Women must understand ties between menopause and mental health

Many women recognize that the transition period to menopause can come with physical symptoms, such as hot flashes and difficulty with sleeping.

But many women don’t understand that perimenopause also can affect their mental health.

One in three women (33%) say they didn’t realize that perimenopause can case mental health symptoms, and nearly half (49%) said they didn’t know those symptoms can last for years, according to a LifeStance Health survey released in August

Dr. Kristin MacGregor, the national clinical director for integrated behavioral health at LifeStance Health, tells Chief Healthcare Executive® that perimenopause and menopause can lead to serious mental health challenges for some women.

“It is above and beyond what you might expect from just life change adjustment for the majority of people,” MacGregor says.

Indeed, two out of three women (66%) say they have somewhat or severe anxiety and irritability, while more than half say they have somewhat or severe depression (54%) and mood swings (62%), the LifeStance survey found.

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Expectations of powering through

Many women are navigating perimenopause and menopause itself as they are dealing with a host of other stresses in their life.

With some women having children at older ages, they are entering menopause - or are in menopause - even as they are raising kids. Many are also taking care of aging parents. Plus, some are in the sandwich generation, where they are taking care of children and having to take care of their parents. 

“It is a lot, and for so long, I think this has also been misunderstood as well … I think the expectation is that you just power through,” MacGregor says. “I think there's historically been a lot of underrepresentation for this age group in particular for support, and even just validation that this is hard and you don't actually have to do it alone.”

Many women also become so focused on taking care of kids and/or parents that they sometimes don’t look after their own health needs, she adds.

“Women do tend to give their resources to their children, to their parents, to their workplace and don't necessarily take the time for themselves,” MacGregor says. “People are busy throughout the day, and so thinking about going online or making a phone call to make an appointment to see who's in network with their insurance, to make an appointment with their primary care provider, people don't have time to do those things, even if they think that they're worthwhile.”

MacGregor encourages women who are struggling with mental health as they face perimenopause, or menopause, to reach out for help.

Most women (83%) in perimenopause or menopause who seek therapy say they find it helpful, and a solid majority (59%) of women said they would be more likely to seek care for their mental health if they knew it could improve their symptoms.

“Once the connection is made, yes, it can be incredibly beneficial for folks for many reasons,” she says. “Therapy can teach you skills to help manage a little bit better, prioritize yourself, set boundaries around things that are maybe causing distress.”

‘Streamlined referral pathways’

Health systems and providers can take steps to make it easier for women to get the help that they need.

MacGregor says healthcare organizations should consider asking more questions of patients about their mental health, especially those in or entering menopause.

“It's the healthcare providers whose doors these people tend to show up on, especially if they're overwhelmed and don't know that their mental health is actually likely multifactorial with what's going on in their life,” MacGregor says.

She recognizes it can be daunting to direct primary care physicians to ask more questions, since those doctors are already carrying heavy workloads and often don’t have as much time as they’d like with their patients.

But MacGregor says health systems need to look at manageable ways to help screen more women who may be struggling. She also stresses the need for “easy referral pathways” for patients and physicians.

“Having those streamlined referral pathways where if a doctor asks a question, they easily know what to do to get the person connected to care,” she says. “A PCP doesn't want to think too hard about what they need to do next.”

If health systems have the resources, embedding behavioral health clinicians as part of the primary care team is even better, she adds.

Giving patients options

Many patients are using telehealth for mental health appointments, and MacGregor says virtual care can be a great option, particularly for women who have family responsibilities.

“I've had people log into their visits in the parking lot of the grocery store because it's the only time they get,” she says.

But she also notes the importance of giving patients access to care in a brick-and-mortar session. Some patients may want the option of going to an office where they don’t have to worry about kids interrupting a virtual appointment.

“I think a lot of people want the space and the privacy of being able to be away,” MacGregor says. “They don't hear their kids yelling in the background when they're on an appointment, and so having the ability to do both, I think, is really helpful. And at flexible hours too, because not everybody's available at 11 a.m. on a Tuesday.”

She also repeatedly cites the importance of healthcare organizations following through if patients say they need assistance, or are showing signs of depression.

If health systems are doing screening questions even as part of the appointment process, the surveys and responses can’t be lost.

“That can't be the thing that happens,” MacGregor says. “Just because you're screening, you need to do something with those things.”“You have to identify the people that are struggling, and then you have to have a place to send them because if both of those things aren't happening, then people are going to get lost,” she says.