Ask Nurse Darby: When you feel stressed & depressed
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Q: I am 44 years old and recently had a total hysterectomy. While I am content with not having to deal with the dreaded monthly menstrual cycle, the downside is that I am now experiencing some issues that seem to be increasingly worse and I’m not sure what to do. I always feel SO TIRED and am very irritable. The worst thing is vaginal dryness. It has caused my desire for sexual intimacy to be almost non-existent because it is painful. For some reason, during all my pre-op education, I missed the part of the presentation that told me I may experiences these issues. I feel like I am being so unfair to my spouse because of the lack of intimacy and to my other family and friends because I don’t feel well and would rather be alone. I just don’t feel like myself anymore. What causes this to happen, and is there anything I can do about it?
First Things First…...You Are NOT Alone
As a nurse, I have had many opportunities to take care of women and help provide education on female health issues. The first thing that is important for you to know is, you are not alone.
If learning to maintain balance as a healthy woman were not already enough, women who begin to enter the menopausal stages of life experience several additional changes. While changes in hormone levels is one of the most common contributing factors to female health complaints, not all women have the exact same experiences. For this reason, I always advise finding a women’s health practitioner that you feel comfortable with and develop a good relationship with them.
Menopausal Symptoms & Facts
Women experience menopause differently. Menopausal symptoms appear to be more severe when it occurs over a shorter period of time or suddenly, such as with a total hysterectomy.
· Perimenopause is the stage during which menstrual periods begin to become irregular.
· Menopause is clinically defined as the lack of menstruation for at least one full year.
· Post-menopause is the time after which menopause has occurred.
Other than the changes in menstruation, the symptoms of the menopausal stages are very similar. Common symptoms include:
· Hot flashes
· Night sweats
· Weight gain
· Anxiety
· Decreased libido (sex drive)
· Headaches
· Increased growth of hair on other areas of the body, such as the face and neck
Let’s Talk Estrogen…...
While people have several hormones in their bodies, estrogen is considered the main female hormone. At the onset of puberty, estrogen plays a role in the development of what we commonly call female secondary sex characteristics. These characteristics include the development of breasts, wider hips, and the growth of armpit and pubic hair. It also helps regulate the menstrual cycle and controls the growth of the uterine lining during the first part of the cycle. As women age and begin to experience pre-menopause, estrogen levels begin to decrease. When estrogen levels become so low that the uterine lining no longer thickens, menopause occurs. A total hysterectomy is commonly called “surgical menopause.” This is because when a total hysterectomy is performed the ovaries are often removed, thus causing a woman’s body to stop producing estrogen.
Low levels of estrogen, whether caused by a physical condition or by menopause (natural or surgical), can have a huge impact on a woman. There are the well-known symptoms of hot flashes, mood swings, appetite changes, and sleep disturbance. Further, during menopause, when estrogen levels start to drop, vaginal walls become thinner, less elastic and less lubricated. This results in a few of the most common symptoms related to menopause which are vaginal dryness and painful intercourse.
So, What’s the Big Deal?
The big deal is, hormone imbalance is real, and it is more common than many people realize. For some reason, we women seem to have always had the notion that taking care of everyone else is more important than taking care of ourselves. While it is a nice gesture, and in some instances necessary, this is not always the case. Also, many women seem to have difficulty bringing up painful subjects like the ones we are discussing in this article. I cannot stress to you enough how important your health, happiness, and overall well-being is.
One thing that really concerns me is the number of women who feel depressed when they are going through menopause but don’t think they need to see their health care provider. The feeling of depression that many menopausal women experience can be attributed to several things. Some are physical, while others are psychological. For instance, many women value the ability to bear children and attach it to their self-worth. Once menopause occurs and that ability is gone, an unfortunate result is often depression. Don’t be afraid to talk to your physician or nurse practitioner!
Take Control
True story- When my son was eight years old, my best friend had to have an emergency hysterectomy. Her son and my son were best friends, as well. She had a habit of not taking the estrogen replacement medications that her doctor prescribed, and I could always tell when she had stopped them. In fact, everyone could. I will never forget the day that I realized I was having issues, too. I was feeling so frustrated and on edge all the time. This day, my son came into the kitchen and looked at me with a stern face and said, “Mom, you seriously need to buy a hormone like Ms. Jenny. It would make us all feel better.” I can laugh at it now, but at the time all I wanted to do was cry. The things kids say! Nevertheless, his “wiser-than-his-years” statement made me realize it was time for me to address what was going on in my own body and take control.
The old saying, “the first step is the hardest” is true on so many levels. However, you are worth it! I can’t stress to you enough the importance of having a women’s health provider that you can consult with. Having a routine exam and bloodwork is the first step to addressing any issues that may be going on in your body. Aside from seeing a practitioner, there are several things that YOU can do that will make such an enormous impact on your feeling of balance.
Yep! You guessed it! Two of the main things that you can do are to implement a healthy diet and exercise. Nutritionists encourage patients to be very conscientious of their diets when trying to achieve balance, especially post-menopausal women. Diet is important, for instance, because many female hormones are derived from cholesterol, which comes from foods like eggs, meat, or whole-fat dairy. Our bodies work in such a way as to try to create balance from the inside out, a process known as maintaining homeostasis. One way this happens is, if one hormone level is low, the level of another may increase. Further, if your diet doesn’t supply enough of the hormones you need (like no estrogen after a hysterectomy), your body will prioritize production of stress hormones first because they are necessary for survival.
Additionally, when we exercise, our bodies release chemicals called endorphins. Endorphins trigger a positive feeling in the body, often described as a euphoric-like feeling which can help ward off the depression minions. Many healthcare providers encourage patients who are dealing with symptoms of depression to not only exercise but try to engage in some type of group exercise. For example, joining an exercise group or exercising with a few close friends, will not only allow you to benefit physically, but will give you a feeling of emotional support, which is important.
When You Need More than Diet & Exercise
Diet and exercise are, of course, important, but there are some menopausal symptoms that simply need some more help. Many pre and post menopausal women mention that the most frustrating part of this stage in life is experiencing painful intercourse associated with vaginal dryness. While there are several options to treat vaginal dryness, which can reduce the incidence of painful intercourse, many people have turned to more natural options, such as V.Harmony. Some key features are:
- An Organic Formula
- Estrogen Free
- No Additives, Chemicals, or Dyes
Don’t be initimidated to mention natural remedies to your care provider. While some providers may encourage prescription medications or creams, you have a say about what is put on or in your body. Further, it has been my experience that most physicians or practitioners really respect the fact that their patients take the time to research options and state their concerns.
If you just don’t feel like yourself, trust your instincts. See your care provider. Talk to your family and friends. Become proactive in your own health and watch how things begin to change! You are worth it! Life has so much more to offer than being Tired, Stressed, and Depressed!
Nurse Darby has been a nurse and Allied Health educator for over twenty years. She has clinical experience in several specialty areas and has instructed nursing students at both community college and university levels. She has coached nursing graduates across the United States as they have prepared to take and pass the National Council Licensure Examination (NCLEX).
Darby loves to cook and spends much of her free time baking specialty wedding and birthday cakes. If you can’t find her writing or in the kitchen, it’s likely she is on a cruise, as this is her favorite get-away!
This blog provides general information and discussion about medicine, health and related subjects. The words and other content provided in this blog, and in any linked materials, are not intended and should not be construed as medical advice. If the reader or any other person has a medical concern, he or she should consult with an appropriately-licensed physician or other health care worker.