Muhammad Shafique ( Department of Psychiatry Khyber Medical College, Peshawar. )
A study of Psychiatric Symptomatology in 20 women in Climacterium is presented. Apart trom the vasomotor symptoms they complained of sadness, nervousness, insomnia, headache, irritability and anorexia. None of them had any such complaints before. The menstruation, pregnancies and puerpeure of these women were uneventful.
Characteristics of a flush have been documented. The cultural beliefs as reported by the patients concerning the effects of menopause on women’s health have been described (JPMA 34 33, 1984).
Psychiatric symptoms are considered to be a part of the cliniacteric syndrome by the majority of workers in the field. Some of them consider these to be the direct result of hormonal imbalance (Furuhjelm and Feder-Preybergh, 1976) while others believe them to be a consequence of the vasomotor and other somatic complaints (Russel de Alvare, 1977). The usually reported symptoms are fatigue and depression (Jaszmann, 1973), nervousness, irritability, sleep difficulties, depression, impaired memory and decreased libido (Furuhjelm and Feder-Preybergh, 1976) and decreased energy with a tendency towards nervous exhaustion (Kopera, 1973/ Culturally determined expectations of the effects of menopause have been considered to be etiologically important (Van Keep and Humphrey, 1976).
Material and Methods
Most of the 20 patients had reported to psychiatric clinic or outdoor while some were referred from Gynaecology Department of Khyber Teaching Hospital, Peshawar. The patients and where necessary and possible the relatives were interviewed and the findings recorded on a proforma. Women in the climacteric age group with or without the cessation of menses presenting with the characteristic vasomotor symptoms were included in the study.
The age of the patients ranged from 35 to 55 years. Sixty five percent of the patients had menopause 1-5 years prior to the consultation while 15% were still menstruating (Table I).
The most commonly reported symptoms were sadness and nervousness (90%) followed by insomnia and headaches (80%). Irritability was reported in 70% and 50% bad anorexia (Table-II).
None of them had any past history of such complaints. 80% reported frank flushes with sweating while the remaining 20% felt a wave of warmth moving’ on the body accompanied by sweating but no obvious redness of face or trunk. Some characteristics of a flush are presented in Table-III.
The menstruation, pregnancies and puerpeurea of these women had been uneventful. Furuhjelin and Preybergh (1976) have reported memory defects but these were not found in the present study.
The attention to the mental state of a woman in climacterium is crucial because in a vast majority of cases she is the mother of children either in adolescence or in early adulthood. Her mental health is going to have far reaching repercussions on the psychological wellbeing of her family and even ,the next generation. On her mood, temper, perceptIon o herself and her environment, will hinge the happiness of the family. This is specially true in cultures like ours where extended family system still survives. As regards woiking woman it is in this period that she achievetthe highest level of responsibility. On her well-being wifi depend the health of the institution, organization or department which she heads.
In the Western culture the gloomier and darker side of the picture has been emphasised. To them, menopause means the end! of youth, beauty, vigour, even feminity (Vankeep and Humphrey, 1976). The usual fear expressed is that she has lost attraction for husband or that her life has become empty with growing up and moving away of the children. In the subcontinental culture, the situation is not all that depressing. While there may be some fears regarding physical effects of the menopause, middle age for a woman in this culture may be the best part of her life. It may bring her freedom, status and authority. There may be some regrets regarding loss of vitality and youthful charm but the maturity of the years brings a flowering of personality. This may be the reason why none of our patients expressed any such anxieties. The cultural beliefs held about the effects of menopause are that it leads to diminution of vision and abdominal distension.
Different women describe the feeling of a flush differently. Usually they feel hot and like to take off their chadar, dopatta, any heavy clothing, unbutton their shirt or more typically throw away the blanket at night. Some may pour water on their head or wash their face. The duration of a flush has been said to be a few sedonds (Russel de Alvare, 1977) but the duration reported by majority of our patients is between 1-5 minutes.
The fact that psychiatric symptoms are important part of the climacteric symptomatology should be kept in mind by the non-psychiatric doctors. Whether hormones alone will control the psychiatric symptoms or psychotropic medication is also indicated remains to be investigated. This will need collaborative studies by psychiatrists and gynaecologists.
1. Mirjam Furuhjekn, P., Feder-Preybergh. “The influence of Estrogens on teric the psyche in climateric and post menopausal women, consensus on menopause research, 1976.
2. Russel de Alvare-1977 ‘The Text Book of Gynaecology’.
3. Jaszmann, L. (1973) Epidemiology of climacteric and post-climacteric complaints’ Aging and Estrogens. Front. Horm. Res., 2 : 22.
4. Kopera, H. (1973) Estrogens and psychic functions. Ageing and Estrogens. Front. Horm. Res., 2:118.
5. Vankeep, P.A. and Humphrey, M. (1976) Psychosocial aspects of climacteric, Consensus on menopause research.