Many women feel despondent, irritable and tired in the few days preceding menstruation. The collective term for these emotions, coupled with physical symptoms of headache, stomach distension and breast tenderness, is called premenstrual syndrome. Female depression around this time varies in severity but in most cases the symptoms subside around a week after the first day of menstruation.
Premenstrual dysphoric disorder is an illness that typically starts around the age of 30-45 and ends with the menopause. Estimates suggest as much as five percent of women in this age range are affected, with symptoms frequently worsening after childbirth. The disorder tends to occur during most menstrual cycles and is characterized by very marked anxiety and high levels of despondency. This form of female depression is associated with strong mood shifts, a sense of exhaustion, severe irritability and rage. The unfortunate outcome of this is that it can place a great strain on interpersonal relationships.
Women, Depression and The Pill
The effects of contraceptive pills on female depression are known yet not fully understood. The Pill is known to reduce the quantity of tryptophan in the body and it is tryptophan that is vital for the production of serotonin. Depression and the contraceptive pill are associated and many women stop using this form of contraception for that very reason. The contraceptive pill is also known to enhance the effects of certain tricyclic antidepressants. Depressed women on the pill who are treated with tricyclic antidepressants may find themselves with excessive levels of antidepressant in the blood. Newer contraceptives contain lower levels of hormones but may still have depression-inducing effects in women who suffer with premenstrual syndrome or premenstrual dysphoric disorder.
Women, Depression and the Menopause
The average age for the onset of the menopause is 51. It may start as early as 42 years of age or as late as 58 in some women. The menopause is often associated with sweating and hot flushes, but feelings of fatigue, irritability and low mood are also reported. It is the reduction of estrogen during the menopause that is considered to affect the woman’s mood. It is a state roughly comparable to premenstrual syndrome or, in fewer cases, premenstrual dysphoric disorder. The menopause does not affect women equally.
It is estimated that roughly 25 percent of women have only very mild or no symptoms at all. In others, the symptoms may persist for as long as 15 years after the initial onset. There is a higher risk of depression in women if the ovaries have been surgically removed prior to the onset of menopause. Estrogen supplements have been shown to have a range of positive effects including less disrupted sleep, better concentration, higher energy levels and decreased anxiety and levels of despondency.
Danuta Wasserman (2006) the Facts – Depression. Oxford University Press.
Menopause. BBC Health https://www.bbc.co.uk/health/physical_health/conditions/menopause.shtml