Will surgical menopause cause depression or anxiety?

Keywords: Depressed. Anxiety. Anxious. Surgical Menopause. Stress.

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Written by IAPMD
Updated over a week ago

It depends. This is a difficult question to answer, because it depends in large part on the reasons for your surgery (e.g., PMDD vs. endometriosis) and whether or not your brain is sensitive to particular hormone changes. 

Brain Sensitivity to Changes in Estrogen.
In general, studies have found that women during menopause were more likely to suffer from depression, when estrogen levels were decreased. Based on the reports, it is important to consider  that the low levels of estrogens may be associated with depressed mood, especially for women with a predisposition to depression. Both experimental and longitudinal studies show that women differ widely in how sensitive they are to these estrogen changes. For those who are sensitive to low or falling estrogen, appropriately-titrated estrogen replacement therapy (ERT) may help to prevent the development of depression during the menopause transition, particularly among women with high levels of stress. However, there are also conflicting studies in this area, so if you are experiencing depression during the menopause transition,  it is important to work with your doctor to find an effective treatment for your individual case (e.g., increased ERT, cognitive behavioral therapy, SSRI, or other treatments). 

Brain Sensitivity to Changes in Progestogens.
Some people, especially those with PMDD, have a severe brain sensitivity to changes in progesterone (which can include a sensitivity to changes in related medications, such as the progestins found in oral contraceptives). This brain sensitivity to progesterone and its metabolites causes severe mood and anxiety changes for these individuals.  Therefore,  for those who have sensitivities to progesterone changes, surgical menopause can provide much-needed relief of their depression and anxiety symptoms, particularly once their bodies have had time to adjust to the surgery and any ERT changes. So although some of these individuals may still experience increased depression in surgical menopause if they are sensitive to changes in estrogen (see above), they will also likely see a massive reduction or elimination of progesterone-related symptoms. 

Remember: Emotional Changes are a Normal Temporary Response to Surgery.
In addition to the impact of hormonal changes, it is important to keep in mind that surgical interventions are very stressful for the body and brain, and that the psychosocial adjustment to being in surgical menopause can also be stressful. During this time, it can be normal to have more intense emotions, and this normal healing time should not be interpreted as “the surgery didn’t work.” It may be important not to over-analyze how you feel immediately following surgery, since it can take a while for the stress of the transition to subside. It can be an overwhelming time - especially if PMDD/PME has had a large impact on your life. Give yourself time and make sure you reach out for support if you need it.

Visit www.iapmd.org/surgery for lots of evidence-based information and resources for those considering, going through or recovering from surgery for PMDD/PME.

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