![]() Women experiencing hot flushes may have restless sleep with night sweats, which will tend to worsen mood and cognitive symptoms. These symptoms often occur in the absence of physical symptoms such as hot flushes (also referred to as “hot flashes”) or vaginal dryness. Mood and cognitive disturbances common during perimenopause include mood swings, irritability, fatigue, a subjective sense of loss of memory, difficulty with word retrieval, decreased concentration, and decreased libido. ![]() While these symptoms may not meet criteria for a major psychiatric disorder, either because of the timing of the symptoms (which may wax and wane) or because they consist of several isolated symptoms, they are still worrisome. The fact that there does not appear to be an increased risk of major psychiatric disorder associated with menopause in large epidemiological studies does not rule out the possibility of mood, anxiety, and cognitive symptoms occurring. However, even in this group the risk of an episode of major psychiatric illness associated with menopause is not high. This group includes women who have a history of mood disorder, women who have had severe premenstrual mood instability and have met criteria for premenstrual dysphoric disorder, and women who have experienced psychiatric morbidity associated with other reproductive life events such as postpartum depression. One study has shown high levels of psychiatric morbidity in women attending a menopause clinic. There was a trend for increased risk for psychiatric morbidity in women who experience early menopause or surgical menopause. The authors of several studies of smaller or more specific populations have suggested that certain individuals may be at greater risk of psychiatric morbidity during the perimenopausal years. Women who used health services extensively before age 45 continue to do so between age 45 and 55. Large epidemiological studies have shown that the years usually associated with natural menopause, that is, 45 to 55, are not associated with increased psychiatric morbidity or more utilization of health services by women. ![]() Women are more likely to experience mood and anxiety symptoms during the years preceding the cessation of the menses than they are after menstruation has ceased. ![]() Although these normal changes may not be detectable by blood hormone measurements, they may be worrying for some women and warrant information sharing and explanation. This is suggested by factors such as declining fertility with increasing maternal age, shortening of the follicular phase of the menstrual cycle, long cycles, and change in the pattern of menstrual bleeding. However, even many years before this stage, subtle changes in the female reproductive cycle may be noticeable. In fact, the term perimenopause, which is the time beginning immediately before the cessation of the menses and ending when the menses have been absent for 1 year, may be a more useful concept both for women and their practitioners. This definition is far removed from what most women are talking about when they refer to the symptoms of menopause, or “going through menopause.” The World Health Organization defines menopause as the cessation of the menses for 1 year. Unfortunately, the menopause is also an ill-defined concept for many medical practitioners. Many premenopausal women have concerns that they will experience mental instability, sudden signs of aging, and diminution of sexuality at this time. For some it can be an ill-defined concept associated with fear, loss, and sinister connotations, while for others it can be a welcome end to menstruation and the fear of unwanted pregnancy. The menopause marks a major life transition for women, an end to the childbearing years and the cessation of the menses.
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