Linda had been well, both physically & mentally throughout her life, with the exception of some benign growths in the uterus, known as fibroids.

 There was no history of PMS/PMDD, post-partum depression or even the post-partum (post-natal) blues, in fact she even had an easy transition through the passage of her teen years.  In other words, from a mental viewpoint, Linda had been like a rock. 

When Linda entered her forties however, and stopped ovulating, her cycles became farther apart & her fibroids now began to bleed.  As time went on, this vaginal bleeding became heavier, more painful & more prolonged, leading to fatigue & Iron-deficiency anemia.  Rather than testing her progesterone levels or giving her a trial of progestins, her gynecologist rapidly recommended a hysterectomy, while casually recommending removal of the ovaries as well and Linda agreed, wanting to get on with her matter of fact, down to earth life.  And that's when Linda underwent an abrupt, atypical surgical menopause, literally overnight, leading to dire consequences for which she was totally unprepared.  

The consequences of castration

There is more than one road leading to menopause, & consequently more than one type or variant of the menopausal experience exists.  A natural, spontaneous form of menopause occurs, if one lives long enough, at the average age of 51, as the ovarian machinery for producing the estrogenic hormones runs down, leading to two sets of symptoms & consequences.  The first has to do with levels of sex hormones (estradiol & testosterone) that are dynamically dipping, whereas later on in the process, as these two sex hormones become consistently depleted, different symptoms & consequences occur, driven by estrogen depletion & later by testosterone depletion.  

During the transition that characterizes a natural, spontaneous menopause, at first the levels of estradiol & testosterone become highly erratic, fueling mood swings, agitation & anxiety.  Then the production of estradiol begins to dip lower & lower, as the estrogen-generating mechanism goes deeper & deeper into a failed state, & the body becomes inexorably depleted of estradiol. However the same does not occur with the  mechanism for producing testosterone.  in normal women, while the shift in estradiol production is taking place, testosterone production continues unabated for about 4 or 5 additional years, thus buffering the menopausal woman against the potentially negative impact of dipping estrogen levels.

dipping estrogen levels. 

An atypical menopause

But in some women, including those whose ovaries have been prematurely removed or those whose ovaries have been poisoned by chemotherapy, all of the hormone-producing mechanisms in the ovaries are simultaneously wiped out, not gradually but abruptly.  As a result the body suddenly becomes depleted not only of estrogens but of androgens, leading to symptoms relating not only to the suddenness but to the completeness of the hormonal depletion.  So whereas depression in the woman going through a natural menopause often depends upon a past history of mood disorder, an inherited vulnerability that hormonal shifts are capable of activating, depression in the castrated woman is frequently triggered by hormonal deltas so severe that they can trigger mood disorders even in those not particularly prone to getting them,even those who have never experienced mood disorders before.  

And of course that is exactly what happened with Linda.  After surgery, she slipped rapidly into a deep, suicidal depression.  Her personality became altered, her persona unrecognizable, & her husband wasn't man enough to support her through this difficult process.  Linda's though-processes became disrupted, with memory loss & difficulty with thought-processing so that she became a poor advocate for herself, a woman easily judged & criticized. Even her grown children became critical of her, and a divorce quickly followed, in which she was poorly served by the system. 

Fortunately for Linda her sister dragged her in to see me.  I was able to explain that the flip-side of having a surgical menopause, the positive aspect of it, is that one cannot develop cancer in a uterus or a set of ovaries that no longer exist, & that since the uterus had been removed already, there was no need to administer progesterone or progestins to Linda, the most likely source of hormone replacement therapy risks & side-effects.  Thus the pro-depressant effects of progestins could be avoided, & one didn't have to worry about irregular bleeding or cancer.  When Linda, by no means yet right in the head still resisted the idea of hormone therapy, I explained the other consequences of early removal of the ovaries, including not only a high risk for suicide but also a dramatic increase in the development of premature heart disease, stroke & dementia.  She finally got the message & was treated with steady-state regimens of estradiol & low dose testosterone with excellent results, both mentally & physically, while avoiding any forms of psychiatric drug therapy. 

Now that she could think clearly & logically again, Linda patched things up with her children, who should have known better, but her ex-husband will never be forgiven.