Suddenly, Menopause: Dealing With the Psychological Impact

Dr. Ford Responds:

Dear Janet:

I am glad you reached out to Dr. Pat, who responded on Monday to your letter with advice about your medical concerns.

Her advice about your psychological symptoms is absolutely correct: you have been struggling with this alone for too long and you need more help.

Even when the source of stress and depression is clear, as it is with your hysterectomy, we often need a professional’s help to dig out of the subsequent problems. Your procedure created a cascading series of issues, and each of them exacerbated the others.

First of all, you gave birth to your first child, an event that by itself is one of the most significant life changes a woman can experience.  A new baby is a demanding creature who puts stress on the whole family, especially the mother. In the early months in particular, women feel overwhelmed by the constant needs of their infant. It is an especially big challenge for a mother who has brought home her first baby. The impact of this can create a crisis-like atmosphere, and even when the mother is not experiencing clinical-level postpartum depression, most women report strong feelings of stress, self-doubt, and tension. Meanwhile, a woman’s body does not recover from the pregnancy/childbirth experience for a long time—usually as long as six months. Your strength, resilience, and energy are all diminished, giving your less ability to fight the psychological stress.

At the same time, you had a major medical procedure, which is also a “crisis-level” event. Not only does surgery like this assault your body in a way that takes weeks, and even months, to recover from, it is psychologically disorienting. Anesthesia alone can lead to feelings of depression, for example. But you had an operation that involved the removal of major organs—your uterus and ovaries—organs that not only govern our moods in a significant way, but that are also a crucial part of a woman’s identity.

Even without hysterectomy, women are prone to feelings of loss, confusion, and sadness when menopause occurs. Added to this is the fact that your loss occurred suddenly, and much earlier than usual. Chris Iliades, M.D., says:

“For many women, early menopause can cause shock, sadness, fear, and anxiety. There may be a sense of loss and loss of control. Loss of fertility may change your self-image and affect your self-esteem. Early menopause can change the way you see yourself as a sexual partner.”

In other words, Janet, you have been “through the wringer.”  You have not been able to find help to relieve your physical symptoms, and your psychological symptoms—fatigue, mood swings, loss of libido—are all taking a toll, and you have been fighting this battle alone. A large-scale study conducted in Britain in 2008 concluded that “women who undergo hysterectomy at a young age are a defined group who may require more support than other women to maintain good psychological health.” (Journal of Affective Disorders, May 2008. Cooper, Rachel

Support can mean several things. As Dr. Pat noted, it important, even essential, that you keep searching for a medical intervention that will help ease your physical symptoms. They are having a major impact on your psychological health.

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