With any major transition in our lives, there is potential for feelings of grief, or deep sadness in response to something we’ve lost. We often associate grief with the loss of a loved one, but grief can also come with other transitions: job loss, divorce, children leaving for college, retirement. Breast cancer and menopause definitely qualify as major life transitions.
Grieving is a natural and expected response to the experience of breast cancer. It’s normal to grieve the loss of security about your own health, the changes in your body, the shifts in relationships, uncertainty about the future. And you could experience grief as a result of menopause. Women who go through menopause naturally sometimes grieve the loss of their youth, the uncomfortable and disruptive symptoms, the uncertainty of aging, and the other life transitions that tend to happen around the same time. Younger women sent into menopause as a result of breast cancer treatments might grieve the loss of fertility, the side effects, the impact on relationships, and the unfairness of being “menopausal” years before they ever expected.
Grief Vs. Depression
If you grieve at this time, rest assured that it’s normal. But you should also be aware of the difference between normal grieving and depression. Both can cause feelings of sadness, loss of interest in usually pleasurable activities, and problems with eating and sleeping. Grieving is a process, though: You have these feelings but you move through them, and with time you start to feel better. Clinical depression tends to last longer and causes more intense feelings with more severe impact on day-to-day function. You can think of depression as being “stuck” rather than moving through a process. You can have incapacitating feelings of anxiety, worthlessness, and/or even despair, which can take away your ability to function and enjoy activities that once gave you pleasure. These feelings may be constant or they may come and go, but you’re not moving forward. You’re not likely to get “unstuck” until you get some kind of treatment.
Going through menopause naturally as a normal part of aging doesn’t appear to increase the risk of clinical depression. But if natural menopause makes you extremely uncomfortable due to hot flashes, vaginal changes, and sleep disturbances, it could contribute to depression — especially if you’re facing other sources of stress at midlife, and/or you’ve had depression in the past. It’s a different story if you’ve been sent into menopause abruptly as a result of your cancer treatments, several years before you ever expected to be there. The rapid decline in hormone levels can throw you into a depression not unlike postpartum depression.
Instead of or even in addition to feelings of depression, some women find that their moods are all over the place when they’re going through the menopausal transition. They may be feeling up one minute and down the next, or snap at friends or family members over small things. We don’t know if this is due to the hormonal changes of menopause or to the bothersome symptoms it can bring, such as hot flashes and sleep problems. We do know that parts of the brain have estrogen receptors — key areas that “lock in” the hormone so it can do its work. So it’s conceivable that the lowering of estrogen could affect your moods—and the effect might be more pronounced when it happens more quickly, as it can with some breast cancer treatments.
If you think you have clinical depression, ask your primary care doctor or oncologist to refer you to an accredited mental health professional, such as a psychiatrist, psychologist, psychotherapist, or counselor. Together you can assess your situation and discuss treatment options. The same advice holds true if your mood changes are severe enough to interfere with your quality of life.
In the meantime, don’t underestimate the power of lifestyle changes to help you start feeling better. Regular exercise is a must for keeping stress levels down and boosting your mood. Also consider activities such as yoga, meditation, or sessions on relaxation and mindfulness training. Visit Breastcancer.org’s sections on Exercise and Complementary & Holistic Medicine for some ideas that can get you started.
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