For some women, the premenopause, perimenopausal and early postmenopausal years are a heightened time of vulnerability to life's stressors—much like what might occur the year after giving birth, says one researcher.
Cosmetic surgeons consulting with these women, often in their 40s and 50s, should ask these women how they have been coping, and if they feel depressed. If they diagnose or suspect clinical depression, cosmetic surgeons should consider putting off cosmetic or other surgery until the patient's depressive state improves, according to Lorraine Dennerstein, A.O., M.B.B.S., Ph.D., D.P.M., F.R.A.N.Z.C.P., professor, department of psychiatry, University of Melbourne, Australia.
"It is a common urban myth, I think, that older women are grumpy and irritable. In fact, they are not," Dr. Dennerstein says. "The peak age for moods among women is about 35, and it tends to get better with time — even as they go through the transition."
Dr. Dennerstein says that one explanation for this waning of moods is the strong link between women's moods and their menstrual cycles.
VULNERABILITY TO STRESSORS Dr. Dennerstein did note in her research, however, that women going through the change tend to have more trouble coping with stressors.
"The body always has to adapt during phases of hormonal change," she says. "So, during the phase of hormonal change, if you are subjected to stressors, they have a much greater impact than when you are in regular hormonal cycles."
These stressors include losing a job or house, the breakup of a marriage, illness and more. Cosmetic surgeons consulting with women in premenopause or menopause might hear, for example, a patient complaining that she used to cope with things better than she does now. Those patients, according to Dr. Dennerstein, could be at greater risk for developing clinical depression.
"That is similar in life to a year after having a baby, which is the time of greatest psychiatric risk for women," she says. "If you think about it, it is a huge hormonal stress going from a pregnant to the postnatal state and, at the same time, if you add another big stress, a woman is likely to have a hard time coping."
However, this does not mean that all women are ultra-sensitive to stressors during times of hormonal shifting. "Some women, even when subjected to enormous stress, will never become depressed," Dr. Dennerstein says.
FINDING THE CLUES Clues that a woman could be at higher risk for clinical depression during the menopausal transition are if she has a history of depression, family history of depression or history of hormonally linked depression, as in premenstrual syndrome or postnatal depression.
Other questions that could help a surgeon determine if a woman in her menopausal transition years is in good psychological shape for surgery include whether she has had any significant, negative issues of late, and how she has coped.
A surgeon's awareness of psychological vulnerabilities when women transition into menopause is the first step. The next is to diagnose the condition. At that juncture, either the surgeon should feel comfortable diagnosing and treating depression or refer the patient to her primary care doctor or a psychiatrist.
"We have come a long way in the treatment of depression and have a multiplicity of excellent options that are quite simple to use," Dr. Dennerstein says. "But I am not sure that a surgeon who has not been using antidepressants is the right person to prescribe them, because if there are side effects, he would not know how to go about treating them." In most cases, patients can safely remain on antidepressants through surgery, she adds.
There is a link between depression and body dysmorphic disorder. Depressed patients are also more likely than non-depressed patients to have co-existing alcohol or drug abuse issues. And self-care tends to lessen when a person is depressed, which could affect compliance, Dr. Dennerstein says.
"It is never a good thing to do surgery (cosmetic or functional, for that matter) on someone who is depressed, because she may be reviewing all her choices the wrong way at that point in time," Dr. Dennerstein says.