Psychological Problems and Menopause

Menopausal transition is known to influence mood in midlife women. It represents “window of vulnerability” with increased risk of major depressive disorder. Data is conflicting regarding occurrences of new-onset symptoms versus worsening of pre-existing mental illness. However, many studies and theories support the new-onset mood abnormalities during perimenopause independent of vasomotor symptoms. Fluctuating reproductive hormone levels rather than absolute deficiency state is proposed as the mechanism for mental ill-health around menopause. Screening for typical symptoms using validated tools for menopausal mood disorders is essential for primary care physicians, so that appropriate timely management can be instituted in accordance with psychiatrist. Cognitive behavioural therapy is used as monotherapy or in conjunction with pharmacotherapy to improve outcomes. Menopausal hormone therapy though improves mood, it is not recommended in major depressive disorders as first-line therapy. It is preferred in women with associated vasomotor symptoms and genitourinary syndrome of menopause. Desvenlafaxine (serotonin-noradrenaline reuptake inhibitor (SNRI)) is the first-line drug in the management of major depression during menopause. Lifestyle modification with positive attitude towards menopause is the key in managing menopausal mood disorders.