Depression in Women

Depression in Women

Here are the facts about depression in women: In the U.S., about 15 million people experience depression each year. The majority of them are women. Unfortunately, nearly two-thirds do not get the help they need.

Depression in women is very common. In fact, women are twice as likely to develop clinical depression as men. Up to one in four women is likely to have an episode of major depression at some point in life.

 

Clinical depression is a serious and pervasive mood disorder. It causes feelings of sadness, hopelessness, helplessness, and worthlessness. Depression can be mild to moderate with symptoms of apathy, little appetite, difficulty sleeping, low self-esteem, and low-grade fatigue. Or it can be more severe.

Symptoms of depression in women include:

Mania is a highly energized state with elevated mood that can occur in bipolar disorder. Moods in bipolar disorder swing over the course of days or weeks or months from the lows of depression to the highs of mania. Even though mania is an elevated mood, it is serious and needs medical assessment and treatment.

The symptoms of mania include:

 

Before adolescence, depression is rare and occurs at about the same rate in girls and boys. However, with the onset of puberty, a girl’s risk of developing depression increases dramatically to twice that of boys.

Some experts believe that the increased chance of depression in women may be related to changes in hormone levels that occur throughout a woman’s life. These changes are evident during puberty, pregnancy, and menopause, as well as after giving birth or experiencing a miscarriage. In addition, the hormone fluctuations that occur with each month’s menstrual cycle probably contribute to premenstrual syndrome, or PMS, and premenstrual dysphoric disorder, or PMDD — a severe syndrome marked especially by depression, anxiety, and mood swings that occurs the week before menstruation and interferes with normal functioning of daily life.

According to the National Institutes of Health, factors that increase the risk of depression in women include reproductive, genetic, or other biological factors; interpersonal factors; and certain psychological and personality characteristics. In addition, women juggling work with raising kids and women who are single parents suffer more stress that may trigger symptoms of depression. Other factors that could increase risk include:

Women can also get postpartum depression after the birth of a baby. Some people get seasonal affective disorder in the winter. Depression is one part of bipolar disorder.

Depression can run in families. When it does, it generally starts between ages 15 and 30. A family link to depression is much more common in women. However, there is not always an apparent genetic or hereditary link to explain why someone may develop clinical depression.

Depression in women differs from depression in men in several ways:

 

 

As many as three out of every four menstruating women experience premenstrual syndrome or PMS. PMS is a disorder characterized by emotional and physical symptoms that fluctuate in intensity from one menstrual cycle to the next. Women in their 20s or 30s are usually affected.

About 3% to 5% of menstruating women experience premenstrual dysphoric disorder, or PMDD. PMDD is a severe form of PMS, marked by highly emotional and physical symptoms that usually become more severe seven to 10 days before the onset of menstruation.

In the last decade, these conditions have become recognized as important causes of discomfort and behavioral change in women. While the precise link between PMS, PMDD, and depression is still unclear, abnormalities in the functioning of brain circuits that regulate mood, along with fluctuating hormone levels are both thought to be contributing factors.

Many women who suffer with depression along with PMS or PMDD find improvement through exercise or meditation. For individuals with severe symptoms, medicine, individual or group psychotherapy, or stress management may be helpful. Your primary care doctor or Ob-Gyn is a good place to start. Your doctor can screen you for depression and treat your symptoms.

Pregnancy was once assumed to be a period of well-being that protected women against psychiatric disorders. But depression in women occurs almost as commonly in pregnant women as it does in those who are not pregnant. The factors which increase the risk of depression in women during pregnancy are:

The potential impact of depression on a pregnancy includes the following:

Pregnancy may have the following impact on depression in women:

 

Preparing for a new baby is lots of hard work. But your health should come first. Resist the urge to get everything done, cut down on your chores, and do things that will help you relax. In addition, talking about things that concern you is very important. Talk to your friends, your partner, and your family. If you ask for support, you will find you often get it.

If you’re feeling down and anxious, consider seeking therapy. Ask your doctor or midwife for a referral to a mental health care professional.

Growing evidence suggests that many of the currently available antidepressant medicines, including most SSRIs (except for Paxil), appear to have minimal (if any) risks when treating depression during pregnancy, at least in terms of the potential short-term effects on the baby. Long-term effects continue to be studied. Risks can differ depending on medication as well as many other factors during a pregnancy that can endanger a developing fetus. Untreated depression can put both mother and infant at risk. Often, electroconvulsive therapy (ECT) is considered to be the safest and most effective treatment for severe depression during pregnancy.

You should discuss the possible risks and benefits of treatment with your doctor.

Postpartum depression, or depression following childbirth, can be treated like other forms of depression. That means using medicines and/or psychotherapy. If a woman is breastfeeding, the decision to take an antidepressant should be made with the baby’s pediatrician along with her own psychiatrist after a discussion of risks and benefits. Most antidepressants are expressed in very small amounts in breast milk and their possible effects on a nursing infant, if any, are not well understood.

Perimenopause is the stage of a woman’s reproductive life that typically begins in her 40s (or earlier for some) and lasts until menstruation has ceased for a year (and a woman is considered to be in menopause). In the last one to two years of perimenopause, the decrease in estrogen accelerates. At this stage, many women experience menopausal symptoms.

Menopause is the period of time when a woman stops having her monthly period and experiences symptoms related to the lack of estrogen production. By definition, a woman is in menopause after her periods have stopped for one year. Menopause typically occurs in a woman’s late 40s to early 50s. However, women who have their ovaries surgically removed undergo “sudden” menopause.

The drop in estrogen levels during perimenopause and menopause triggers physical and emotional changes — such as depression or anxiety. Like at any other point in a woman’s life, there is a relationship between hormone levels and physical and emotional symptoms. Some physical changes include irregular or skipped periods, heavier or lighter periods, and hot flashes.

There are many ways you can ease menopause symptoms and maintain your health. These tips include ways to cope with mood swings, fears, and depression:

 

There are a variety of methods used to treat depression, including medications such as antidepressants, brain stimulation techniques like ECT, and individual psychotherapy.

Family therapy may be helpful if family stress adds to your depression. Your mental health care provider or primary care doctor will determine the best course of treatment for you. If you are uncertain whom to call for help with depression, consider checking out the following resources:

SOURCES:

National Institute of Mental Health: “Depression: What Every Woman Should Know” and “Depression.”

FDA: “The Lowdown on Depression” and “Understanding Antidepressant Medications.” 

American Psychiatric Association, Practice Guideline for the Treatment of Patients with Major Depression, 2000. Diagnostic and Statistical Manual of Mental Disorders: DSM-IV-TR, American Psychiatric Pub, 2000.

Fieve, R, MD. Bipolar II, Rodale Books, 2006.

WebMD: Menopause Health Center.

The Journal of the American Medical Association. “Recommendations for Screening Depression in Adults,” Vol. 315, No. 4, January 26, 2016.

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Slideshow: All About Menopause and Perimenopause

Slideshow: All About Menopause and Perimenopause

Menopause is the process a woman goes through that causes her periods to end. It’s a turning point, not a disease, but it can have a big impact on a woman’s well-being. Although menopause can bring physical discomfort from hot flashes, night sweats, and other symptoms, it can also be the start of a new and rewarding phase of a woman’s life — and a golden opportunity to guard against major health risks like heart disease and osteoporosis.

Age is the leading cause of menopause. It’s the end of a woman’s childbearing years, brought on by the ovaries gradually slowing down. Certain surgeries and medical treatments can also cause menopause. Those include surgical removal of the ovaries (bilateral oophorectomy), chemotherapy, and pelvic radiation therapy. Having a hysterectomy (surgical removal of the uterus) without removing the ovaries does not lead to menopause, although you will not have periods anymore.

On average, women in the U.S. are 51 at natural menopause, notes the National Institute on Aging. But menopause can start earlier or later. A few women start menopause as young as 40, and a very small percentage as late as 60. Women who smoke tend to go through menopause a few years earlier than nonsmokers. There is no proven way to predict menopause age. It’s only after a woman has missed her periods for 12 straight months, without other obvious causes, that menopause can be confirmed. There are tests that can check your ovaries and spot a decrease in fertility.

Natural menopause happens gradually. The ovaries don’t abruptly stop working, they slow down over time. The transition to menopause is called perimenopause. Menopause is a milestone — it’s the day that marks 12 months in a row since a woman’s last period. During perimenopause, it’s still possible to get pregnant — a woman’s childbearing years are winding down, and although her periods may become more unpredictable, her ovaries are still working and she still may ovulate, though not always monthly.

Menopause isn’t a one-size-fits-all event. It affects each woman differently. Some women reach natural menopause with little to no trouble. Others have severe symptoms. And when menopause starts suddenly as a result of surgery, chemotherapy, or radiation, the adjustment can be tough. Here is a look at menopausal symptoms that many women have, though the intensity can vary.

As menopause approaches, a woman’s menstrual periods will likely change. But those changes can vary from woman to woman — periods may get shorter or longer, heavier or lighter, with more or less time between periods. Such changes are normal, but the National Institute on Aging recommends seeing a doctor if your periods come very close together, if you have heavy bleeding or spotting, or if your periods last more than a week.

Hot flashes (or hot flushes) are common. It’s a brief feeling of heat that may make the face and neck flushed and cause temporary red blotches to appear on the chest, back, and arms. Sweating and chills may follow. Hot flashes vary in intensity and typically last between 30 seconds and 10 minutes. Dressing in light layers, using a fan, getting regular exercise, avoiding spicy foods and heat, and managing stress may help you deal with hot flashes.

Nighttime hot flashes can hamper sleep and cause night sweats. Try these sleep tips:

Less estrogen can lead to vaginal dryness, itching, and irritation, which may make intercourse uncomfortable or painful. Try using a water-based lubricant. Your desire may go up or down, but many things besides menopause — including stress, medications, depression, poor sleep, and relationship problems — affect sex drive. Talk to your doctor if you have sex problems — don’t settle for a so-so sex life. And remember, sexually transmitted diseases (STDs) don’t end with menopause. You still need to use protection.

If menopause symptoms are a problem, talk with your doctor. She can help you weigh the pros and cons of treatment options such as hormone replacement therapy. Other treatments include low-dose birth control pills if you’re perimenopausal; antidepressants, blood pressure drugs, or other medications to help with hot flashes; and vaginal estrogen cream. Your doctor may also have lifestyle tips about adjusting your diet, exercise, sleep, and stress management.

Hormone replacement therapy can ease some menopausal symptoms. Various prescription products are available to treat hot flashes and vaginal symptoms. The FDA recommends taking the lowest dose that helps, and only for the shortest time because studies have linked long-term use of hormone replacement therapy to a greater risk of heart attacks, strokes, blood clots, and breast cancer.

“Bioidentical hormone therapy” for menopausal symptoms can refer to FDA-approved prescription drugs. Or it can refer to custom-compounded hormones made at compounding pharmacies mixed according to a doctor’s instructions. These may have two or three types of estrogen, often mixed with other hormones. Some doctors claim that compounded bioidentical hormones are safer. The FDA’s advice — take the lowest dose for the shortest time — applies to bioidentical hormone therapy. Custom-compounded bioidentical products aren’t FDA approved.

Interested in trying alternative or complementary treatments for menopause symptoms? According to the National Institutes of Health, there hasn’t been a lot of well-designed research on this topic, so the research isn’t firm enough to draw conclusions about treatments such as black cohosh, dong quai, red clover (shown here), and soy. Talk it over with your doctor, and tell him about any supplements you take so he can check on drug interactions.

With menopause comes a greater chance of heart disease (which is the No. 1 cause of death for U.S. women) and osteoporosis (thinning bones, seen here). Loss of hormones may play a role in heart disease after menopause, but hormone replacement therapy is not recommended to reduce the risk of heart disease or stroke. Of course, heart and bone health is important throughout a woman’s life, but menopause means it’s really time to step up and get serious about it if you haven’t already.

Living a healthy lifestyle is important throughout a woman’s life. And it’s not too late to start at menopause. Get a checkup that includes measuring your blood pressure, cholesterol, and blood sugar and make appointments for vaccinations and routine screenings such as mammograms and bone density. Menopause is also a great time to upgrade your diet, physical activity, and stress management skills — your doctor can give you pointers as you work together to plan for a healthy menopause.

One of the smartest things a woman can do as she transitions to menopause and afterward is to get regular physical activity. That includes aerobic exercise for her heart and weight-bearing exercise for her bones — both of which may help ward off weight gain and provide a mood boost. Even if a woman hasn’t been very active in her younger years, it’s never too late to start. Menopause is a new beginning and the perfect time to weave more activity into your life.

Western culture has long been obsessed with youth. But today’s postmenopausal women are making the most of — and even celebrating — their new phase of life. Instead of looking back mournfully, Christiane Northrup, MD, recommends using it as a time to redefine yourself with positive thoughts, love yourself, explore what brings you pleasure, and revive (not retire) your sex life.

Sources
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Medically Reviewed on 07/24/2018

Reviewed by Brunilda

Nazario, MD on July 24, 2018

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Christiane Northrup, MD, Yarmouth, ME.
Cleveland Clinic’s Women’s Health Center.
FDA.
Hormone Health Network: “Bioidentical Hormones.”
Kryger, Meir, et al, editors: Principles and Practice of Sleep Medicine. Fourth Edition, Elsevier, 2005.
Kryger, Meir, et al, editors Sleep Medicine, Third Edition, Elsevier, 2000.
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National Center for Complementary and Alternative Medicine.
National Institutes of Health.
National Institute on Aging.
National Women’s Health Information Center.
North American Menopause Society.
Northrup, C. The Secret Pleasures of Menopause, Hay House, 2008.
U.S. Department of Health and Human Services Office on Women’s Health.
Women’s Health Initiative.
Wulf Utian, MD, PhD, consultant in women’s health, Cleveland Clinic; executive director emeritus, North American Menopause Society.

Reviewed by Brunilda

Nazario, MD on July 24, 2018

This tool does not provide medical advice. See additional information.

THIS TOOL DOES NOT PROVIDE MEDICAL ADVICE. It is intended for general informational purposes only and does not address individual circumstances. It is not a substitute for professional medical advice, diagnosis or treatment and should not be relied on to make decisions about your health. Never ignore professional medical advice in seeking treatment because of something you have read on the WebMD Site. If you think you may have a medical emergency, immediately call your doctor or dial 911.

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Slideshow: All About Menopause and Perimenopause

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Menopause Health Center

Menopause Health Center

10 tips for hot flashes, mood swings, and more.

Learn what to expect and how to stay healthy.

It’s possible, even after menopause.

How to make the most of intimacy.

Menopause symptoms include irregular periods, hot flashes, night sweats, sleep difficulties, and irritability. Menopause treatments may include hormone replacement therapy or herbal.

An Abusive Partner May Worsen Menopause Symptoms

Women who are emotionally tormented by a spouse or partner may suffer from more night sweats, painful sex and hot flashes when their periods stop, researchers say.

Read Full Article

Menopause happens when you haven’t had a period for 12 straight months and you aren’t pregnant or sick. It’s a normal part of aging.

It happens because female sex hormone levels naturally go down as you get older. Your ovaries eventually stop releasing eggs, so you’ll no longer have periods or be able to get pregnant.

How to handle headaches, night sweats, and more.

Symptoms and treatments.

Some of these may surprise you.

Is it menopause or something else?

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Menopause Health Center

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