That sinking feeling


That sinking feeling

Have you seen elderly women, happily settled, suddenly behaving oddly? Is depression more common among women in their autumn years? Anju Munshi takes a look at women in the ‘changing years’

The normally placid Leela Roy (name changed), a homemaker in Kolkata, gave quite a fright  to members of her family one day by bursting out in anger, throwing things around and then retreating into a sullen silence. What could have stirred her so after thirty odd years of happy conjugal life?  Hysterical outbursts, bouts of depression, mood swings followed in the following weeks and ultimately the family reluctantly decided to consult a psychiatrist.

The doctor was not at all surprised. The emotional health of women in the post-menopausal stage can be quite fragile; Some cope while some break down under the impact of both physical and mental change. Today, people are aware of the hormonal warfare that goes on as a woman stops menstruating and the estrogen level dips but often the emotional health that accompanies it is ignored.

Many think that as long as the physical well-being of post-menopausal women is taken care by way of mammograms, pep smear tests, vitamin and supplements etc. everything should be ‘normal.’ But one vital parameter goes unnoticed — her mental and emotional well being. Around this time many changes take place in her life within the family; children leave for colleges or jobs, husband retires or is ready to, the daughter-in-law steps in and her authority gets diluted, ailing seniors may need attention. In short, a pile of woes followed by unexplainable fatigue.

This is also a time when her self-worth as an attractive woman is under threat. The sagging skin, crows’ feet, wrinkles — the mirror tells the true story. Because of the physical changes, she feels less comfortable with her body and that affects her self-esteem too. Depression or anxiety starts interfering with her libido and sex life. She feels confused and rejected. “Already frazzled by her depleting hormonal resource and the empty nest syndrome, she compounds her misery by her misconception that changes in her spouse’s behaviour are not symptomatic of his age, but a clear indications that all is not well with their relationship,” observes Roma Circar, 52, a writer and teacher from Kolkata, who feels that men also undergo a ‘slow down’ but get misunderstood as being callous.

Research by the Menopause and Mood Disorders Clinic, a part of the Yale Behavioral Gynecology Program at the Yale University School of Medicine, USA, shows that estrogen regulates brain activity and that, loss of estrogen can impact mood and behaviour. An approximately 85 per cent of women have some kind of reaction to estrogen loss and 15 per cent of them have more severe symptoms. The clinic offers comprehensive evaluation and anti-depressant treatment for menopausal women.

‘Coping’ is something a  women are generally endowed with but that is too general an
idea. She too needs help, says Purnima  Kaul, a Kolkata based gynecologist. “Almost one third of a woman’s life is in post-menopausal period and two aspects of modern life — urbanisation and migration, have deprived elderly women of the traditional support from family and community at this time leaving them insecure and vulnerable.”

Generally, women don’t talk about these psychological symptoms due to socio-cultural and economic factors. “Symptoms such as anxiety, irritability, depression and insomnia are most common before the onset of menopause. Falling estrogen levels contribute directly to mood changes, vasomotor symptoms with night sweats often lead to chronic fatigue, sleep deprivation and hence indirectly to psychological symptoms like depression,” says Kaul, adding,  “These have to be dealt with medical and social responses.”

Research also points to the fact that women end up feeling defeated and unhappier than men later in life — even though they start out happier. “Women start happier and enthusiastic than men in early adulthood — but the glow wears off with time,” says Bhashwini Thakkar, a psychologist with Delhi’s Basera, an old age home.  In later life it is men who come closer to fulfilling their aspirations, are more satisfied with their family lives and financial situations, and are the happier of the two, she observes.

Doctors usually recommend physical activity to fend off the problems, says Mumtaz Wani, psychologist, Lal Ded hospital, Srinagar.  “Physical symptoms like hot flashes do go away with diet and exercise but mental and emotional health is something women still need to think about post-menopause,"

Sheila Rathore, 58, a  grandmother from Indore, feels that research on menopause needs more attention as more and more women are getting educated and becoming increasingly aware of their needs and are taking greater interest in their  health issues.

Doctors say that it is imperative to go through a proper medical treatment after a woman reaches menopause, even if she has no specific symptoms. That way, one gets to evaluate the vulnerability to depression and be prescribed antidepressants especially for women who are left alone as widows, abandoned mothers or wives. Some women disagree with this line of treatment as the drugs have side effects. “More important than being used as guinea pigs, support groups and counseling works better,” feels Veena Chauhan, a widow who lives all by herself.

In South-East Asian countries, aged parents traditionally stay with their children, which can be ‘debilitating’ for them, feel some. “In our country upbringing and values are such that you cannot leave your aged parents alone, but I don’t agree with this. My mother, 69, stays alone in Chennai. I visit her twice a year. She is actively involved with her domestic errands and enjoys it. She moves around with her gang of friends and must have a weekly coffee and bridge session. Also staying with your peers makes you see yourself in an equal light,” says Jaya Thambi, 30, from Kolkata .

Kaul strives to make women aware that they do not have to suffer in silence. “We want to let women know that treatment is available for many of these symptoms.”

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