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    Mood and Hormones

    Your Mood and Hormones Over 40

    Introduction

    Women over 40 are often surprised to learn that despite having a consistent menstrual period, hormone changes that lead towards menopause begin1. These hormone changes can lead to a worsening of old symptoms such as PMS, but can also bring new symptoms such as insomnia, hot flashes, cycle changes and low mood1. Mood changes over 40 are caused by wide fluctuations in hormone production as the body has to work harder over time to produce an egg each month. The definition of perimenopause includes cycle length changes of greater than 7 days in either direction of your regular cycle, which is a small insight into the changes going on under the surface with hormone levels2. As estrogen and progesterone are produced less consistently, some months may have higher than average production and some months may have lower than average production.

    Signs and Symptoms

    Estrogen is a necessary hormone for positive mental health in women, and the fluctuating levels experienced in perimenopause can cause new onset of low mood or a worsening of it in women who were already at risk3. Lab testing for hormone levels during perimenopause is challenging because the fluctuation of hormone levels happens daily, which means relying on a woman’s recount of her experience and a history taking of both hormonal symptoms, cycle changes and how she is feeling4 is important when diagnosing for low mood.

    Causes and Prevalence

    The hormone changes at perimenopause are part of a natural progression of aging, but the symptoms that some women experience are significant and deserve attention and support. Upwards of 20% of women at 40 years of age have enough hormone changes to be classified as perimenopausal, and the incidence increases every year before 505. Despite these changes, very few women are assessed by their practitioner for symptoms of low mood6, leaving many women to feel their circumstances are causing their low mood, not an internal hormone change. With 40% of perimenopausal women reporting low mood as one of their most significant symptoms, this is an area that women need resources and solutions to better support their health7. The risk factors that increase the likelihood of having low mood during perimenopause include a higher body weight, social determinants of health such as income and education and stressful life events around the time of menopause8. Having other symptoms related to perimenopause such as hot flashes and insomnia also increase the risk of having low mood8.

    Diet (foods that make the condition better or worse)

    Women can support themselves during this time by focusing on nutrition and nutrients that have been shown to improve mood and other symptoms of perimenopause. Women who eat more fruit9 and who include soy in their diet have lower risks of persistent sadness, and the addition of soy in the diet of women who are struggling may help reduce her symptoms10,11. Women also increase their alcohol intake during perimenopause, which may have a negative impact on her mood and overall health12.

    Lifestyle

    The most important message for women over 40 is to help them understand the changes that are happening in their body so that they can connect their symptoms with their changing hormones. Many women believe that menopause begins at 50 with a loss of their period, which leaves them feeling confused in their 40s when their bodies change, and they continue to have a menstrual cycle. Tracking your symptoms and speaking with your health care provider about your hormonal health, a healthy diet and the inclusion of nutrients known to support mental health can help you feel more in control of your perimenopausal years and lead a happy and fulfilled life. Women who engage in regular exercise13, have higher self compassion14,15 and focus on stress reduction have a better experience through perimenopause.

    Exercise has a significant role in supporting mental health and overall wellbeing in perimenopause with women who engage in regular physical activity (that includes sweating and being breathless a few times per week) having better overall mood and wellbeing16. Guidelines that make recommendations for exercise in low mood include women in the perimenopause transition as people who may benefit from regular exercise in combination with other supports to help mood symptoms17.

    Nutraceuticals:

    Melatonin is a nutrient that may support the symptoms of perimenopause, especially if there is an overlap between low mood and disturbed sleep. Melatonin secretion during perimenopause is different than in other times of a woman’s life18, and this disruption may be contributing to both the mood and sleep challenges women face at this time. Research suggests that the addition of melatonin in poor sleepers may support their ability to sleep, and may support symptoms overall in perimenopause, including mood19.

    Saffron is a herb that is gaining interest as research has shown positive results with its use in various in health conditions20 - 22. Saffron has been studied in women in post menopause for low mood and hot flashes and was found to be a safe and effective herbal treatment for these symptoms23,24.

    Herbs that support the stress response such as Rhodiola and Ashwagandha can also be considered in this stage of life. Rhodiola improves energy and an overall sense of wellbeing25,26. Ashwagandha improves a sense of stress and anxious feelings 27,28 which may support women during this stressful time to feel more like themselves.


    References

    1. Peacock, K. & Ketvertis, K. M. Menopause. in StatPearls (StatPearls Publishing, 2021).
    2. Santoro, N. Perimenopause: From Research to Practice. J. Womens Health 25, 332–339 (2016).
    3. Gordon, J. L., Sander, B., Eisenlohr-Moul, T. A. & Sykes Tottenham, L. Mood sensitivity to estradiol predicts depressive symptoms in the menopause transition. Psychol. Med. 1–9 (2020) doi:10.1017/S0033291720000483.
    4. Inwald, E. C. et al. Perimenopause and Postmenopause – Diagnosis and Interventions. Guideline of the DGGG and OEGGG (S3-Level, AWMF Registry Number 015-062, September 2020). Geburtshilfe Frauenheilkd. 81, 612–636 (2021).
    5. McLeod, G. F. H. et al. Menopause status and climacteric symptoms in a birth cohort of mid-life New Zealand women. Climacteric J. Int. Menopause Soc. 1–7 (2021) doi:10.1080/13697137.2021.1948005.
    6. Raglan, G. B., Schulkin, J. & Micks, E. Depression during perimenopause: the role of the obstetrician-gynecologist. Arch. Womens Ment. Health 23, 1–10 (2020).
    7. de Kruif, M., Spijker, A. T. & Molendijk, M. L. Depression during the perimenopause: A meta-analysis. J. Affect. Disord. 206, 174–180 (2016).
    8. Willi, J., Süss, H., Grub, J. & Ehlert, U. Biopsychosocial predictors of depressive symptoms in the perimenopause-findings from the Swiss Perimenopause Study. Menopause N. Y. N Publish Ahead of Print, (2021).
    9. Wu, T. et al. Association Between Self-Reported Food Preferences and Psychological Well-Being During Perimenopausal Period Among Chinese Women. Front. Psychol. 11, 1196 (2020).
    10. Li, N. et al. Soy and Isoflavone Consumption and Multiple Health Outcomes: Umbrella Review of Systematic Reviews and Meta-Analyses of Observational Studies and Randomized Trials in Humans. Mol. Nutr. Food Res. 64, e1900751 (2020).
    11. Hanachi, P. & S, G. Assessment of Soy Phytoestrogens and Exercise on Lipid Profiles and Menopause Symptoms in Menopausal Women. J. Biol. Sci. 8, (2008).
    12. Hyvärinen, M. et al. Predicting the age at natural menopause in middle-aged women. Menopause N. Y. N 28, 792–799 (2021).
    13. Shorey, S., Ang, L. & Lau, Y. Efficacy of mind-body therapies and exercise-based interventions on menopausal-related outcomes among Asian perimenopause women: A systematic review, meta-analysis, and synthesis without a meta-analysis. J. Adv. Nurs. 76, 1098–1110 (2020).
    14. Tobin, R. & Dunkley, D. M. Self-critical perfectionism and lower mindfulness and self-compassion predict anxious and depressive symptoms over two years. Behav. Res. Ther. 136, 103780 (2020).
    15. Brown, L., Bryant, C., Brown, V., Bei, B. & Judd, F. Investigating how menopausal factors and self-compassion shape well-being: An exploratory path analysis. Maturitas 81, 293–299 (2015).
    16. Bondarev, D. et al. The role of physical activity in the link between menopausal status and mental well-being. Menopause N. Y. N 27, 398–409 (2020).
    17. Maki, P. M. et al. Guidelines for the Evaluation and Treatment of Perimenopausal Depression: Summary and Recommendations. J. Womens Health 2002 28, 117–134 (2019).
    18. Toffol, E. et al. Nighttime melatonin secretion and sleep architecture: different associations in perimenopausal and postmenopausal women. Sleep Med. 81, 52–61 (2021).
    19. Treister-Goltzman, Y. & Peleg, R. Melatonin and the health of menopausal women: A systematic review. J. Pineal Res. e12743 (2021) doi:10.1111/jpi.12743.
    20. Baziar, S. et al. Crocus sativus L. Versus Methylphenidate in Treatment of Children with Attention-Deficit/Hyperactivity Disorder: A Randomized, Double-Blind Pilot Study. J. Child Adolesc. Psychopharmacol. 29, 205–212 (2019).
    21. Ross, S. M. Saffron (Crocus sativus L.): A Phytomedicine as Effective as Methylphenidate in Treating ADHD in Children. Holist. Nurs. Pract. 34, 65–67 (2020).
    22. Tóth, B. et al. The Efficacy of Saffron in the Treatment of Mild to Moderate Depression: A Meta-analysis. Planta Med. 85, 24–31 (2019).
    23. Kashani, L. et al. Efficacy of Crocus sativus (saffron) in treatment of major depressive disorder associated with post-menopausal hot flashes: a double-blind, randomized, placebo-controlled trial. Arch. Gynecol. Obstet. 297, 717–724 (2018).
    24. Lopresti, A. L. & Smith, S. J. The Effects of a Saffron Extract (affron®) on Menopausal Symptoms in Women during Perimenopause: A Randomised, Double-Blind, Placebo-Controlled Study. J. Menopausal Med. 27, 66–78 (2021).
    25. Olsson, E. M., von Schéele, B. & Panossian, A. G. A randomised, double-blind, placebo-controlled, parallel-group study of the standardised extract shr-5 of the roots of Rhodiola rosea in the treatment of subjects with stress-related fatigue. Planta Med. 75, 105–112 (2009).
    26. Anghelescu, I.-G., Edwards, D., Seifritz, E. & Kasper, S. Stress management and the role of Rhodiola rosea: a review. Int. J. Psychiatry Clin. Pract. 22, 242–252 (2018).
    27. Fuladi, S. et al. Assessment of Withania somnifera root extract efficacy in patients with generalized anxiety disorder: A randomized double-blind placebo-controlled trial. Curr. Clin. Pharmacol. (2020) doi:10.2174/1574884715666200413120413.
    28. Pratte, M. A., Nanavati, K. B., Young, V. & Morley, C. P. An alternative treatment for anxiety: a systematic review of human trial results reported for the Ayurvedic herb ashwagandha (Withania somnifera). J. Altern. Complement. Med. N. Y. N 20, 901–908 (2014).
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