ABC’s of Menopause: Depression

Menopause is the “gift” that keeps on giving. With 34 associated symptoms that can easily be ascribed to a myriad of other health conditions, it can be impossible to know if what you’re experiencing is tied to menopause without a hormone test. Each week this series will break down symptoms to empower women to take back control of their health and enjoy some relief.

It’s been reported that 18% of women in early perimenopause and 38% in late perimenopause experience depression. Mental health has become an integral part of the cultural Zeitgeist, with awareness and concerns about emotional well-being now deeply embedded in society’s collective consciousness. However, menopause can still feel isolating due to its stigma and a lack of comprehensive support from healthcare providers. As a result, when hormone fluctuations cast a dark shadow, many women find themselves silently grappling with its impact. 

Depression during menopause is a challenging journey, but you do not have to navigate it alone. With help, it's possible to embrace this new chapter with resilience and strength. And if you are currently experiencing a crisis and thoughts of self-harm, don’t lose hope. Call or text 988 to speak with a mental health professional who will provide you with confidential, free support and resources. You’re not alone in this.

What Causes Depression in Perimenopausal Women?

The onset of perimenopause is primarily driven by hormonal changes, most notably a  decrease in testosterone and progesterone with high fluctuations in estrogen levels. This hormonal shift can impact the brain's neurotransmitters, leading to mood disturbances and potentially contributing to depression. Progesterone and Estrogen play a vital role in regulating serotonin, a neurotransmitter associated with mood and emotional well-being. As a woman officially enters menopause (after no periods for greater than 1 yr) and estrogen levels decline, serotonin levels can become imbalanced, leading to feelings of sadness, despair and anxiety.

According to another study published in the Journal of Women's Health, it is estimated that approximately 20% of women experience depression during perimenopause and menopause. The hormonal fluctuations that occur during this transition are considered a significant factor in the development of depression. Other risk factors for menopause-related depression include a personal or family history of depression, chronic stress, and a lack of social support.

How Do I Know if My Depression is Menopause Related?

Differentiating menopause-related depression from other forms of depression can be challenging, as the symptoms often overlap. Common symptoms include:

• Persistent feelings of sadness or hopelessness.
• Loss of interest in previously enjoyable activities.
• Irritability and mood swings.
• Changes in sleep patterns, such as insomnia or oversleeping.
• Fatigue and low energy levels.
• Difficulty concentrating and making decisions.
• Changes in appetite and weight.
• Other menopause symptoms such as hot flashes, night sweats, and weight gain.

If you are experiencing these symptoms, it is crucial to consider your age and whether you are in the perimenopausal or postmenopausal stage. By having your hormones tested, a healthcare professional may be able to determine if this is contributing to changes in mental health.

What Else Causes Depression?

Depression can show up at any age and there are a number of factors that can play a role in its development. According to the Mayo Clinic, triggers include:

• Traumatic Events: Life events such as divorce, loss of a loved one, or financial stress can trigger depression, irrespective of menopause.
• Preexisting Mental Health Conditions: Women with a history of depression, anxiety, or other mental health disorders may be more susceptible to developing depression during menopause.
• Physical Health Issues: Chronic medical conditions, such as thyroid disorders, can mimic symptoms of depression or exacerbate existing depressive symptoms.
• Lifestyle Factors: Poor diet, lack of exercise, and substance abuse can contribute to depression during menopause.

What Are My Treatment Options?

If you suspect you are suffering from menopause-related depression, your healthcare provider may suggest you explore the following treatment options:

• Hormone Optimization: As mentioned, HRT may help alleviate both physical and emotional menopausal symptoms by bringing your hormones back into balance. This requires your healthcare provider to keep a close eye on your changing hormonal needs through ongoing testing.
• Antidepressant Medications: Selective serotonin reuptake inhibitors (SSRIs) or serotonin-norepinephrine reuptake inhibitors (SNRIs) are often prescribed to manage depression symptoms. These can have significant side effects and be challenging to stop; however, they play an important role in managing severe depressive symptoms and are appropriate when indicated.
• Cognitive-behavioral therapy (CBT): Forms of talk therapy can be highly effective and help women develop coping strategies to manage emotional changes.
• Lifestyle Modifications: Adopting a healthy lifestyle, including regular exercise, a balanced diet, high quality sleep, and effective stress management techniques, can significantly improve emotional well-being during menopause.

When Should I See A Doctor?

Menopause-related or not, we encourage you to contact a healthcare professional especially if your symptoms are prolonged and interfere with your daily life, relationships, or overall well-being, you have a history of mental health conditions, or are contemplating self-harm. Again, call or text 988 if you are experiencing an immediate crisis. There is help and it will get better.

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