healthy and happy! 

Reviewed by the Ovia Health Clinical Team

Menopause can be a tough transition that impacts many aspects of your life. Many people find this stage of life difficult to cope with — so if you’re noticing that your mood has changed lately, you aren’t alone.

Mood swings and feelings of anxiety and sadness are common during perimenopause. Like most other symptoms, they can be associated with fluctuating hormone levels, specifically estrogen, progesterone, and serotonin. However depression during this time of life can also occur for reasons other than menopause. Here’s what you need to know about the link between depression and menopause. 

How your hormones play a role 

Estrogen and serotonin

The production of estrogen is correlated with serotonin, a neurotransmitter that acts as a “happy hormone” by reducing anxiety and fostering feelings of wellbeing. So as estrogen levels fluctuate during the menopausal transition, this can disrupt serotonin pathways, which can affect mood.

Progesterone and GABA

Progesterone is the “calming hormone” that may also influence Gamma-Aminobutyric acid or GABA for short. GABA is a neurotransmitter that produces a calming effect when it binds to its receptors. Progesterone increases the effects of GABA, so lower progesterone levels during perimenopause may result in less GABA-like activity, which then increases the chances of mood swings, anxiety, and sleeplessness.

Women between the ages of 40 and 55 are more likely to report depressive symptoms than premenopausal or postmenopausal women, suggesting that the highest risk for new-onset depression is during the transition into menopause, not during postmenopause.

In addition to depressive symptoms, menopause also presents physical symptoms like hot flashes/night sweats and sleep disturbances which can overlap and complicate depression, leading some researchers to believe that there is a correlation (not causation) between the two.

Those suffering from depression also report other menopausal symptoms like:

• Brain fog and difficulty concentrating
• Decreased energy
• Increased appetite
• Decreased libido (attributed to depression and/or vaginal dryness)
• Urinary incontinence (The science behind this potential association isn’t 100% understood but it may be due to decreased serotonin levels in the central nervous system, which is correlated with symptoms of depression as well as increased urinary frequency/bladder contractions. Of course, urinary incontinence can be linked to multiple factors, including its well-established link to declining estrogen levels and physical changes of menopause.)

Keep in mind that there are so many factors at play here that are difficult to discern: socioeconomic considerations, psychological, social, and health status, among others. Plus, let’s not forget that we’re dealing with our fair share of life stressors during this transition. Maybe we’re caring for children or aging parents, navigating career shifts, or struggling with our changing bodies. All of the above can adversely impact mood and should not be discounted as “par for the course.”

If you are experiencing severe symptoms that impact your everyday life or if you have suicidal thoughts, reach out to your healthcare provider right away. There is nothing shameful about getting the help you deserve.

Lifestyle

If you’ve been having a hard time lately and think you may be struggling with depression, you aren’t alone. You’re going through so many big physical and emotional changes that impact many menopausal people. Many lifestyle interventions have been studied to assess their effect on mood disorders, including depression. Please don’t struggle through these feelings on your own — everyone deserves support. Speak to your provider about getting the proper care, and if you are interested in exploring additional methods of support, here are some recommendations from Elektra’s founding physician, Dr. Anna Barbieri, MD. 

Nutrition and diet

Focus on eating more nutrient-dense foods like fruits and veggies and try to cut back on overly sugary snacks. Lean proteins (like fish and chicken) and whole foods (like veggies and beans) are good for our brain health, mood, and overall health!

Spend time in nature

Frequent exposure has been shown to reduce anxiety and depression while improving an overall sense of well-being. Taking a walk through the park or spending an afternoon by a lazy river can help you feel better.  

Practice gratitude

Practicing gratitude has been shown to improve our mood, help reduce symptoms of depression, and even lower blood pressure! 

Prioritize high-quality sleep

A lack of sleep can impact your stress hormone levels which, in turn, impair thinking and emotional regulation. Prioritize your sleep by limiting screen time before bed, drinking a soothing cup of chamomile tea, and curbing your caffeine intake before bedtime. 

Psychotherapy 

There are two types of psychotherapy recommended for menopause-related depression: interpersonal therapy and cognitive behavioral therapy (CBT) — both of which are often used in conjunction with medication. If you are interested in seeing a therapist, be sure to ask about their particular approach and practice.

Exercise

Studies show a clear link between regular movement and an elevated mood, improved sleep, and higher self-esteem. The effect of exercise specifically on depression proves to help prevent the development of depression in adults and is a useful strategy to help manage and treat existing symptoms. And don’t worry about pushing yourself too hard —- even a brisk walk around the block is a wonderful way to get your blood pumping. 

Hormonal prescriptions

Hormone therapy is a viable treatment option for women with elevated depressive symptoms who have been screened for common risk factors. Oral contraceptive pills are typically prescribed for early-late perimenopause, while hormone replacement therapy (HRT) is prescribed for late perimenopause-menopause.

Estrogen therapy alone is not approved to treat perimenopausal depression; however, there is evidence that it has antidepressant effects, particularly for those suffering from vasomotor symptoms (e.g., hot flashes & night sweats). 

Non-hormonal prescriptions 

Antidepressants such as SSRIs and SNRIs are a helpful option for anxiety and depression in peri- and menopausal women. SSRIs are selective serotonin reuptake inhibitors and SNRIs are serotonin and norepinephrine reuptake inhibitors. These antidepressants work by regulating serotonin (the “happy hormone” that controls mood) and norepinephrine (which plays a vital role in the body’s “fight-or-flight” response to stress). Like therapy, there is still a stigma around taking these medications but for many of us who experience symptoms, they can be incredibly effective and helpful, and we have decades of research to back this up. 

Sources

• Yoon, H. “As Menopause Nears, Be Aware It Can Trigger Depression And Anxiety, Too”. NPR. NPR. January 16, 2020. https://www.npr.org/sections/health-shots/2020/01/16/796682276/for-some-women-nearing-menopause-depression-and-anxiety-can-spike 
• Freeman, E. W. “Depression in the menopause transition: risks in the changing hormone milieu as observed in the general population”. Women’s Midlife Health. 11;1:2. Web. August 2015. 
• Soares, C.N. Almeida O.P. “Depression During the Perimenopause”. Archives of General Psychiatry. 58(3), 306. Web. March 2001.
• “Perimenopause: Rocky road to menopause”. Harvard Health Publishing. Harvard Health Publishing. April 14, 2020. https://www.health.harvard.edu/womens-health/perimenopause-rocky-road-to-menopause 
• “Depression, Mood Swings, Anxiety, Sexual Side Effects of Menopause” The North American Menopause Society. The North American Menopause Society. https://www.menopause.org/for-women/sexual-health-menopause-online/causes-of-sexual-problems/depression-mood-swings-anxiety 
• Ventriglio, A., Sancassiani, F., Contu, M. P., Latorre, M., Di Slavatore, M., Fornaro, M., & Bhugra, D. (2020). Mediterranean Diet and its Benefits on Health and Mental Health: A Literature Review. Clinical Practice & Epidemiology in Mental Health, 16(1), 156–164.
• Li, Y., Lv, M.-R., Wei, Y.-J., Sun, L., Zhang, J.-X., Zhang, H.-G., & Li, B. “Dietary patterns and depression risk: A meta-analysis”. Psychiatry Research. 253, 373–382. Web. July 2017.
• “Spend Time in Nature to Reduce Stress and Anxiety”. American Heart Association. American Heart Association. August 1, 2019. https://www.heart.org/en/healthy-living/healthy-lifestyle/stress-management/spend-time-in-nature-to-reduce-stress-and-anxiety  
• “Giving thanks can make you happier”. Harvard Health Publishing. Harvard Health Publishing November 2011.https://www.health.harvard.edu/healthbeat/giving-thanks-can-make-you-happier 
• Cohut, M. “What are the health benefits of being social?”. Medical News Today. Medical News Today. February 23, 2018. https://www.medicalnewstoday.com/articles/321019  
• Ackerman, C. M. E. “83 Benefits of Journaling for Depression, Anxiety, and Stress”. PositivePsychology.Com. PositivePsychology.Com.October 12, 2020. https://positivepsychology.com/benefits-of-journaling/ 
• Chowdhury, R. B. M. A. “The Neuroscience of Gratitude and How It Affects Anxiety & Grief”. PositivePsychology.Com. PositivePsychology.Com. September 1, 2020. https://positivepsychology.com/neuroscience-of-gratitude/ 
• “Exercise for Stress and Anxiety”. Anxiety and Depression Association of America.Anxiety And Depression Association Of America. https://adaa.org/living-with-anxiety/managing-anxiety/exercise-stress-and-anxiety 
• Siefken, K., Junge, A., & Laemmle, L. “How does sport affect mental health? An investigation into the relationship of leisure-time physical activity with depression and anxiety”. Human Movement. 20(1), 62–74. Web. March 2019.
• Frühauf, A., Niedermeier, M., Elliott, L. R., Ledochowski, L., Marksteiner, J., & Kopp, M. (2016). Acute effects of outdoor physical activity on affect and psychological well-being in depressed patients – A preliminary study. Mental Health and Physical Activity, 10, 4–9.
• Villines, Z. “What are the differences between SSRIs and SNRIs?” Medical News Today. Medical News Today.October 23, 2020.  https://www.medicalnewstoday.com/articles/ssri-vs-snri 
• Rocca, W. A., Grossardt, B. R., Geda, Y. E., Gostout, B. S., Bower, J. H., Maraganore, D. M., de Andrade, M., & Melton, L. J. “Long-term risk of depressive and anxiety symptoms after early bilateral oophorectomy”. Menopause. 15(6), 1050–1059. Web. November 2008. 
• Stewart, J., Garrido, S., Hense, C., & McFerran, K. “Music Use for Mood Regulation: Self-Awareness and Conscious Listening Choices in Young People With Tendencies to Depression”. Frontiers in Psychology. 10. Web. May 24, 2019.
• Freeman, E. W. “Associations of depression with the transition to menopause”. Menopause. 17(4), 823–827. Web. July 2010.
• Schuch, F. B., & Stubbs, B. “The Role of Exercise in Preventing and Treating Depression”. Current Sports Medicine Reports. 18(8), 299–304. Web. August 2019.

Menopause and perimenopause often bring up intense feelings of anxiety, worry, and stress. While anxiety is a normal symptom of menopause, it’s still tough to deal with — especially when you’re already going through so many other changes. Whether you’re familiar with anxiety or this is the first time you’ve experienced it to this degree, it’s overwhelming when these feelings negatively impact your daily life.

Although it’s normal to experience heightened anxiety during menopause, if you have prolonged, intense feelings of worry and/or stress that make it hard to go about life normally, speak with your healthcare provider right away. There are a range of treatment options available, including lifestyle changes, new practices (like therapy), and medication. Your provider can work with you to find the best treatment plan. You can feel like yourself again.  

If you’re thinking about what you can do on your own, there are some ways to cope with anxiety. Lifestyle and mood disorders are related, and it’s possible to make positive changes that help curb your symptoms. Here are some lifestyle changes you may want to consider if you are battling anxiety during menopause. 

Consider your diet

Try to limit processed foods and added sugars and instead focus on maintaining a well-balanced diet with a wide range of whole foods, especially veggies and healthy fats (e.g., olive oil, avocados, nuts like almonds and walnuts, and fatty fish). Eating a healthy diet leads to improved brain health and mood. 

Spend time in nature

Routine, frequent exposure to the great outdoors has been shown to reduce anxiety and depression while improving an overall sense of wellbeing. Never underestimate the power of Mother Nature (aka vitamin N) to boost your mood!

Reduce stress

We know it’s easier said than done when everything and everyone seems to be competing for your attention. Here are some ways to manage stress. 

Try meditation

Many people enjoy taking the time to sit with their thoughts each day. If you are a beginner, try meditation with an app or a guided class.

Cultivate a gratitude and/or journaling practice

Studies have linked both practices to decreased anxiety, and they can also help improve general feelings of wellbeing and facilitate mindfulness. 

Get high-quality sleep

Sleep disruptions affect our stress hormone levels which, in turn, impair thinking and emotional regulation. That’s why it’s so important to prioritize those Zzzzs. 

Prioritize downtime with family and friends

While we may be conditioned with a “go-go-go” mentality, it’s important to step back and prioritize rest and downtime with loved ones (pencil it into your calendar!). After all, human beings are social creatures, and we gain a great deal of comfort from connection.

Don’t forget about “me” time

Call it what you want — self-care, alone time, R&R — but you deserve it. There’s nothing selfish about taking time for yourself, especially when it supports your mental health and overall wellness.

Cognitive Behavioral Therapy (CBT)

CBT involves working with a coach or therapist to recognize and change beliefs — including negative thoughts and worries. That’s the “cognitive” part. And then there’s the “behavioral” part, which helps you develop better habits and mindset. It’s ideal for those looking to address underlying causes of anxiety while working toward long-term management.

Exercise

Scientists have found that regular movement decreases overall levels of tension, elevates and stabilizes your mood, improves sleep, and boosts self-esteem. According to the World Health Organization, 150 minutes per week of moderate-intensity movement (a brisk walk counts!) can help reduce the risk of developing symptoms of anxiety and depression.

Supplements and over-the-counter solutions

According to some studies, certain supplements and over-the-counter solutions may help reduce symptoms of anxiety. Talk to your healthcare provider about which solution may be best for you.

Medication

SSRIs and SNRIs remain the first line of pharmacologic defense for anxiety and depression in peri- and menopausal women. SSRIs are selective serotonin reuptake inhibitors and SNRIs are serotonin and norepinephrine reuptake inhibitors — total tongue twisters! These neurotransmitters are antidepressants that work by regulating serotonin (the “happy hormone” that controls mood) and norepinephrine (which plays a key role in the body’s “fight-or-flight” response to stress). 

A note about antidepressants: there is still a stigma around taking these medications but for many of us who experience symptoms, they can be incredibly effective and helpful, and we have decades of research to back this up. Talk to your provider if you have questions or are wondering if an antidepressant might be a good fit for you.

Sources

• “8 principles of low-glycemic eating”. Harvard Health Publishing. Harvard Health Publishing. February 15,  2014. https://www.health.harvard.edu/healthbeat/8-principles-of-low-glycemic-eating 
• “Spend Time in Nature to Reduce Stress and Anxiety”. American Heart Association. American Heart Association. August 1, 2019. https://www.heart.org/en/healthy-living/healthy-lifestyle/stress-management/spend-time-in-nature-to-reduce-stress-and-anxiety 
• “Giving thanks can make you happier”. Harvard Health Publishing. Harvard Health Publishing November 2011.https://www.health.harvard.edu/healthbeat/giving-thanks-can-make-you-happier 
• Cohut, M. “What are the health benefits of being social?”. Medical News Today. Medical News Today. February 23, 2018. https://www.medicalnewstoday.com/articles/321019 
• “Exercise for Stress and Anxiety”. Anxiety and Depression Association of America.Anxiety And Depression Association Of America. https://adaa.org/living-with-anxiety/managing-anxiety/exercise-stress-and-anxiety 
• Siefken, K., Junge, A., & Laemmle, L. “How does sport affect mental health? An investigation into the relationship of leisure-time physical activity with depression and anxiety”. Human Movement. 20(1), 62–74. Web. March 2019.
• Nobre AC, Rao A, Owen GN. “L-theanine, a natural constituent in tea, and its effect on mental state”. Asia Pac J Clin Nutr. 17 Suppl 1:167-8. Web. 2008. 
• Villines, Z. “What are the differences between SSRIs and SNRIs?” Medical News Today. Medical News Today.October 23, 2020.  https://www.medicalnewstoday.com/articles/ssri-vs-snri 
• Ackerman, C. M. E. “83 Benefits of Journaling for Depression, Anxiety, and Stress”. PositivePsychology.Com. PositivePsychology.Com.October 12, 2020. https://positivepsychology.com/benefits-of-journaling/ 
• Chowdhury, R. B. M. A. “The Neuroscience of Gratitude and How It Affects Anxiety & Grief”. PositivePsychology.Com. PositivePsychology.Com. September 1, 2020. https://positivepsychology.com/neuroscience-of-gratitude/ 
• Ortmann, O., et al. “Peri- and postmenopause—diagnosis and interventions interdisciplinary S3 guideline of the association of the scientific medical societies in Germany”. Archives of Gynecology and Obstetrics. 302(3), 763–777. Web. July 13, 2020. 

As you approach perimenopause and menopause, you’re likely juggling a lot! You may be caring for kids or aging parents, busy at work in peak career years, or all of the above. So it’s natural to feel overwhelmed sometimes, but it’s important to recognize that there are physiological factors at play here as well.

Anxiety, which may (but doesn’t always) go hand-in-hand with depression, is thought to be influenced by changing hormone levels.

Hormones that can impact anxiety

• Serotonin: the “happy hormone” that stabilizes mood and fluctuates with age and decreasing estrogen levels.
• Estrogen: results in increased serotonin levels and increased serotonin receptors. More serotonin = less anxiety and depression. The relationship between these two hormones is complex though and we are just starting to scratch the surface!
• Progesterone: the “calming hormone” that may also influence GABA.
• Gamma-Aminobutyric acid (GABA): a neurotransmitter that produces a calming effect when it binds to its receptors, which may support a reduction in stress, anxiety, and sleeplessness. With lower progesterone levels, GABA’s receptors don’t bind as well, thereby prolonging the stress response and increasing anxiety.

The most common anxiety symptoms are tension, nervousness, panic, and worry. Some may feel physical signs too, like an upset stomach, headaches, racing heart, or sweating. Others may experience panic attacks, which is an extreme episode of anxiety that is accompanied by physical symptoms such as heart palpitations, shortness of breath, and even chest pain.

Hot flashes and anxiety

There is one interesting connection between hot flashes and anxiety. Research has shown that women who experience anxiety are 3-5x more likely to have hot flashes. Another study found that women who experienced anxiety with physical symptoms (upset stomach, racing heart, etc.) had a strong tendency to have hot flashes.

Can the cause of anxiety, mood swings, and depression be independent of menopause? Of course. Either way, it’s important to talk to your healthcare provider, especially if you’re experiencing intensive, excessive, and persistent worry or fear about everyday situations that are difficult to control, interfere with your day-to-day life, and/or peak within minutes.

Read more to learn about treatments and options to help manage anxiety. 

Sources

• Bromberger, J. T. et al.  “Does risk for anxiety increase during the menopausal transition? Study of Women’s Health Across the Nation”. Menopause: The Journal of The North American Menopause Society. 20(5):488-495. Web. May 1, 2014. 
• Beck, T. “Estrogen and female anxiety”. Harvard Gazette. Harvard Gazette. August 9, 2012. https://news.harvard.edu/gazette/story/2012/08/estrogen-and-female-anxiety/ 
• Yasgur, B. S. “Mood Changes in Menopausal Women: A Focus on Anxiety”. Psychiatry Advisor. Psychiatry Advisor. December 17, 2018. https://www.psychiatryadvisor.com/home/topics/anxiety/mood-changes-in-menopausal-women-a-focus-on-anxiety/ 
• Mayo Clinic Staff “Anxiety disorders – Symptoms and causes”. Mayo Clinic. Mayo Clinic. May 4, 2018. https://www.mayoclinic.org/diseases-conditions/anxiety/symptoms-causes/syc-20350961 
• Young, L. M., Pipingas, A., White, D. J., Gauci, S., & Scholey, A. “A Systematic Review and Meta-Analysis of B Vitamin Supplementation on Depressive Symptoms, Anxiety, and Stress: Effects on Healthy and ‘At-Risk’ Individuals”. Nutrients. 11(9), 2232. Web.September 16, 2019.

So why this big jump in depression? Researchers aren’t completely sure. But studies suggest that estrogen is beneficial for our moods, so our bodies’ decreasing estrogen levels may play a major role. 

The physical symptoms around menopause, such as hot flashes that make it hard to get enough sleep, can cause women to feel irritable and anxious as well. On top of that, many women face significant life changes around the time of menopause — for example, children may be getting ready to leave home while aging parents need more care. 

For women who’ve been focused on looking after others for years, it can be hard to pause and tend to their own mental health.

Is this depression? 

The symptoms of depression include feeling tired or low on energy, losing interest in your usual activities, feeling sad or irritable, having a hard time sleeping, and a lower libido. If you’ve had any of these symptoms for more than two weeks, it may be a sign of clinical depression.

Please know that depression doesn’t come from weakness, and it’s not anyone’s fault. The truth is, depression is a treatable medical condition and your healthcare team can help. If you think you may be experiencing depression, talk with your doctor. 

Medications to treat depression

If you and your doctor agree that it’s time to treat depression, there are lots of medications that can help. Deciding what to choose will depend on how severe your symptoms are, and whether you’ve been through depression before. 

If your symptoms are severe, your doctor may recommend a combination of antidepressant medications and hormone replacement therapy (HRT). For milder symptoms, especially if you don’t have a history of depression, your doctor may recommend trying antidepressants or HRT alone to see what works for you. 

There are many types of antidepressants to choose from. Your doctor will likely recommend a selective serotonin reuptake inhibitor (SSRI). SSRIs work by increasing the levels of serotonin in the brain. Serotonin is a hormone that helps brain cells communicate with each other, and it’s known to stabilize mood and support feelings of wellbeing. SSRIs are the most prescribed type of antidepressant, and they come with a good safety record and few side effects. Common SSRIs include fluoxetine (Prozac™), sertraline (Zoloft™), and paroxetine (Paxil™). 

Your doctor may suggest HRT for mild-to-moderate symptoms of depression, especially if you haven’t experienced depression before. Since HRT includes estrogen, it may help with mood changes that come with decreasing estrogen levels in your body. HRT can also ease the other physical effects of menopause, which may help with mood. Your doctor can prescribe HRT as a pill (common HRT pills include Premarin, Estrace, and Estratab) or a patch. 

While it’s rare, depression can be a side effect of HRT. If you notice an increase in your symptoms after you begin HRT, talk to your healthcare team.

How does therapy fit in?

Whether you go with an antidepressant, HRT, or both, psychotherapy is another important piece of the puzzle. Experts recommend interpersonal therapy, which helps people understand how relationships impact depression, and cognitive behavioral therapy (CBT), which helps people reframe the thoughts and beliefs that come with depression.

When will I feel better?

If you begin with HRT treatment, most patients notice a difference in two to four weeks. With antidepressants, you will likely work up to the right dose for you, so it can take one to two months to know if your antidepressant is working well. If your medication isn’t helping you feel better, or you have side effects, your doctor may suggest switching to a different prescription. 

Psychotherapy usually works more gradually — on its own, people notice a change after two months or more. Although therapy takes time and commitment, the benefits tend to be long-lasting. 

If you’ve noticed mood changes and you’d like to talk over the options for treatment, reach out to your provider.

Reviewed by the Ovia Health Clinical Team 

Sources

• Ovia-recommended: North American Menopause Society: https://www.menopause.org/for-women/menopauseflashes/mental-health-at-menopause/depression-menopause
• Ovia-recommended: The Association for Women’s Healthcare: https://www.chicagoobgyn.com/blog/how-menopause-affects-your-mental-health
• Ovia-recommended: MGH Center for Women’s Mental Health: https://womensmentalhealth.org/wp-content/uploads/2008/04/menopause_guide.pdf 
• Mayo Clinic (for how SSRIs work): https://www.mayoclinic.org/diseases-conditions/depression/in-depth/ssris/art-20044825
• Hormone Health Network (for the role of serotonin in mood): https://www.hormone.org/your-health-and-hormones/glands-and-hormones-a-to-z/hormones/serotonin 

In case you haven’t found your menopause joy yet, here are some of the things to celebrate. 

The best physical changes at menopause

Menopause comes with lots of natural changes to our bodies, and some of them can be truly wonderful. As actress Kim Cattrall said, “I feel more myself and love my body more now, at 58 years old, than ever before.” 

Finding the joy in menopause

• Your periods — and PMS — come to an end. No more cramps, pads, tampons, leaks, or checking the calendar to figure out when to expect your next period. And if you’re among the 90 percent of women who’ve experienced symptoms such as irritability, bloating, breast tenderness, and headaches during the week or two before your period starts, you can breathe a sigh of relief at the end of PMS, too.
• You don’t have to manage contraception or worry about unwanted pregnancies anymore. Once you’ve reached menopause (a year without periods), you can reclaim the time and effort that went into figuring out a birth control method and sticking with it. Some people feel more liberated and enjoy sex more once the worry of pregnancy is behind them.
• Hormonal headaches subside. Of women who suffer from migraines, about 70 percent have menstrual migraines brought on by changes in estrogen and progesterone levels each month. After menopause, estrogen and progesterone levels decrease, and so do the headaches.
• Fibroids stop growing and may get smaller. If you’ve had uterine fibroids, you know they can cause pain and heavy periods. And while they might grow during perimenopause when hormones are fluctuating, fibroids tend to stop growing, and often shrink, after menopause. 

The best life changes at menopause

Beyond the physical changes, many of us find that menopause brings a refreshing new view on things. The physical changes give us a moment to pause and realize that we’ve weathered a lot of challenges, and we’ve earned our self-assurance. We know so much more about who we are, what we’re capable of, and what we really want in life. 

Many take this moment to re-evaluate careers and relationships, and re-think where we want to put our time and focus. Some of us realize that we’ve been waiting to take risks, and now’s the time, whether it’s switching jobs, traveling, picking up new hobbies, getting politically active, or just taking time for self-care. 

These self-discoveries can make menopause profoundly meaningful and energizing. Margaret Mead, an anthropologist who studied gender across cultures, may have put it best: “There is no greater power in the world than the zest of a postmenopausal woman.”  

Reviewed by the Ovia Health Clinical Team

Sources

• The North American Menopause Society: https://www.menopause.org/for-women/menopauseflashes/menopause-symptoms-and-treatments/make-your-menopause-a-positive-experience. 
• Everyday Health: https://www.everydayhealth.com/menopause-pictures/positives-of-menopause.aspx. 
• Office on Women’s Health, US Department of Health and Human Services: https://www.womenshealth.gov/menstrual-cycle/premenstrual-syndrome.
• Cleveland Clinic: https://my.clevelandclinic.org/health/diseases/8260-menstrual-migraines-hormone-headaches.

If you’ve noticed that your body image and self-esteem are low, you are not alone, but it’s time to take some action. Here are a few things you can do to help build a happier, more confident relationship with your body: 

• Exercise and eat well. Doing these fundamental things makes you feel better, which can help you be happier and more at ease in your body. 
• Take time to do things that make you feel good. It could be yoga or meditation or even getting a new haircut or setting aside some time for a luxurious skincare routine. For those of us who’ve spent years caring for everyone else, taking time for ourselves might feel uncomfortably indulgent at first. But stick with it — you are worth the time, and you deserve gentle care, too. 
• Do something that’s meaningful to you, and that reminds you of the wonderful things your body can accomplish. You might like to plant a garden (check out community gardens if you don’t have the space), take on a home improvement project, volunteer for a cause you believe in, or work toward a new exercise goal. 
• Remember the parts of your body that you love. Instead of focusing on the things you like least, take a few minutes to write down the things about your body that are worth celebrating. 
• Treat menopause symptoms if they’re getting you down. If hot flashes, sleep disturbances, or vaginal dryness are making you uncomfortable in your body, there are lifestyle changes and medications that can help. 
• Talk with people who are going through the same changes. For most of us, menopause comes with some aspects we don’t like, and some that may be welcome. Either way, it can help to simply talk (and laugh!) through it all with people who really understand what we’re going through. Reach out to friends and family, or search for support groups. There are online groups for menopause in general, and groups especially for women who’ve experienced menopause early through surgery or other medical treatments. 

Reviewed by the Ovia Health Clinical Team

Sources

• The North American Menopause Society: https://www.menopause.org/for-women/menopauseflashes/women’s-health-and-menopause/get-positive-about-body-image.
• Everyday Health: https://www.everydayhealth.com/menopause/4-ways-to-boost-confidence.aspx. 

Here are eight habits to add to your self-care list:

1. Keep a period calendar

During perimenopause, menstrual cycles begin to change. Cycles can get longer or shorter, and flow can be heavier or lighter. Keeping a calendar of your cycles can help you track changes and figure out your new normal (for a great way to do this, check out the cycle-tracking in the calendar section of Ovia Fertility app!). A calendar is also helpful if you have questions or concerns you want to share with your doctor. 

2. Take care of your bones

The risk of bone loss (osteoporosis) goes up around menopause. So now is a great time to start taking care of your bone health. Here’s what you can do to keep your bones strong:

• Add sources of calcium and vitamin D to your diet.
• Avoid smoking and drink in moderation.
• Get regular weight-bearing, strength-training, and balance exercise. Weight-bearing and strength exercises put stress on your bones, which increases bone mass — aim for this kind of exercise at least three times each week. Balance exercises protect your bones by helping reduce your risk of falling. 

3. Stick to a healthy weight

Many women start gaining weight in the years heading up to and after menopause, especially around the belly. Since abdominal fat may raise your risk for heart disease, it’s a good idea to keep an eye on weight gain. Consider taking this opportunity to focus on eating well and making time for exercise. And talk with your doctor about the weight that’s healthy for you. 

4. Protect your sleep

Some women have a harder time getting a good night’s rest around menopause, so consider leveling up your sleep habits. Try setting aside some time before bed each night to do something calm and relaxing that puts you in the right mood to let go of the day. 

You can also improve your sleep by keeping a regular sleep schedule, making sure your bedroom is cool and dark, and skipping alcohol, caffeine, and heavy meals for a few hours before bedtime. 

If hot flashes (also known as night sweats) are interrupting your sleep, there are lots of things that can help. Read about treatments here. 

5. Give your teeth and gums some love

Did you know that gum disease increases your risk for heart disease? It’s just one more reason to take good care of your mouth, including daily brushing and flossing, along with dentist visits twice a year.

6. Nurture your skin

Healthy skin isn’t just about cleansers and moisturizers. To keep your skin glowing, avoid smoking, lower stress, get enough sleep and physical activity, and drink plenty of water—yep, pretty much all the important things that help keep the rest of your body well, too. It’s also important to use sunscreen regularly. If your skin is dry, skip hot showers and baths because they can dry your skin even more.

7. Don’t forget your Kegels

You might remember Kegels if you’ve ever been pregnant, and they’re important again now. That’s because urinary incontinence is common around menopause and beyond. Kegels can help by strengthening your pelvic floor—and you can do them pretty much anytime and anywhere. Simply contract the muscles you use when you urinate, hold, and release. Try for 10 Kegels, five times a day. (One great side effect of Kegels: they can improve your sex life, too.)

8. Be good to your heart

There’s lots you can do to keep your heart strong and lower your risk for cardiovascular disease. Plus, if you’re already planning to try the self-care habits above, you’ve got most of the healthy-heart list covered:

• Get regular exercise.
• Keep your weight in the healthy range.
• Eat well, including plenty of fruits, veggies, protein, and whole grains.
• Lower stress.
• Avoid smoking. (We know that quitting is one of the hardest lifestyle changes you can make. Talk to your doctor about ways to help.)
• Have your blood pressure checked, and work with your doctor if your numbers are high.
• Have your cholesterol and triglycerides checked, and make changes to your diet or begin medication if your numbers are above the healthy range.

Reviewed by the Ovia Health Clinical Team

Sources

• The North American Menopause Society: https://www.menopause.org/for-women/menopauseflashes/women’s-health-and-menopause/staying-healthy-at-menopause-and-beyond
• National Institute on Aging (NIH): https://www.nia.nih.gov/health/infographics/menopause-tips-healthy-transition 
• ACOG: https://www.acog.org/womens-health/experts-and-stories/the-latest/my-periods-have-changed-is-menopause-around-the-corner
• The North American Menopause Society: https://www.menopause.org/for-women/menopauseflashes/bone-health-and-heart-health/bone-health-exercise-is-a-key-component

For women who enter menopause after a hysterectomy or other medical treatment, grief can come over the sudden loss of fertility, along with new health worries. 

What can I do to ease my grief?

If you’re feeling grief with menopause, please know that it’s normal and you’re not alone. Grieving is a natural response to big life transitions, and it’s a process. The only way out is through. 

But you may be about to channel your grief into healthy changes and meaningful personal discoveries. Here are some strategies that may help: 

• Try meditation or mindfulness (there are lots of apps that can get you started). These practices help people cultivate self-compassion during a difficult time. 
• Consider putting your emotional energy into a satisfying creative endeavor. You might like to write, paint, design a garden, learn to play an instrument, or take a course in something that fascinates you. 
• Boost your exercise plan. The hormones your body releases during exercise can help boost your mood. And exercise can help you feel more comfortable and confident in your body. 
• Set aside a bit more time for self-care habits that matter to you, whether it’s eating better or something else that makes you feel good. You can learn more about health habits for staying well through menopause here. 
• Read up on perimenopause and menopause (Ovia is a great resource for this!). Knowing what to expect can help take the stress and fear out of the changes. 

When to get help

The physical changes during menopause can contribute to feelings of grief. So if hot flashes are frustrating you or keeping you from sleeping, if vaginal changes are uncomfortable, or if you’re noticing new mood swings as your hormone levels change, talk to your doctor. There are lots of lifestyle changes and medications that can help.

Some experience clinical depression around the time of menopause, especially if they’ve been through depression in the past. Symptoms of depression include feeling tired or low on energy, losing interest in your usual activities, feeling sad or irritable, having a hard time sleeping, and losing interest in sex. If you’ve had any of these symptoms for more than two weeks, it may be a sign of clinical depression. If you think you may be experiencing depression, talk with your doctor about treatments.

Reviewed by the Ovia Health Clinical Team

Sources

• Breastcancer.org: https://www.breastcancer.org/tips/menopausal/treat/emotional-changes
• Welldoing.org: https://welldoing.org/article/is-menopause-grieving-process
• Healthline): https://www.healthline.com/health/menopause/menopause-anger