by Amanda Thebe

I didn’t even know I was depressed, that’s the strange thing about depression. I've always been a happy-go-lucky person, who occasionally would get fed-up, but not depressed.  I had no comprehension of what that actually meant. 

I realised I was in perimenopause about 3 years ago.  Various symptoms were having a major impact on my quality of life and I felt like I was living in a fog most of the time.  My cognitive awareness was compromised, as was my chronic fatigue and low sex drive.  I wasn’t reaching my potential in my everyday existence and that was so bloody frustrating, yet I didn’t have the drive in me to do a damn thing about it.

My job as a fitness professional is very rewarding, so my time spent with clients is always a pleasure, yet I would come home from those appointments completely exhausted. A quick nap on the sofa would turn into 2-3 hours where I would just sit still, having no desire to move, until the time I had to pick my kids up from school.  

Whatever was happening to me was consuming my life and robbing me of my desire to thrive.

And then I realised... I was depressed.

Why is it that depression seems to be a dirty secret that we are afraid to talk about?

At first I didn’t want to admit to people that I had depression, I was ashamed and felt like a failure.  I come from a British background and have always had the “soldier on, there’s a war to be won” attitude, yet it was starting to be difficult to hide my depression from those closest to me. My husband and my boys could see that I wasn’t present and was generally sad about life.  I knew they were concerned but I just continued pretending everything was ok, until I went to my routine gyn/ob appointment.

Reviewing my records, the gynecologist was about to send me on my way, when something stopped him from leaving the room. He walked over to me and held my hands, he asked me if everything was OK?  Are you the same as me at the doctors? They make me cry so easily!  Well this time the floodgates opened and I sobbed my heart out.  Long story short, he identified that yes, I was suffering from depression, and bloodwork would confirm this.

You see, during menopause the fluctuations in our hormones can cause major biochemical disturbances that have myriad symptoms. For me personally, low estrogen (one of the happy hormones) was depleted, I was fighting a fight that I just couldn’t win on my own.  The relief I felt after speaking to my doctor was indescribable. We are always looking for answers right? 

A Clinical Nurse Specialist at The Cleveland Clinic, Ms Hagan says  “There's some evidence that estrogen has some mood-enhancing benefits. So the decrease of this hormone may contribute to the mental health issues women experience during this period.” The drop in estrogen can also lead to hot flashes that disturb sleep. This can cause anxiety, fears and mood swings. The drop in estrogen can also lead to hot flashes that disturb sleep. This can cause anxiety, fears and mood swings and ultimately depression. [2]

So now I knew what beast I was dealing with, I could start making changes that would help me. I also knew in my case there was a high likelihood of the depression leaving me, once I was post-menopause. I asked friends, clients and experts about depression, especially during menopause. Women are suffering and suffering in silence. We like to be seen as resilient and don’t want to been seen as complaining all the time, in addition to this we sometimes feel like we are alone in our suffering. I certainly did, I never spoke to anybody about it because I assumed they wouldn’t understand. In reality the truth is very different, statistics show us that one-fifth of the population will have an episode of depression during their lifetime and women are twice as likely to be affected [1] and there is evidence that perimenopause represents another period of vulnerability for women, with African Americans twice as likely to have depressive symptoms.

What are the strategies for coping with depression in menopause?

First seek out a medical professional who understands the issue and will stay on this journey with you.  That was my lightbulb moment, when I felt that somebody truly understood me.  I personally choose to take an antidepressant, some women choose HRT, natural remedies and/or lifestyle changes. I'm not writing this article to give medical advice that I am not qualified to present, that my dears is up to you and your medical team. What I did realise though, is that I needed to make changes to my lifestyle and daily mindset to help me move forward.  As well as dealing with the physical changes of my body I knew that I had a duty to myself, and my family. to do everything I could to improve my state of mind and quality of life. The way I had been doing things in the past just weren't working, it was time for some specific changes.

A pilot study in people with severe depression found that just 30 minutes of treadmill walking for 10 consecutive days was "sufficient to produce a clinically relevant and statistically significant reduction in depression." Aerobic workouts can also help people who aren't suffering from clinical depression feel less stressed by helping to reduce levels of the body's natural stress hormones, such as adrenaline and cortisol, according to a recent study in the Journal of Physical Therapy Science. [3]

So one of the lifestyle changes I made to my daily life was running.   I introduced a steady-state cardio program that helped me access some natural highs. The brain chemicals such as endorphins, dopamine, norepinephrine, and serotonin that get released during running were a game changer for me. The time outside in nature, running through the forest, by the water and along the trails gave me time to relax, reflect and process any negative feelings I was having.

In addition to this, life changing events are occurring for women during menopause that will also impact the severity of the problem; these might include: changes to her marriage, family or employmen;, new or different responsibilities; plus physical changes in looks and body shape can also contribute to the problem. So, understanding that you may be experiencing any of these circumstances, and need support and to be heard during this time, is very important. 

Self-care could be an article all by itself because this is a huge part of the puzzle. Nutrition, exercise, stress management, support, therapy, sleep and open dialogue with your loved ones, are all going to make this journey easier for you.

I reached out to my Facebook group, Menopausing So Hard, recently asking them what the biggest issues they face every day are.  Overwhelmingly they cited depression and anxiety as a major obstacle in their daily lives.  Mood changes that differ from day to day depending on their hormonal fluctuations cause them deep rooted feelings that are difficult to explain to others, yet with a supportive community group for women to express themselves, these problems can lessen slightly. So find your support system, find a friend to talk too and realise that you aren’t alone.

And remember that the power of talking about your story is a huge way to deal with depression.

References
1.    Menopausal Symptoms and Their Management, Department of Obstetrics & Gynecology, University of Colorado School of Medicine https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4890704/
2.    Is Menopause Causing Your Mood Swings, Depression or Anxiety?, Cleveland Clinic health essentials
https://health.clevelandclinic.org/2015/06/is-menopause-causing-your-mood-swings-depression-or-anxiety/
3.    Benefits from aerobic exercise in patients with major depression: a pilot study. Department of Sports Medicine, Freie Universitaet, Berlin, Germany
https://www.ncbi.nlm.nih.gov/pubmed/11273973