How Puberty, Pregnancy And Perimenopause Impact Women's Mental Health
"Crazy," "hysterical," "overreactive," "hormonal." These are stereotypes many women still have to fight to be taken seriously. And that fight can be especially challenging because so many women do face very real symptoms such as bloating, headaches, irritability and mood changes — often on a monthly cycle.
These symptoms, especially ones around mood, are often stigmatized and hidden. But they can be signs of changes in hormone levels — estrogen, specifically — and those changes can become more pronounced, and even severe, at key points in women's lives: puberty, pregnancy and perimenopause.
Perimenopause is the longest of the three phases — it can go on for a decade or longer — and is often the most misunderstood by women, who may not know its symptoms until it's happening or confuse it with menopause. Perimenopause is when a woman's fertility is winding down, menstrual periods become irregular and, eventually, when menopause is reached, menstruation stops. Mood swings are among the symptoms women report, as well as hot flashes and difficulty sleeping.
There's a lot that researchers don't know about the role hormones play in mood changes and depression — the latter affecting women at twice the rate for men. But they do know that changes in hormone levels are linked to certain types of depression, and there are types of depression that are unique to women.
In a series airing this week on Morning Edition, NPR explores what's actually happening in a woman's body at these pivotal moments and how to manage the unforeseen effects, such as anxiety and depression.
Click the play button to hear the first conversation in the series. Copyright 2020 NPR. To see more, visit https://www.npr.org.
RACHEL MARTIN, HOST:
Last week, I talked with author Ada Calhoun about the unique stresses facing women who are part of Generation X, the generation born between about 1965 and 1980.
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ADA CALHOUN: The pressure on women now to not only be great at work and, you know, great at home but also just, like, to be really exceptionally thoughtful and patient parents - it does feel like it's really high right now.
MARTIN: Her book is called "Why We Can't Sleep: Women's New Midlife Crisis." And in it, she also addresses the physical and emotional stress women face in midlife, not just the social pressures or economic strains. All of that stress is actually compounded by the big reproductive change that happens in that time of life. Yeah, we're talking about menopause, the end of monthly periods and the end of fertility. Here's Ada Calhoun.
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CALHOUN: I just found it really helpful to know that this is a set period of time, that these years, middle age, have been rough, especially for women, for many, many generations and that it's hard for us. But it's going to be over at some point.
MARTIN: Menopause is the last big reproductive shift for women. There are all the hormonal changes that happen in pregnant women and after those women deliver babies. Here's Jennifer Ford (ph) of Massachusetts.
JENNIFER FORD: It's very hard to admit that, you know, something's not right, I mean, especially when you have a new baby in the house and it's supposed to be this wonderful, happy time. And it's just that's not how it was.
MARTIN: And, of course, the first big change happens in puberty. This is 15-year-old Isatou Barrow (ph). She's from New York and one of the hosts of the podcast Shh! Periods.
ISATOU BARROW: No, I actually suffer from, like, depression. Like, I really get depressed a lot. Whenever, like - whenever I get depressed, that means, like, my period, like, comes - that's why.
MARTIN: All this week, we're going to be talking about these pivotal moments in a woman's life, what is actually happening biologically and how to manage the unforeseen effects. Our guide through this series will be NPR health correspondent Rhitu Chatterjee, who joins us in the studio now. Thanks so much for coming in.
RHITU CHATTERJEE, BYLINE: My pleasure, Rachel.
MARTIN: So we just heard that very moving tape from 15 year old Isatou Barrow talking about her own depression, what she feels when she's about to start her period. And that is what is so complicated - right? - about these reproductive turning points in a woman's life. There's the physical and also the emotional stress.
CHATTERJEE: Right. And these are times when women's bodies are going through these enormous, big changes, which often involve hormonal changes. And that makes them vulnerable to emotional stress and mood and mental health symptoms. So a lot is changing in the lives of girls and women socially, emotionally, physically. And most women, I think, will experience PMS symptoms, for example, around their periods. And then there are more serious symptoms, like depression and anxiety, that can crop up at these times in life.
MARTIN: And then for women who get pregnant, there's this period around pregnancy postpartum. Talk about what that can look like.
CHATTERJEE: So 1 in 7 women usually develop major depression during pregnancy and postpartum. And among some women, like those who have a history of trauma, the rate is even higher. And the symptoms are usually like that of any major depressive episode. So women get - you know, they feel hopeless. They - getting out of bed is hard. They can feel weepy, and they struggle to get through sort of daily activities taking care of themselves and even their babies in the sort of postpartum period. And some women have heightened anxiety, so they have trouble sleeping. They're hypervigilant, worried about something happening to their baby. And for an even smaller minority of women, things can get as bad as postpartum psychosis. Now, it's rare, estimated in only about 1 or 2 out of a thousand deliveries, most often within the first two weeks of childbirth. But it can happen.
MARTIN: Right. So understanding that it's rare, what does that look like? How does it manifest?
CHATTERJEE: So psychosis is a break from reality. So women can feel delusional. They have hallucinations. They can be hyperactive, unable to sleep. They feel paranoid and suspicious. And a small minority of them can even be suicidal and attempt to take their own lives.
MARTIN: So now and again, it's worth saying we're identifying all these stages because we're going to talk about coping mechanisms...
MARTIN: ...Through this series and how women can deal. But let's talk about menopause because this is something that is confusing to a lot of women because we don't talk about it a lot.
CHATTERJEE: We don't talk about it. And that's something that, in the process of reporting on this, we sort of reinforce just how much of a silence there is around this and lack of information. So menopause is just one day in a woman's life when she hasn't menstruated for a year. And the period most of us think of as menopause is actually what researchers called perimenopause. And we don't realize that that period can last anywhere between four to 10 years when our bodies are sort of changing dramatically to prepare to put a stop to menses - or the periods - which we've spent our entire lives (laughter) getting accustomed to.
MARTIN: But wait. Ten years?
CHATTERJEE: It can for some women. Not everybody - but yep, it's four to 10 years.
MARTIN: It's so interesting - the menopause, the actual moment of menopause - it's just a day.
MARTIN: Wow. So we're going to talk about all this through this series, but we have to acknowledge in this conversation that the very idea that a woman would be mentally or emotionally compromised during reproductive turning points is something that has been manipulated since the dawn of time to diminish women, to oppress women. Those societal stereotypes have been used to push women out of public life.
CHATTERJEE: Oh, I still hear it. You know, when - as a joke, people will say, oh, she's just hormonal. She's just, like, crazy hormonal. And it's still used to sort of belittle women to not take them seriously. But what researchers tell me is that women going through these sort of stages of life and times when they are under the influence of hormones that might be affecting their mood, the problem is that they're way too tough and resilient, that they're so used to dealing with so many of these big changes throughout their lives, they're always trying to sort of tough it out and not take care of themselves, not pay attention to whatever symptoms they're experiencing. And on top of that, take the stigma, societal stigma around mental illness in general. And that prevents women from sort of speaking up or even acknowledging to themselves that, hey, I'm not doing that well. And if I don't take care of myself, I'm not going to be able to take care of all the other people in our lives, which is what, a lot of times, women are way too busy doing.
MARTIN: Rhitu Chatterjee, NPR health correspondent. Thank you so much, Rhitu.
CHATTERJEE: Thank you, Rachel. Transcript provided by NPR, Copyright NPR.