Stories: Voices from the frontline


Veronika Zantop, M.D.

Anxiety. Depression. Irritability. Rage. 

Aside from the well-known physical changes that come with menopause, women can experience a range of mental health complications. Unfortunately, for too long health care hasn’t given them the information they need to anticipate those effects and popular culture has treated them as a punchline. 

Psychiatrist Veronika Zantop, M.D., understands that that needs to change. She has extensive experience treating pregnant and postpartum women with anxiety and depression at our Center for Perinatal Bonding and Support that she’ll bring to bear when she joins the Women’s Wellness and Specialty GYN Services at Swedish this December to care for women in menopause. 

Before she does, though, we asked her to explain why women experience these complications and how comprehensive, coordinated care can help. 

Are these complications a result of biology or an emotional response to a change as significant as menopause? 

There are some women for whom there’s no question that their symptoms are specifically related to changes in hormones. It’s like a switch flips and suddenly they’re really depressed of extraordinarily anxious. There’s a lot of research going on right now about how changes in hormone levels affect cellular energy in the brain and the issues that can arise when neural circuits aren’t working as well as they used to. 

On the other hand, there is also a situational component to it. Menopause represents the end of your reproductive potential. And on top of that, we live in a society that values beauty and being young over all else. So maybe you’re dealing with that on top of hot flashes and insomnia. These things can piggyback on one another—insomnia increases your risk for anxiety and depression, which can increase your risk for insomnia, for example—and lead to a negative spiral. 

It probably doesn’t help that as a society we either don’t talk about menopause as much as we should or we attach a stigma to it. 

When you’re going through puberty, there are classes in school that prepare you for it. There are funny books about it. It’s the subject of movies. But people don’t really talk about menopause. So women are very uninformed. I think most women know about hot flashes or maybe insomnia, but the cognitive effects, the effects on your libido, anxiety, depression—those are discussed a lot less. And that’s a problem. 

How do we fix that? 

We need to talk about it more, to make it public. But we have to be careful. We don’t want to imply that when women are in menopause, they’re all suddenly going to lose their cognitive faculties or become moody or enraged and therefore less productive. A lot of these things can be used against women. 

So the idea is to support women through these biological changes while framing it as something that’s not just negative. It’s a life transition, but what does it mean to be going through it or on the other side of it? 

And it’s important to point out that not every woman looks at it as a negative. For some, their kids are out of the house and they have more freedom. They can spend more time with their partner. They’re closer to retirement. They have all of this accumulated wisdom. So focusing more on the positives, while still being real about it. 

How has our understanding or perception of menopause and the associated mental health complications changed over the years? 

We have research that indicates that there is a biological basis for these effects, as opposed to them being “all in your head.” That’s been really, really important. 

What treatments are available? 

A combination of talk therapy and medications that are very effective for treating mood or anxiety symptoms precipitated by shifts in hormones. In fact, there are new infusions developed for treating postpartum depression—another period when women experience a significant hormonal shift—that may one day be available for treating depression related to menopause. 

Aside from “talk to your doctor,” what advice would you give a woman who’s experiencing these mental health complications while going through menopause? 

That’s the problem, right? A lot of women talk to their doctor, who tells them, “I don’t know,” or “We don’t have those resources,” or “Go see a psychiatrist or a sleep specialist or …” What women want is a more holistic approach to addressing menopause from a team of specialists who work together to provide treatment that’s tailored to their needs. That’s what we plan to provide at Women’s Wellness and Specialty GYN Services at Swedish.

Medicine has worked in silos for so long. But everything in your body is constantly communicating back and forth. That’s true of menopause as well. Everything comes together to impact your brain function and body function, so breaking down some of those barriers between disciplines and offering women more collaborative care is so important. 

For more information on how you can support Women’s Wellness and Specialty GYN Services at Swedish, please contact us at 206-386-2738 or [email protected].