Do you know how menopause can affect your mental health and what you can do about it?
Dr Harper is an innovative doctor interested in optimising women’s wellbeing and health and empowering them to look and feel their best. She looks after women of all backgrounds and ethnicities enabling them to make informed choices for their optimal health. She has an understanding of the symptoms and concerns that women face as she herself is one of six sisters and has a grown up daughter.
Her areas of expertise include perimenopause and menopause, Polycystic Ovarian Syndrome, premenstrual stress disorder, healthy ageing and weight management.
Henpicked: Perimenopause can be a bit of a mysterious time, when women may not realise why they’re experiencing certain symptoms. What can the psychological aspects of menopause be?
Dr Shahzadi Harper: Mental health and menopause go hand in hand but lots of women don’t realise it. Such a lot of people think menopause is all about hot flushes. In fact, menopause is often used as an umbrella term for all symptoms, but often women aren’t aware hormonal change can disrupt their mental wellbeing.
One of the biggest issues is sleep. Women tell me they can fall asleep but don’t have that good, deep sleep, and wake in the early hours. It’s common to also feel anxious, overwhelmed and not able to cope as well. Some also say they are struggling to find the words that would normally flow easily. That can play on their minds, and some even worry they’re getting dementia. If you find yourself asking ‘Where’s the joy in my life?’ it could be time to seek help. It can be a different feeling to clinical depression, but it still impactful in all areas of life.
We have oestrogen receptors all over our body and they are part of our brain’s connectivity – a bit like wifi in our brains. When your wifi at home is down it’s very annoying. And this is the same – things aren’t connecting as well. Oestrogen can keep serotonin, dopamine and noradrenalin levels up – which makes us feel good. So as our oestrogen lowers, these hormone levels can dip and cause fluctuation in mood.
Henpicked: Would women be prescribed antidepressants or HRT?
Dr Shahzadi Harper: The NICE guidelines do say that SSRIs (antidepressants) should not be used as first line treatment for menopausal mood disorder. These are the most common type of antidepressant, and prevent the brain from breaking down and metabolising serotonin too quickly. HRT is hormone replacement therapy, used to combat declining ovarian function. With menopausal mood disorder, we should also be talking about exercise, mindfulness, breathwork, lifestyle, diet, alcohol, caffeine. All of these might be perpetuating symptoms.
Henpicked: Techniques like Cognitive Behavioural Therapy (CBT) can also help. Is this about becoming more accepting?
Dr Shahzadi Harper: And becoming more aware, listening to what’s going on in your body. You don’t have to accept being low, or not having joy or energy. Recognise what’s going on, listen to your body and seek out the resources you need.
We are all doing a lot more now, and there’s more to juggle. Some days you may go upstairs and not know why. Other days you’ll be less energetic than others. It’s learning to understand and manage these days. Keep talking to others and maintain connections. If friends haven’t connected with you, reach out to them. We often hold back and don’t want to tread on people’s toes.
Henpicked: You mentioned sleep earlier. Women often tell us disrupted sleep can put them in a downward spiral.
Dr Shahzadi Harper: Sleep is very important for mood. It’s a bit chicken and egg. If you don’t sleep so well your mood is going to be bit lower, when your mood is better your tend to sleep well.
Sleep disruption in perimenopause can be a tipping point for some women. It’s important to think about sleep hygiene. Don’t take your phone to bed, don’t drink caffeine late on. Think about breathwork to slow your body down. But be realistic. When you’re anxious trying to slow down can be hard. Count to four, hold for four, breathe out for four – then build up to longer. Or there are apps out there to help you relax.
Try not to do everything all in one go. Have a dumping list to get everything out of your brain so it’s not all playing on your mind at night. Then work through in small bitesize chunks during the day.
Henpicked: Are there any other lifestyle changes that can help with anxiety and low mood?
Dr Shahzadi Harper: Exercise is really important, as it releases happy endorphins. Do things you enjoy, find a hobby you like. It can be hard to start it if you feel lacking in motivation and energy. But the effects last for hours afterwards and improve your mental sharpness. Even if you put some music on and dance around the house for ten minutes, that can be very good for you.
Henpicked: Are there any supplements we should consider?
Dr Shahzadi Harper: Look at your gut health. I often recommend probiotics, as the majority of our serotonin is made in our gut. Also a general multivitamin with b complex, which can help with mood and hormonal balance.
Henpicked: If antidepressants are working should a woman still try HRT instead?
Dr Shahzadi Harper: It’s very individual. If something is working for you then why rock the boat? If I saw someone on antidepressants who had got other symptoms I wouldn’t stop their treatment but would do an overlap with HRT and wean off antidepressants later. Some women worry antidepressants are addictive. You do have a withdrawal reaction if you come off them quickly, so you need weaning off.
Henpicked: Lots of women tell us about driving anxiety after always being confident drivers. Is this common?
Dr Shahzadi Harper: This is surprisingly common, and not in the text books. CBT can really help here, along with medication. It’s about retraining and rewiring the brain. Have someone with you in the car, and go small distances. It’s about baby steps until you’re ready for more.
Henpicked: Women can experience a lot of symptoms and it can be complicated to tackle them one at a time. Do you recommend a holistic approach?
Dr Shahzadi Harper: Yes, listen to your body and keep notes of any symptoms so you can discuss with your doctor. It’s also important to remember, not everything is menopause related. Some symptoms do need to be investigated, and you need to keep up with your regular smears and mammograms.
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