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Psychological symptoms
Author:
A. R. Genazzani
Project Coordinator - Gynaecologist
Last Review: 21/02/2003
Menopausal Symptoms the early symptoms are due to the functional
modification occurring in the Central Nervous System (CNS) that
are correlated with the sharp decrease of estrogen levels. In
the late part of menopause, there is onset of degenerative alteration
involving the estrogen responsive tissue/organ that became clinically
evident after years. A part of postmenopausal women experience
those symptoms that may create a great physical and psychological
discomfort. Some of those symptoms may be transitory. The hot
flushes and the psychic symptoms slowly decrease during the
years and may be tolerated. The most important consequences
for the postmenopausal women health are associate with the long-term
effects of estrogens deficiency, like decrease in BMD, wreckage
of lipid serum profile and impairment of brain function.
Hot Flushes this is the symptom that affects the 65-80%
of women in the menopausal years, and represents the typical
manifestation of menopause, expression of clinical modification
of hypothalamic thermoregulatory center. The hot flushes may
last for few minutes or more than an hour. The hot flush is
generally report as a sudden, transient sensation ranging from
warmth to intense heat that spreads over the body, particularly
on the chest, face, and head, typically accompanied by flushing,
perspiration, profuse sweat and often followed by chill. One
of the majors complains of women with hot flush is that their
sleep is disrupted with implication in mood state. Profuse sweating
during a hot flush is another of the most bothersome complaints;
it can be an embarrassment, particularly at work or in social
situations. However, the HRT may treat this bothersome symptom.
Sleep disturbances The sleep disturbance is due to the
beginning of hot flushes during the night, but they may represent
the results of psychological problems correlated to change in
social role that occur in postmenopausal period. However, this
sort of manifestation is more frequently correlated with the
alteration of thermoregulatory homeostasis.
Psychological symptoms Irritability, depression, anxiety,
are manifestations that frequently onset in the menopausal period.
Steroids are surely involved in the trophism, modulation and
function of CNS improving memory capacity and concentration.
The decrease in estrogen blood level determines alteration of
the neuroendocrin systems that regulate the brain function (mood
and behavior). The great part of the most recent study
put in evidence that the psychological problems that occur in
menopause are strongly correlated with the estrogen deficiency.
Sexuality After menopause some woman refer a decrease in
the libido and frequency of intercourse. Other may have benefit
from this situation, because menopause makes them free from
an unwanted pregnancy. However the majority of postmenopausal
women do not report any change in sexual function and desire.
In the postmenopausal period the sexual behavior may be influenced
by objective problems like vaginal dryness, dispareunia, or
by psychological and social implications. The society in which
the postmenopausal woman live, and the religion rule that the
woman observe can strongly influence the postmenopausal woman
sexual behavior, i.e. linked the sexual activity only with the
target of pregnancy and not with the enjoyment per se. In this
way, the woman has to know that the resolution of genitourinary
complaints should be supported by a psychological assistance.
CNS estrogens influence many of biological process that
take place in CNS as neurotransmitter synthesis and release,
neuronal plasticity, functional organization and development
of the brain, behavior, cognitive functions etc. The decrease
in estrogen serum level is associated with deleterious effects
that are not only limited to those regions of the brain involved
in sexual differentiation and function. Despite this evidence,
the role and the importance of estrogens in human CNS function
has largely been ignored by the woman and often by physician.
A correct HRT regimen may resolve those problems and preserve
the CNS from the effects of aging.
Alzheimer disease The Alzheimer disease (AD) is a degenerative
pathology of CNS that impairs the cognitive and behavioral functions.
After 65 years, the frequency of AD is two-three time greater
in women that in men. The 30-50% of women over 85 years is affected
by AD. Certainly, the age, the family history, the skull trauma
are universally recognized risk factors, but in the postmenopausal
women the estrogen deficiency seems to be one of the most important
factors in the etiology of AD. Since the estrogen deficiency
is a risk factor that may be corrected, an early therapeutic
intervention with HRT protects against the degenerative alteration
that conduct to AD clinical onset.
Gender Differences in Depression
Author:
HD Mary C. Blehar, MD. Dan A. Oren
National Institute of Mental Health
Last Review: 21/02/2003
Abstract: Beyond the repeatedly confirmed finding that
women diagnosed with mood disorders greatly outnumber men lies
a widely varying set of hypotheses that attempt to explain the
suspected causes, incidence, symptoms, and comorbidities from
various perspectives. Several complex factors, however, have
impeded attempts to study why women are so vulnerable to depression.
This article examines the problems associated with studying
affective disorders in women and reviews the current hypothetical
constructs of the etiology and pathophysiology of depression
and their potential relevance to the disproportionate number
of women with unipolar depression. The association of depression
to biological stages of a woman's life and the differences between
the biology of men and women are described, and the potential
social, psychological, and environmental factors that might
particularly promote the development of depression in women
are discussed.
Menopause
Despite earlier clinical beliefs that menopause was associated
with increased depression, the preponderance of evidence now
indicates that the climacteric is not associated with increased
risk for affective episodes Incident or recurrent rates of mood
disorders in fact decline in women after menopause and rise
in men in later years so that gender differences in mood disorders
narrow with age. Such trends are more consistent with psychiatric
models that link depression to psychosocial vulnerability factors
than they are with simple biological models linking estrogen
deprivation to depression. Nonetheless, in the perimenopause
period, defined as 1 or 2 years immediately preceding cessation
of menstruation, there is a peak in dysphoric mood, disturbed
sleep, and somatic complaints. Moreover, dysphoric mood is associated
with a long perimenopause, but it subsides with the onset of
menopause.
The National Comorbidity Survey, in which a cohort of men between
45 and 54 years old were interviewed, also indicated that the
number of 12-month recurrent depressive syndromes is higher
in women than in men during the period that corresponds to women's
perimenopause and menopause years. The relation of recurrent
mood disorders to hormonal changes or life events at this time,
however, cannot be estimated from the study.
In studies of mood disorders in women who are undergoing reproductive
transitions and hormonal changes, a tendency to equate individual
depressive symptoms with a clinical depression syndrome may
have the effect of multiplying the variety of etiologic subtypes
under the depression rubric to make the heterogeneity seem even
greater than it is.
There has also been a tendency to examine hormonal biological
variables to the relative exclusion of psychosocial variables
or even of sleep deprivation, which may mediate vulnerability.
The preponderance of research suggests that direct hormone/mood
relationships are not to be found.
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