Menopause & Mental Health: What Can Help You Feel Better?

Transcript:

Jamie Forward:

So how can certain treatments help, maybe hormone therapy, antidepressants, talk therapy, how can these approaches help manage the mental health issues that somebody may be facing during this time?

Dr. Karen Horst:  Yeah. Let’s start with talk therapy because that can play a big role. There are a couple of different things. First, for insomnia, there’s something called cognitive behavioral therapy for insomnia that provides a lot of psycho education around what we know about sleep.

And then, it gives people a prescription for how to navigate their nights. And the goal is to consolidate sleep, i.e., when they’re in bed, they are asleep, partly by restricting sleep, which everybody hates in the beginning, and by making sure if you’re not asleep, you get out of bed. So, that’s sort of the prescription.

And there’s a lot of psychological support because it’s scary to not sleep. It’s traumatic to not sleep. It’s both important, but part of the treatment is to learn to reduce your anxiety about sleep. So, that’s CBTI. There’s a strong evidence base for that. And we in our clinic study it.

We’re trying to develop a streamlined version of it for women going through the menopause transition struggling with insomnia. We’re studying the efficacy of a sort of streamlined shorter course of CBTI.

Jamie Forward:  Yeah. And while we’re talking about this, I think it’s really important to point out that sleep affects everything, right? So, if you’re not getting sleep, it can heighten the other things that are going on, other symptoms. Would you say that’s accurate or…?

Dr. Karen Horst:  Absolutely. Yeah. Yeah. People are going to be moody, irritable or depressed, anxious about sleep. Often the first thing to go is the morning exercise routine. “I can’t get out. I’m just too tired. I can’t get out of bed and get to the gym.” And then, that makes everything else worse because then you’re not – exercise helps sleep, but if you’re too tired to exercise, it’s a perpetuating problem.

Jamie Forward:  And exercise affects mood.

Dr. Karen Horst:  Right. And then – yes, exactly. And exercise improves mood and helps with stress management. So, I hate to hear when people tell me their insomnia is keeping them away from their exercise because that’s a snowball effect. So, it’s good to try to get on sleep. But we’ve got to reduce anxiety about it because being anxious about sleep leads to insomnia. So, that’s that.

And then, there are a few different approaches, but mindfulness-based therapies are basically about helping people develop tools to accept reality as it is and to prune the negative thoughts that create negative mood and instead be more nonjudgmental about what is happening right now.

And then, developing techniques to calm their nervous system through breathing through other sensate practices that kind of get you back in your body. So, mindfulness-based therapy approaches can be very helpful for a woman having a lot of physical symptoms with the menopause transition, such as vasomotor symptoms.

There is also cognitive behavioral therapy, which cognitive behavioral therapy, the idea is you identify your thoughts and learn tools to work with your thoughts more skillfully and in order to decrease that “thought creates a mood” state.

So, they’re different approaches, but they’re both working with your thoughts, basically. So, those can be very helpful. And then, of course, there’s a lot going on, usually, in a person’s life at midlife. You are navigating certain developmental stages that are stressful, whether it’s children becoming teenagers, leaving home, parents becoming elderly and more dependent on you. If you have a career outside the home, that career is probably pretty stressful right now because you hold more responsibility, or you’re having a job change.

And then, there’s also health. We start to see more health complications, or just health conditions, whether it’s joints that hurt, whatever it is, come up in your 50s.

And so, all of that is sort of what’s going on at this time of life, and therapy can help people cope with whatever it is that life is bringing them. As people tell me, life is lifing.

Jamie Forward:  No, that’s absolutely right.

Dr. Karen Horst:  So, that’s therapy. And then, the main treatments, and I have sort of a table in my paper about it, [ 31:38 ]  hormone therapy can be beneficial for a number of the symptoms that show up, including insomnia, cognitive change, mood change, sexual dysfunction. I’m forgetting if there’s – I feel like there’s another one, but I’m not thinking of it at this moment.

There is also evidence that hormone therapy may help manage the weight gain of the menopause transition, which can be very distressing and that symptom is one that is very bothersome, along with the vasomotor symptoms. So, hormone therapy really kind of ticks every box of symptoms and that’s why it should be used more than it is.

Exercise is a really helpful tool at this time of life for mood management, improving insomnia, some people will argue sexual function, cognitive function. So, exercise is actually a really important tool we have. And the issue is how do you help people get to exercise and figure out what that means for them?

Sometimes we’ll call it movement. It doesn’t have to be called exercise. It’s just moving more and taking care of your body. And then, antidepressants actually have an important role in that they both can help with the mood changes, sometimes they help with the insomnia, and they also help with vasomotor symptoms. Some of the antidepressants, so not every single one, but many of them do.

So, antidepressants are actually – they have a role to play. They are overused and hormone therapy is underused right now. And there’s a really interesting study by Robert McIntyre that charts that. He shows that after the WHI, the number of prescriptions for hormone therapy plummeted and the same exact pattern in reverse happened with antidepressants.

They shot up after the WHI hormone therapy shot down. So, Gabapentin and Lyrica can be helpful for insomnia and vasomotor symptoms, and psychostimulants like Ritalin, Adderall, Vyvanse can be helpful for cognitive change. What we know from the studies most consistently is women will report a change in their verbal – or, actually we’ve measured it, change in verbal memory. So, the ability to be told something and then hold on to it and be able to summon it and bring it back.