The Interaction of Hormonal Shifts and Responses of Depression, Anxiety, and Sexual Dissatisfaction at Menopause

Caroline Dott, PhD

There is no clearly established relationship between the improved mood effects (decreased depression and increased well-being) of estrogen and adequate estrogen levels in the body. Why is this?

There are many determinants of how effective estrogen is in the individual woman=s body. These include:

	Adequacy of the dose level for that particular woman
	The ability of the woman=s body to absorb the estrogen
	The number of receptors available in the individual woman=s body to receive the estrogen

	The degree of positive or negative beliefs, feelings, attitudes, and expectations a woman has about her own body and her own menopause influences the amount of depression, anxiety, and sexual dissatisfaction she experiences.
	Psychosocial stressors at midlife combined with perimenopausal hormonal shifts can stimulate depression and anxiety leading to sexual disinterest and dissatisfaction:

	Losses such as the loss of good health or parts of the body due to disease, accident; separation, divorce, widowhood, job change, significant people, or any other important loss can predispose to depression.
	Women with a history of childhood shocks to self-esteem due to losing parents physically or emotionally early in life, or to parental abuse and neglect, are more likely to become depressed at menopause or later.
	Women choosing the more culturally accepted Afeminine personality constellation@ of passivity, dependence, and changing self-esteem due to anxiety about their dependence, are more likely to become depressed. Culturally prescribed feminine behavior limits healthy expression of assertiveness, activity, and achieving competence and autonomy, which reinforces helplessness and powerlessness, paving the way for depression.
	Women more vulnerable to depression are stay-at-home, married, with children, and working-class women.
	Change in social roles at midlife, and/or the dual role of Aparenting@ both children and aging parents increases stress.

On the positive side, premenopausal women who exercise regularly are LESS likely to suffer depression later and MORE likely to experience increased well-being.