My husband and I went shopping for a new mattress last weekend and it got me thinking about menopause. Why? Well, the sales woman kept talking about the Brisk mattress and winking at me. Ok, I’ll bite. I finally asked her, “What is a Brisk mattress?” She looked cautiously from me to my husband, and back again, and whispered: “You know, for the CHANGE. It’s for when you get hot at night.” Ohhhhh. Well, damn. Do I look old enough for that?!?!? Trying not to get offended, I thanked her and we moved on. Since I currently use 3 blankets to my husbands one, we laughed it off and did not buy a Brisk mattress. The interaction, however, got me thinking...
Comedienne Sandra Tsing Loh jokingly says that, "Menopause isn't the "CHANGE" it's the “RETURN” to who you were before the fertility cloud came down!" Her funny TEDx talk made me think about menopause, and the psychological symptoms related to reproductive change, in a completely different way. Check it out:
When I was in graduate school I reviewed the research literature on perimenopause and depression. Researchers had discovered that the risk of new-onset depression increased during the perimenopause and that sex hormones (like estrogen and progesterone) were associated with this risk. Whether depressive symptoms are directly related to changes in reproductive hormone levels is a controversial issue in women’s health. Specifically, some researchers insisted that depression in women occurs more often during times of intense hormonal fluctuation (during menstruation, postpartum, and menopause) and it is exposure to changes in hormone levels that are important - rather than absolutely low levels. In support of their theory, they note that there is a relatively low incidence of depression at times of stable hormone levels, as in the postmenopausal years. More recent research found that the earlier a woman goes through menopause, the higher her risk for depression, especially if the early menopause is due to medical reasons, i.e. cancer treatment etc.
Ten years and 2 kids later, the science hasn’t changed too much. Thanks to Loh, however, my perspective on this topic has. She exaggerates to say that fertility is a relatively short period of our lives. Depending on how long you live, it could be half of your life! But the wisdom in her joke is that we can choose to perceive it as the most important half, or not. If not, then we don’t have to grieve the “CHANGE.” We may struggle at first, with the physical and emotional changes, and we may need support through those changes. But we don’t have to despair nor do we have to go through it alone.
1. Accortt EE, Bower JE, Stanton AL, Ganz PA. Depression and vasomotor symptoms in young breast cancer survivors: the mediating role of sleep disturbance. Archives of women's mental health. 2015; 1; 18(3):565-8.
2. Cohen LS, Soares CN, Vitonis AF, Otto MW, Harlow, BL. Risk for new onset of depression during the menopausal transition. The Harvard Study of Moods and Cycles. Arch Gen Psychiatry. 2006; 63:385–390.
3. Freeman EW, Sammel MD, Lin H, Nelson DB. Associations of hormones and menopausal status with depressed mood in women with no history of depression. Arch Gen Psychiatry, 2006; 63:375–382–382.
4. Georgakis MK, Thomopoulos TP, Diamantaras AA, Kalogirou EI, Skalkidou A, Daskalopoulou SS, Petridou ET. Association of age at menopause and duration of reproductive period with depression after menopause: a systematic review and meta-analysis. JAMA psychiatry. 2016; 1; 73 (2):139-49.
5. Richardson T, Robinson R. Menopause and depression: A review of psychologic function and sex steroid neurobiology during the menopause. Primary care update. Obst Gynecol. 2000; 7: 215–223.
Dr. Accortt in the News
July 2020: Cedars Sinai Newsroom, Reproductive Psychology Program Focuses on Mother and Family Wellness
May 2020: Hawaii News Now, Sunrise, How to Prevent Anxiety & Depression Before and After Giving Birth
April 2020: The Bump, How to Spot Postpartum Depression in Your Partner or Friend
12/3/19: Quartz, Ten questions about mothers’ mental health could promote resilient pregnancies
5/10/19: CGTN America, US comedian uses her act to turn the spotlight on postpartum depression
5/1/19: KTLA News, How One Comedian’s Battle With Postpartum Depression Turned Laughs Into Legislation
3/20/19: KFI News Radio, FDA Approves First Drug for PPD, Brexanolone (Zulresso) - Correction: Rix states that Dr. Accortt "treats thousands of women at CS" - Thousands of women delivery babies at CS every year. Dr. Accortt does not treat them.
Winter 2019: Cedars-Sinai Discoveries Magazine, Stop The Stigma
9/11/18: USC Center for Health Journalism, Cedars-Sinai PPD Screening Program May be Model for State
Summer 2018: Cedars-Sinai Catalyst Magazine, The Helping Hand of Los Angeles Funds Postpartum Depression Screening Program, scroll down to page 40 of magazine
5/18/18: TODAY.com, Alyssa Milano on Postpartum Anxiety
5/3/18: Cedars-Sinai Maternal Mental Health Research
10/19/17: Cedars-Sinai Postpartum Depression Screening Program
3/24/17: MomCo. App for Social Support
Dr. Accortt is a California licensed clinical psychologist. When she isn't seeing patients in private practice she conducts research in the OBGYN department at Cedars-Sinai. She will update this page with important maternal mental health news and research.