The Effect of Emotional Freedom Technique on Depressive and Menopausal Symptoms in Postmenopausal Women

Menopausal period is defined as the stage of transition to old age, which starts with the decline in ovarian function and decrease in reproductive capacity and ends with the end of reproductive ability over time. According to the WHO definition, natural menopause is the permanent cessation of menstruation with the loss of ovarian activity. The average age of menopause worldwide is 51 years and the transition to menopause occurs between the ages of 45 and 55. Menopause is defined after a 12-month amonereal period. Induced menopause is the cessation of menstruation as a result of surgical removal of both ovaries or external factors such as chemotherapy and radiotherapy. Before the age of 40, cessation of menstruation is defined as early menopause.

Approximately one-third of women experience no or mild symptoms during menopausal life, one-third experience moderate symptoms, and the remaining one-third may experience severe symptoms.The symptomatology experienced during this period is characterized by a hypoestrogenic state that occurs due to the decline in ovarian function in 60% to 80% of women. With menopause; estradiol level decreases 5-10 times, testosterone level decreases, follicle stimulating hormone (FSH) level increases 10-20 times and luteinizing hormone (LH) increases 3 times. As a result of insufficient secretion of sex hormones in women during this period, insomnia, vaginal dryness, irregular menstruation, depressive mood, irritability, headache, forgetfulness, dizziness, and vasomotor symptoms such as changes in body thermoregulation and night sweats may be observed. The experience of menopausal symptoms is individual and depends not only on hormonal changes but also on external factors such as living conditions, general health, social functioning and perceptions of aging. These factors can influence the perception and assessment of menopause.

The menopausal period is associated with various biopsychosocial changes, and some women may have physical and psychological symptoms of different severity. Increasing evidence suggests that increased sensitivity to estradiol fluctuation plays an important role in the development of depressive symptoms during the menopausal transition. A meta-analysis of 11 studies found that perimenopause is a period in which women are more likely to experience depressive symptoms compared to other menopause periods. In a descriptive study conducted to determine the quality of life in 99 perimenopausal women aged 45-55 years, almost all women experienced physical and psychosocial symptoms, while severe vasomotor symptoms and psychosocial symptoms were found in women who could not manage stress.

Depression affects approximately 350 million people worldwide and is a global burden. Depression is twice as common in women compared to men and the risk of depression may increase during periods of hormonal changes such as puberty, pregnancy and menopause. Although it is not specifically stated that there is a definite relationship between hormonal changes and depression, hormonal changes in the stages of women's life are called risky periods. Although the menopausal period, when hormonal changes are intense, is not associated with psychiatric disorders alone, it may increase the risk of a history of depressive disorder, especially in women in the perimenopausal period. Absolute levels and fluctuations of hypothalamic-pituitary-gonadal hormones during menopause are possible predictors of mood disorders and depression in perimenopause.

In a cross-sectional study conducted in Switzerland with 114 women aged 40-56 years, menopausal symptoms were significantly associated with perimenopausal depressive symptoms. As a result of a study on Women's Health Needs in China, in which 3199 women aged 40-55 years were examined, the prevalence of depressive symptoms was 19.3%, while there was a significant relationship between menopausal symptoms and depressive symptoms. In a descriptive study conducted with 176 women aged 45 to 60 years in Korea, it was determined that menopausal symptoms significantly affected depression status. In a descriptive study conducted with 749 women aged 45-60 years in Brazil, it was determined that moderate menopausal symptoms were significantly associated with depression or anxiety. Elaslan (2018) found that 64.4% of menopausal women aged 45-55 years experienced physical-psychological problems. Aygün (2019) conducted a study with 112 women aged 40-64 years and found that 25% of women had depression, while those who entered menopause had higher depression scores than those who did not.