Menopause, cognition and mood

thank you very much for joining us today I'm Deborah garlic from henick HP picked menopause in the workplace and author of the book menopause the change for the better and the the theme of today's lunch and learn is cognition and mood and actually that's the theme of this year's World menopause day which I'm delighted about and I'm also delighted to be joined Again by Dr Claire Spencer from The Fabulous my menopause Center who's going to help us explore this topic more um so CLA if you're like me I'm I'm delighted that this this year's themes cognition and mood because it's start we're starting to appreciate that menopause is so much more than just hot flushes yes that's absolutely right thank you Deborah lovely to be here again no that's so true so if we think about the breadth of symptoms of the menopause really falling into categories of think of it as sort of physical vasomotor symptoms so the hot flushes the night sweats joint aches and pains headaches Etc I could go on um there's the psychological symptoms which we're going to talk about a bit more today and under that sort of heading I'd include um symptoms related to changes in cognition and then symptoms related to sex and yes it's great that they've chosen the sort of more psychological and cognitive symptoms to home in on because they are so incredibly common and as debilitating some women will say to me that actually they can cope with the hot flushes it's those changes which really feel like you're changing the essence of you isn't it so the the changes to mood and how your brain functions which then obviously affects how you can just go about your job your family life your juggling um really having a big impact and your job that's an interesting one isn't it because that's what we hear from people every single day when we're doing training in the workplace um as you say they can handle the hot flushes but actually it's the psychological symptoms that often affect them the most and I think you know the things around anxiety mood changes difficulty focusing and concentration and you can really understand how that can affect someone at work but the interesting thing is when these symptoms can start to happen and what's going on in our bodies that actually triggers these symptoms yeah so it's really well it's mainly to do with estrogen in terms of the drop in estrogen and fluctuations of estrogen and testosterone may play A Part as well so if we think about the beginning of the menopause transition where our ovarian estrogen production can start to go a bit Haywire instead of of having a nice rhythmical monthly flow up and down the the rhythm is sometimes just shocked a bit your estrogen can be high and it can be low and the troughs can be deeper than they were before the start of the menopause transition so the start of the per menopause um and there are two important factors here you can get symptoms that are triggered by the big fluctuation itself from the change from high to low to high so that's known to trigger anxiety particularly as well as for some women migraine um and then those deeper troughs and the overall drop in estrogen can really affect mood so really dampen mood lower mood and also um affect how your brain functions so that cognitive function that many women suffer from and and um when you say about mood um fluctuations and things this is quite a tricky one for many of us because how do you know particularly if you're in this mysterious phase the perimenopause when you don't necessarily have notification that your your your hormones are changing how do you know that these symptoms are as a result of menopause or just something else yeah a and in reality it can be really difficult and it's why often um blood tests can be useful to rule out other physical um other physical conditions like for example changes in thyroid function um so how do you know so I think if we just home in on mood changes first and that lowered mood and maybe heightened anxiety there are a few Clues so some women's Brains are just more susceptible to hormonal fluctuations and drops and so there may be a history you may have had premenstrual syndrome through your reproductive life you may sort of have had a shocker at puberty you know sort of felt really Grim as your ovaries came burst into life and started making um estrogen or you might have had postnatal depression um some women have really struggled on hormonal contraception and there sort of it's not 100% fail safe but there are indications that actually as your hormones start to change in the per menopause what you're experiencing is a result of changing hormones and of course if you've got a history of depression or anxiety if you've suffered in the past we know that the menopause transition can re-trigger that or it can wor some pre-existing dementia um pre-existing depression and anxiety also it it's really hard there's a big overlap of symptoms it is difficult so it's worth understanding how your body um was affected by hormonal changes before yes but I think it's also really important to say that you may have swam through life merrily without any anxiety without any mood issues and then with those profound changes for no good reason you just notice um you just notice changes creeping in like for example I think it's such a common symptom women will say to me that they don't want to drive on the motorway anymore you know that confrontation with your own mortality just seems to trigger any sort of underlying anxiety or sweating the small things or just not finding enjoyment not looking forward to holidays or events that you usually would be looking forward to you know it doesn't have to be a swamp of symptoms it's small subtle changes that you just notice that don't make you feel quite like yourself it's um unusual that you say about um getting in the car going in the motorway because I'd say that's probably one of mine I'm the ner I'm a nervous passenger I'm never was before um and it's one of those where I just feel out of control so the slightest thing in the road I start to catastrophizing my head my husband's actually a very good driver but I'm not a good passenger anymore so I know yeah it's knowing those things to watch out for them is actually empowering isn't it because it's like well is this could this be something that is telling me my hormones are changing no completely and once you know there's a reason once you understand what's going on behind the scenes once I explain it to women often you can just see the relief in their faces that there is a reason it's not like suddenly you can't cope you can't juggle you know it it's knowing that because then also it allows you to consider your options to know what to do about it for the positive one of the things that we've discussed before is actually some of these symptoms are the ones that can really chip away at your confidence you don't feel like you anymore I think that's absolutely right and going back to what you were saying about work at the beginning I hear that such a lot it doesn't matter if you're working in the home working in a workplace it does chip away at your self-esteem your self-confidence you start to not feel like yourself you start to doubt your abilities because of that negative thinking um that's creeping in absolutely yeah well I think um uh the fact that this um webinar this lunch and learn booked so fast as soon as we put out the uh the topic says just how many people are affected by this um but when it comes down to to being affected and we're all individual we're all unique in this and so will be our preference on how we manage those symptoms um so what what are the options what can people do if they are experiencing these symptoms okay so again if we're just focusing on low mood and depression the first thing I would say it's not uncommon for women to feel down depressed hopeless and even to feel that they don't want to be here it's it's uncommon to feel suicidal with me the menopause but it is you know some women do and I think the first thing is if you are feeling desperate if you are feeling in any way like that if you're having dark thoughts please please speak to somebody your GP call 111 have a look at the Samaritans there's a helpline on the Samaritans um website um with a free phone number um or take yourself to a you know please do something if you are having those thoughts don't just keep them hidden away and worrying by yourself if you are at the milder end of the Spectrum which is going to be the majority of women having some form of of um depressive symptoms then there is lots that you can do to self help self-help so looking at lifestyle there's really good evidence that um increasing exercise which we know can be just small it doesn't have to be running a marathon just increase what you're doing get outside if it's not activity then you know looking at other forms of activity like yoga um where you're actively switching your brain off you're making yourself relax can be helpful looking at diet I know that you're you're just about to have another um lunch and learn on diet and mood which is absolutely brilliant so I'm not going to take say too much about that but having big Peaks and troughs of blood sugar probably doesn't help already mood there are feel-good foods keeping your blood sugar stable there's evidence that that can help so diet exercise talking therapies you know even if it's chatting to your friends and sharing your feelings sharing the load through to sort of looking at cognitive behavioral therapy and counseling which you can self-refer to um available on the NHS that there is a weight um the nice guideline advise that it's up to 18 it should you should be seen within 18 weeks um but obviously there are areas that are better and worse than that talking therapies if your symptoms are related to the menopause and the menopause transition actually there's evidence that hormone replacement therapy so replacing the estrogen is really effective at helping you feel better and I do see the transformative effects of HRT you know h chy is not for everybody it's an individualized choice but it can be really helpful and or anti-depressants you know if you are at the more severe end of the spectrum if you've been diagnosed as having clinical depression it may be that you do need anti-depressants um and sometimes I do see women who are really struggling you can get part of the way with HRT but then maybe you need a lowd dose anti-depressant just to take you that you know just to where you need to be so I would say it's a really it's a combination of all of the above that can be really helpful it is and and actually the first step is understanding what's going on for you isn't it um so you know I'm really glad that you said that around if you're getting to that place that you're absolutely desperate to seek help straight away but it's also Worth US understanding what's going on for us reading up from expert resources my men Center the henic menopause Hub where there are experts talking about there's no advertisements or anything else like that but there expert advice and information and that enables you to make informed Choice um around this time uh because I can see the chat is Going Bonkers um with comments coming through and quite clearly I've seen a couple of them as they've um as they've sort of uh dropped in the in the in the uh chat box that say I'm glad this is not just me um and I think that's something we hear a lot isn't it yes because if you think about the symptoms of depression you know as well as those horrible feelings it's the activities that then it's the sort of changes in activity that then are affected so you know withdrawal not wanting to go out not wanting to speak to people you know that can then just you just get knocked in this vicious cycle you know we talked about loss of confidence again impacting on your not wanting to reach out to other people so yes absolutely one thing um that that just came into my mind when you were saying all of that is because um one thing when you say about anti-depressants we often hear from women that say but I'm not depressed I'm menopausal why am I being prescribed yeah anti-depressants and particularly if they've been to the GP and the GP said oh I won't give you HRT try these anti-press where are we with that I think so the important Point here is GP education which I'm completely passionate about um so it it's just educating GPS actually you know this is a symptom it's a common symptom of the per menopause and HRT is likely to be more effective than an anti-depressant um and so I do think the tide is turning I think it's brilliant for example we're all talking today and so women are increasingly asking for HRT rather than anti-depressants so I do think that that's changing but I'm not going to move you know that really was the case you know it would be very common that somebody would be given an anti-depressant rather than HRT for these symptoms but you say for some people it might be HRT and then anti-depressants on top you might and not commonly but just occasionally the the HRT doesn't take you all the way back to where you need to you know if there's been a a sort of overlap between depressive symptoms and clinical depression yeah okay and I know when we've talked before um understanding how you're where you are right now and how these treatments are working for you is important because you know it's likely that you won't get exactly what you need first time no absolutely and tweaking HRT which was spoken about before is you know it's it's sort of unusual to get it right the first time and it's not being despondent if you start a form of HRT and you're not feeling quite right you know it may be that the HRT just isn't the best HRT for you and I do think it's worth calling out that we know that HRT is to hormones if you haven't had a hysterectomy you need estrogen which obviously makes you feel better but you also need another hormone called a progestogen and that's because estrogen can thicken the WB lining and that can increase your risk of cancer of the womb lining so you need this other hormone called progestogen to keep the womb lining thin but there's a small percentage of women who really do not tolerate progestogens when you swallow progestogens um some of the breakdown products can affect the brain and lower your mood and that can be really tricky it can take a few attempts to find a root and a type of progestogen that you tolerate so I do think it's worth calling that out that you do you know it is a conversation it is looking at the different options and how it suits you as an individual um agree and I think um uh the don't give up when you don't necessarily find the first one because we sometimes hear people saying I tried HRT once and it didn't work for me and we say well which one which one there's different brands there's different delivery methods there's different or strengths in all of this so don't give up in all of that um and one that's come up in chat is um why is testosterone not offered more that it does that have a role to play in this too yes no it can um so testosterone probably does have an impact well we know that testosterone is important in how in keeping normal brain function is probably the best way to think about it it's important um it contributes to mood it contributes to your brain firing in the way that it's needs to be fired it probably contributes to repair of the brain if it's injured um the issue with testosterone is it's not licensed for women in this country and it's not easy for GPS to prescribe it GPS aren't allowed to initiate um testosterone in the majority of areas there are small Pockets um of of um small areas around the country where they are increasingly being able to initiate it um the evidence though for testosterone helping also is tricky so the best evidence for the benefits of testosterone is around libido and sex drive so we know that testosterone can help liido for a percentage of women if it's totally gone out of the window in the menopause but actually the evidence that it does help mood and cognitive function so the brain fog um that mental sharpness memory word finding um is actually quite poor when you look at the research studies and so it's not currently recommended to be initiated just for that purpose although we all know women I hear a lot anecdotally um from women who have found it has helped their mood and their brain function so stone is complicated as part of this picture helps some doesn't help others and the research at the moment doesn't quite back up what we're hearing in clinic thank you very much uh Dr CLA I'm going to invite my colleague Sarah on to answer some of the questions but one tiny one I've got is is there a time limit to being a how long you can take Hy for this is a continual theme that we see on the questions yeah so I would always say there is no time limit um we know that in your 50s the benefits definitely outweigh any small risks of HRT and the risk is sort of dependent also on the type of HRT that you take as you gain years you may need to change the type of HRT that you're taking and you may need to accept that really small increase risk of breast cancer year on year um that that exists for with HRT as I say some types of HRT have a lower risk of breast cancer than others but as long as you accept those and you remain healthy Etc um I would say there's no arbitrary cut off carry it as long as you want to take it for thank you and I'll hand over to Sarah Brin Jones now to who who's been looking at the questions all the way through Sarah H thank you so much Deborah and thank you so much Dr CLA I just wanted to touch on a few things Dr CLA that have been raised you know people are saying it's a relief to hear about the symptoms so what you've been sharing today people saying I'm so glad I'm not alone you so you've created this incredible support group within the chat as well people are exchanging email addresses with each other and yeah really lovely really lovely support and lots of sharing so thank you so much for all of you that have been doing that a couple of people were asking earlier on Dr CLA alterist to H H RT you've covered a lot about HRT but what if you can't take HRT what are the Alternatives and how can they help so I would say that sort of depends a little bit on what your main symptoms are what the most bothersome symptoms are so all the lifestyle F changes that I've touched on can really significantly help all menopause symptoms across the board generally um then if Hot flushes are your main complaint um keeping you awake at night affecting sleep then there are there is medication that can be prescribed by uh your GP or a menopause specialist that can Target hot flushes so for example there is a blood pressure tablet called clonidine which for some women will take the edge off or stop hot flushes which then has a knock on positive effect um on sleep and if you can sleep then Everything feels better um there are other prescription medications that can help take the edge off so um for example Gabapentin um oxybutinin which is a bladder related tablet um anti-depressants do have their role to play if you are really struggling and have been advised not to take HRT they can help lift mood they can help keep a lid on anxiety and they can help take the edge off hot flushes you might have to work through two or three to get to where you need to be but there is evidence that they can help and finally I I'd really call out cognitive behavioral therapy because there is a lot of good evidence that not only does it help psychological symptoms of the menopause but also cognitive and physical symptoms and the way it challenges your thoughts and your beliefs and the impact on then that has on Behavior if you've suffered from cancer and that's why you've been advised not to take HRT um the Maggie charity is amazing actually there are Maggie centers in many hospitals around the country and I know that that's one place you can access CBT there will be others it just that's one that that I know about um there are supplements there's alternative therapies um that you know some people will find help with you just have to be a bit careful with supplements and particularly herb remedies that it's not going to interact with medication that you're taking and that it's not actually got estrogen like activity that could potentially have risk so just Eyes Wide Open on that one fantastic thank you so much yeah there are a number of questions related to what vitamins what supplements could I take and Deborah hosted a Super Deborah didn't you the the um herbs and complimentary session that we ran back in July i' well worth having a look at that recording from lunch and learn because that was really useful so lots of personal questions coming in which obviously we can't answer the personal questions I'm trying to look at themes Dr CLA that we can we can respond to we touched on the time limit for HRT but you know the actual end a couple of people are asking is there an end to my menopause symptoms you know when can I finish and I suppose if you touch on the you know the theme of cognition and moood any advice anything you can give up front on that one yes um so just in terms of mood well on average menopause symptoms last around eight years but we all know women who it's just gone on and on and on and certainly I have women in my clinic in their 70s even 80s utterly completely Fed Up and seeking help but that's a small percentage of women so eight years is the sort of average and we do know know that if your mood dips if your anxiety heightens in that transition it can improve it can get better and that is evidence to show and I just wonder if it's something to do with how your body adapts to its sort of New Normal State and cognitive symptoms also you know for some women will get better so we haven't talked so much about so brain fog that cotton wool feeling in your brain word finding difficulties memory issues um poor concentration poor self-esteem that comes across as a result of it and some of it is a direct effect of the loss of estrogen and so you might adapt some of it is because of physical symptoms or loss of sleep so it is quite complicated but in a roundabout way they can get better for some women they may just Linger on if your symptoms are lingering on I think it's worth just speaking to your doctor and making sure that it just ruling out other medical conditions um and then you know obviously just think do do I want HRT after all am I fed up what what am I going to do and how can I change my life in a way that could help my symptoms and help me deal with them better in a more positive way fantastic thank you sorry Deborah were you going to speak it's an interesting one isn't it Dr because I'm I'm reading through some of these comments in the chat and actually I think I could have written most of them myself at some point during my menopause transition particularly the one about brain fog and when you saying earlier about what can we do to help ourselves one of the things that we do know makes things worse is stress stress makes things where so if there was a time to say um I need a bit of me time uh or I've got too much on I need to take a pause to manage my stress levels drop my shoulders because actually that will help with some of the psychological symptoms so we do really have to prioritize our well-being much more than just taking HRT or um and everything else don't we it is that lifestyle can make such a huge difference yes I I completely agree and it's not a personal failing I think I hear that a lot as well symptoms cause stress life is stressful at this time symptoms cause stress the impact of the symptoms causes stress in the working en you know there's increased stress has increased pressure and if there as you say ever was a time to teach yourself how to switch off if you're somebody who's been used to juggling the whole time running on high octane in a high octane job the whole time you just sort of have to teach yourself to step back don't you and just switch off give your brain a break yeah just reset a little bit as you said Sarah the the comments in the chat and the support people are giving each other and saying it's not just you it's me as well in some ways I find that quite reassuring because you know I used to think it was just me and being able to talk about it you know I'm sure talking about this is helping people understand you're not alone it can happen Don't Panic about it cut yourself some slack and say I'm only human and um you know understand what you can do about it but you know don't sort of berak yourself and think actually now I'm failing yeah and I love one of the chats that's just come in Deborah you know don't forget how strong you are is is you know and that's it isn't it we all beat ourselves up on a daily basis don't we we do we do indeed many many many sharings on you know uh yoga meditation lots of people are making so many suggestions in the chat as well someone's asked to where they can get the recordings from previous sessions I'll post that link in a moment for you as well and we'll look through all of the comments because there is cognitive behavioral therapy there are free resources available on cognitive behavioral therapy while you're waiting for your appointments um under the NHS if you can use those there was one other thing that came up and we've heard this on a couple of other um lunch and learns which is the link between menopause and autism and I can give you a little update on that one because there um is little understood around menopause and and autism and you might think well how are the two connected well actually what we've learned from the professors at University of Bournemouth is um that many men tend to or males tend to be diagnosed more with autism and ADHD than women however during the menopause transition um more and more women are being diagnosed retrospectively as experiencing autism or ADHD it was just never picked up before but it does influence how they experience the change so I'm delighted to say um and this is something that we're doing through menopause friendly employers sorry menopause friendly employer Awards next week henick will be paying for a threee study on the link between menopause and autism and ADHD because we've recognized it is a significant Gap in research and we want to understand how our different neuro neurodiversity actually impact on menopause so we'll probably get the two professors that are leading that study sharing the information that they've got in the initial part of the study very very shortly so um yes there is there is um a link and we'll be able to share more about that shortly that was a huge amount of content to cover in a short period of time are we are we out of time now Sarah or oh I'm afraid I'm sorry we do need to bring the session to an end but thank you so much Dr Claire and thank you so much Deborah yes as always thank you very much Dr CLA Spencer from my menopause Center and hop over to their website as well it's always got really helpful resources in there too and thank you very much Sarah as you say um thank you to everybody for all of your comments in chat and for the support you're giving each other and the more we do all get together like this and bust those myths and learn all about menopause together and then I'm sure it's going to be better for us all so thank you very much

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Id: fY6Sfw6lVCE

Length: 32min 9sec (1929 seconds)

Published: Tue Apr 30 2024