Menopause. Perimenopause. It’s probably fair to say that women are bracing themselves for “the change,” after reading so much about the roller-coaster of symptoms that can accompany this life transition.
So first of all, let’s say this: Not all women suffer greatly through menopause. As women have done for millennia, many women move right through the cessation of menstruation with little more than a sigh. Some actively welcome the end of menstrual cycling, monthly bleeding, and worries about pregnancy.
But let’s also note that, for many other women, menopause brings an upheaval – physical and emotional - at a challenging stage of life.
See our Menopause Blog for a frank discussion of some of the issues surrounding this stage of life – by female physicians and “ordinary” women like you.
For those who do suffer from serious symptoms of menopause, can SSRI medications – like Prozac and Zoloft – play a role? MyLifeStages talked with Dr. Katarina Laner-Cusin , a Berkeley area Gynecologist and Medical Director of Women’s Services at Alta Bates Summit Medical CenterOpens new window. We also consulted with Judy Mikacich, MD, OB/Gyn with Sutter Independent Physicians in Sacramento. Both women treat patients through the experience of menopause, and shared their experience and wisdom.
Both doctors agreed that SSRI medications can have a place in treating menopausal symptoms – for the right women in the right situation. “It’s not the first line of defense,” notes Dr. Lanner Cusin, “but it can be helpful.”
SSRIs are not the first thing to consider when a woman presents with menopausal symptoms, said Dr. Mikacich. Each woman brings a unique set of issues – from what is bothering her most about the changing hormones to her family health history and lifestyle habits.
Dr. Mikacich notes that several other treatments may be more suitable, including low-dose birth control pills often prescribed during perimenopause that can help with heavy bleeding and with mood swings. These are not appropriate, however, for women with a strong history of cancer in their families, or those who smoke.
Another possible treatment for irregular periods and the symptoms of hormonally induced mood swings is the Merina IUD which, when inserted in the uterus, secrets Progesterone. Since it does not secrete estrogen, it is a safer option for many.
For those who cannot use hormonal treatment to help with symptoms, including mood swings, then SSRIs can be very effective. “They can help some with hot flashes,” notes Dr. Mikacich, although the mechanism is not clearly understood. “It may be that they relieve anxiety and stress responses, making hot flashes a bit more bearable.”
SSRIs primarily address moods, both depression and anxiety, through their impact on the chemical activity in the brain. During menopause, even women who have never considered taking a psychoactive drug may find that they can help, says Dr. Mikacich.
Both doctors stress that the life transition that includes menopause can be difficult for women – for many reasons. “Women at this stage are facing aging,” notes Dr. Lanner Cusin. “They may be in the peak of their professional career, their children may be leaving home, and the divorce rate among women in the age group is rising.” The appearance of menopause may trigger emotions related to the choices they made about having children. For those who chose not to have kids, and even for those who did, menopause is the final reality that their choices are permanent.
On top of that, women may be losing sleep due to hot flashes and their fluctuating hormones may disrupt their relationships and fray their nerves. “It can be a multi-faceted bummer!” says Dr. Mikacich. “If SSRIs can lighten the woman’s mood or relieve anxiety, it can make the other situations more tolerable.”
Both doctors stress that the decision to use SSRIs should be made in consultation with your physician, and the treatment should be monitored carefully to ensure the right drug in the right dose.
Women who have already been taking SSRIs may need to adjust their dosage during perimenopause, or even switch to a different type of medication.
How long? Don’t be in a hurry to go off, says both doctors. Due to the stigma that can be attached to these medications, many women ask to go off, or simply make that decisions themselves to stop the drug. This may happen before the need has passed. If the woman does want to stop the drugs, it should be done by tapering off slowly.
For women who don’t want to consider SSRIs – or any medications – what can help the mood disruptions of menopause? Exercise – Understanding – and Time.
“Exercise has a wonderful impact on mood, “says Dr. Mikacich. “It also benefits you physically and, if you exercise with a friend, it can help provide social and emotional support .”
Both doctors acknowledge the impact of the midlife transition and ask that women acknowledge it, too. “This is a busy time of life with lots going on,” says Dr. Mikacich. “It is convenient to suggest that all emotions are due to fluctuating hormones, but that’s not the entire story.”
Midlife may be a good time for introspection, coaching or counseling, and creation of a positive plan for the post menopausal life.
Dr. Mikacich reminds women that time is an ally –for those who suffer during the change, it will get better! The difficulties of menopause are time-limited and this, too, shall pass.