Dr. Jessica Shepherd, MD ’05, OB-GYN author of a new book on menopause answers questions on how it affects the brain, what you can do about it, and more.
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Dr. Jessica Shepherd, MD ’05, is an OB-GYN, entrepreneur, and graduate of Ross University School of Medicine. Here, she shares answers to common questions about menopause from her new book, Generation M: Living Well in Perimenopause and Menopause.
Does menopause affect your brain?
Mood and memory issues can be frustrating (What was that word again?) and scary (Am I getting early-onset dementia?), and can have a negative effect on relationships (Why does everything my partner does suddenly annoy me?). For many women, the symptoms manifest as a vague sense of flatness or lack of spark; for others, outright anger.
Estrogen receptors in various regions of the brain interact with the neurotransmitters responsible for mood, memory, and cognition. Think of neurotransmitters as little chemical messengers that send signals between nerve cells throughout the body. As hormone levels dip during perimenopause and menopause, these signals weaken and your brain goes through estrogen withdrawal. Three of the neurotransmitters most affected by this include serotonin, dopamine, and norepinephrine.
Serotonin promotes a sense of calm, well-being, and happiness. Low serotonin levels can lead to irritability and anxiety, which, along with making you generally cranky, can disrupt sleep. Eight weeks of aerobic exercise has been shown to increase both serotonin and endorphins. The vitamin D you get from spending as little as fifteen minutes in sunlight also boosts serotonin levels.
Dopamine, another key neurotransmitter modulated by estrogen, influences the reward and pleasure centers in the brain. When dopamine is low, it not only creates depressive moods, but also impacts motivation, concentration, and energy. Yoga, meditation, and walking may all increase dopamine.
Estrogen also impacts norepinephrine, the neurotransmitter that regulates the fight-or-flight response, and can increase alertness. Imbalances can raise blood pressure, and cause anxiety and panic. This is why some women get panic attacks during menopause. Exercise and meditation can help to regulate norepinephrine.
How can I beat menopause depression?
Approximately 20% of women experience some degree of depression during menopause. That’s alarming, but in some ways not surprising. Hormones play a big role, but they aren’t the only cause. There are other external factors to consider.
Society continues to bombard us with outdated notions of women and aging. Representation across media of older women, especially those who choose to age naturally, continues to lag, while youth is held up as the paradigm.
On the job front, it can be a time when women struggle to re-enter the workforce, feel stuck in their careers, or find themselves reporting to people younger than them. Family stress is often at its height as we get sandwiched between taking care of our kids and our elders. A lack of social support, education level, social demographic, and cultural experiences that impact different races and ethnicities can all contribute to the risk for depression. These factors go a long way to explain why depression is more common among Black and Hispanic women. In fact, Black Americans are twice as likely as white Americans to experience depression.
These societal factors along with a woman’s menopausal status should be taken into account when health care providers screen for depression and consider treatment options. Having a full picture of the entire scope of a woman’s experience may allow for earlier intervention with complementary and alternative modalities such as cognitive behavioral therapy (CBT), mindfulness, acupuncture, yoga, and tai chi, all of which can have a beneficial effect on the mood and behavioral changes women go through during menopause.
Women often ask me how they can tell whether their depression is due to menopause or life circumstances. The answer could be all of the above. The deeper point is it may not matter. While hormone replacement therapy and, if necessary, antidepressants and/or therapy can in many cases be beneficial, the proactive lifestyle steps you can take to deal with stress, anxiety, or depression are the same regardless of the cause.
While I always advocate for a lifestyle approach to physical and mental health, depression and anxiety can be serious medical conditions and need to be treated as such. If you have a history of depression or have overwhelming feelings of sadness that last for more than two weeks or are interfering with your ability to function, it is important to seek professional help. If you don’t have a therapist, ask your general practitioner for a recommendation. If you are in immediate distress, reach out to the suicide and crisis hotline at 988.
What is the best diet for menopause mental health?
Loss of estrogen can lead to irritability, low energy, anxiety, and stress, all of which make it more tempting to reach for snacks and prepackaged foods that are high in sugar and fat. (It’s chips for me.) Depression can lead you to self-medicate with food, either by overeating or opting for unhealthy “comfort foods.” Because depression can also make you more sedentary, the effects of the increased caloric intake are compounded by lack of exercise, setting up a vicious cycle.
Foods high in B vitamins and healthy fats can help to strengthen membranes in the brain, improve the flow of neurotransmitters, reduce mood swings, and support neurotransmitters. Dr. Melissa Mondala, an expert in women’s nutrition, suggests incorporating almonds, walnuts, and pecans into your diet. Be careful not to overindulge, though, as they can be high in calories.
Here are her suggestions for incorporating some other feel-good foods into your diet: Mix ground flax seeds into a smoothie, oatmeal, or pancakes. Sprinkle them onto brown rice or quinoa. Make chia seed pudding by mixing the seeds with soy or almond milk and adding your favorite berries for added antioxidants. Toss sesame seeds on roasted vegetables and salads. Roast pumpkin seeds and add them to your salad instead of croutons.
Dr. Shepherd talks about self-advocacy in “How to Be Heard in the Doctor’s Office and the Corporate Office.”
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