Part 2: The next segment is a follow up to our prior discussion on women’s reproductive cycles and psychiatric aspects of care.

We would like to begin by focusing on menopause. By definition this phase of reproductive life is a time when permanent cessa­tion of menses occurs due to the stop­page of egg cell production as well as the cessation of estrogen production. The phase leading up to menopause, or peri-menopause, is the time before menopause and lasts into the first year of amenorrhea (no menses).

Many women use menopause as a catch-all term to depict a time when there are a myriad of uncomfortable syndromes and symptoms. These notably may include vasomotor disruption – better known as “hot flashes.” They consist of both copi­ous sweating and intense heat. Hot flashes may be sudden and diffuse, gradual and progressive, single episode or in rapid succession. They may occur any time, but have a propensity to be more prevalent at night. These “attacks” are due to decreasing levels of female gonadal hormones – espe­cially estrogen. Other commonly experienced symptoms may include vaginal dryness, libidinal decline, uro-genital issues involving bladder dys­function, difficulty with discomfort during intercourse, varying degrees of increased cardiovascular risk, osteopo­rosis and a variety of psychiatric and psychological intrusions. Included in these are: mood disorders, i.e. major depressive disorder, exacerbation of this, especially when there are other co-morbid states such as: dysthymia, anxiety disorders, i.e. panic disorder, obsessive compulsive disorder, general­ized anxiety disorder, hypochondriasis and phobic reactions. There may also be an increase in somatic complaints – organic or perceived, decreases in cognitive skill and acuity leading to decreased attention, concentration and productivity. Sleep disturbances - i.e. insomnia, is prevalent.

Mood disorders, depression especially, is twice as common in women as in men (21% versus 12%). Additionally, according to the World Health Organization’s Global Bureau of Disease Survey, unipolar depression (not bipolar depression) is the leading cause of disease-related disability in woman. Ischemic heart disease was the only chronic disease with greater impacts.

When you consider that the mean age of onset for perimenopausal transition is 47.5 years and the average life expectancy for women is 77 years, it means a possible 30 or more year phase of living with these lingering consequences if left untreated. Each year 1.3 million women reach meno­pause. Approximately 20% of them will experience a dysfunctional depres­sion. The Harvard Study of Moods and Cycles recruited premenstrual women from the age of 36 to 44 years old who all had major depressive episodes. They followed these women for 9 years looking to observe new epi­sodes of their pre-existing depressive symptoms. It was noteworthy that those who entered peri-menopause were twice as likely as those women who had not yet started the perimeno­pausal transition to develop clinically significant major depression.

During the perimenopausal periods of transition, estrogen levels fluctuate and decline; levels of fol­licle stimulating hormone (FSH) and luteinizing hormone (LH) increase; melatonin and growth hormone levels decrease as does progesterone levels. These hormonal variations help to quite extensively constitute many of the aforementioned and other symp­toms.

Treatment options include hor­mone replacement therapy –standard or bioidentical varieties. These may play a useful role however risks and benefits must be thoroughly reviewed and understood prior to a decision to use or not to use them. Antidepressants, in particular SSRI and SNRI classes have been help­ful for many but not all symptoms. They are safe and non-addictive tools to treat these needs. Clonidine and gabapentin have some benefit in reducing hot flashes. Group therapy, individual cognitive-behavioral thera­pies, alternative methods, healthy diet and routine physical activity may all be positive factors for the treatment of the symptoms/disorders. Younger women with surgically induced menopause have a markedly enhanced likelihood of having major depres­sive symptoms. Additionally, several related biopsychosocial issues help to contribute to this outcome.

Attitudes towards midlife, aging, loss, change and menopause itself are very significant considerations that do affect onset and intensity of the dis­orders. In addition to this, questions about purpose in life, interpersonal relationships, body image, social sup­ports, cultural/familial influences, “empty nest” issues are all psychologi­cal influences upon this syndromal disorder. Smoking is also a negative factor.

It is important to understand and examine both the physical and psy­chological reasons for these disorders. When both areas are assessed, we get closer to addressing the true needs of each patient in context and are more successful in determining how treat­ment should proceed on an individual basis.

 

Q. In these challenging eco­nomic times what should new or even existing patients do about seek­ing treatment?

A. Patients who postpone or aban­don necessary psychiatric care will very likely struggle with more intrusive illnesses that rob their potentials to lead healthier and productive lives. The decision to select treatment when finances are hard is very difficult. We work with patients on an individual basis to assist with these challeng­ing obstacles whenever possible. It is a respectful patient and doc­tor partnership.

Q. “What form of treatment for these problems do you provide?

A. I provide the comprehensive psy­chiatric evaluation of these biological and emotional states. Subsequently, any need identified which would benefit from psychopharmacologic interventions, several psychothera­peutic modalities, appropriate labora­tory testing and OB-GYN collabora­tive referral and alternative medical care are readily available. Medication needs and psychotherapies are provided solely by me for better continuity of care and greater patient convenience.

Q. Are there any age limits to the female population that you treat?

A. We begin our age appropriate care at 14 years of age and continue it into geriatric care.

Q. How long does it take to see some improvement?

A. A patient’s preferences, psychiatric history, depression, anxiety – even psychosis will create the severity that will determine which options to consider and in what sequence. An individualized plan will be formu­lated. The veracity of improvement depends upon the patient’s issues, priorities and comfort with recom­mended treatments.

Q. How do I make an appointment? Is a refer­ral needed? What is the wait time and how are fees handled?

A. Call for an appointment for an evaluation with our office manager or leave a message in our confidential voice mail and we will assist you with your appointment needs. Referrals are generally not required, but you may check with your insurer. The wait time is generally about one week. It is a fee for service basis, but we also again suggest you check with your insurer for details.

Medicare is accepted but at the non-par reimbursement rates.