Its relation to neurological and psychiatric disorders, implications for treatment

Menopause is a phase in woman’s life that is connected with the development of multifactorial disorders and a host of biological, personal, intrafamillial, occupational burdens. A biopsychosocial model forms the basis of uderstanding the development of neurological and psychiatric manifestations in menopause.

What pertains to neurological disorders, menopause is connected with a relatively advanced age and other conditions, such as hyperlipidaemia and hypertension. Ischaemic and hemorragic strokes, therefore, are not rare.

On the other hand, there is also a development of dementias (Alzheimer’s and Pick’s diseases). Alzheimer’s disease is a degenerative disease of the brain, whose etiology remains uncertain, and which has characteristic neuropathologic and neurochemical findings. The disease is more prevalent in an advanced age. Although onset in middle age is not rare (Alzheimer’s disease with early onset). In those cases with early onset, there is a higher propability of hereditary factors, faster deterioration of symptoms and clinical characteristics of lesions in temporal and parietal lobes, including aphasia or apraxia. Alzheimer’s disease is, for the time being, not reversible. Many medications are used to delay the aggravation of symptoms and in many cases the treatment is only symptomatic and far less than satisfactory. The burden to caregivers, who need much support, is enormous.

The psychiatric manifestations in menopause can be divided into two categories of symptoms:

  1. Anxiety, reslessness, insomnia, ability of affect, irritability.
  2. Depression.

Depression is often triggered by a life event (death of husband, a sense of isolation because of children’s marriage, somatic disease etc.).

The premorbid personality traits in relation to those life events and the inability of some women to adapt to the new reality may lead to depression. On the other hand, there may be a history of phychiatric disorder in the past.

A biopsychological model may better explain the psychiatric manifestations in the menopause. This phase of woman’s life coincides with biological, psychological and social changes in her life. We have the appearance of endocrine and metabolic disorders, a decline in bodily and mental strength. There are also social changes, such as retirement, children leaving house (the empty nest syndrom), somatic disease in other family members etc. Only the hot flushes have a strong hormonal basis. The treatment should involve psychotropic medications and psychotherapy. Estrogen replacement therapy still remains controversial.

What pertains to social and intrafamillial changes, the main port is the personal attitude of the woman, in relation to premorbid personality characteristics. Individuals that are immature, with inappropriate attachment to the family of origin, exaggerated devotion to the children as a sole purpose in life, difficulties in adaptation, fear of ageing, often rigid, strong superego and feelings of insecurity and obsessive-compulsive traits and attitudes, are in highrisk to develop a psychiatric disorder.

Women have to reassured from the clinicians that the menopause is a normal phenomenon. In addition, they have to be trained how to better handle the frustrations of the new situation and the symptoms have to be reframed in a such a way that women can find new sources of satisfaction which will open new frontiers for them.

Key words: Menopause, neurological and psychiatric manifestations.