Menopause usually begins around the age of 50 occurring 12 months after a woman’s last menstrual period. The menopausal transition, and more specifically perimenopause, is when the body’s production of oestrogen and progesterone slows bringing on hormonal fluctuations that can have adverse effects on women’s mental health with some women more at risk to these changes than others. The mood swings of menopause can sometimes be serious leading to depression but can be managed with specific and timely treatment.
Due to the complexities of menopause symptoms complicating, co-occurring, and overlapping with depression, there are currently no conclusive link between depression and menopause. However, some research observed that women were two to four times more likely to experience a major depressive episode during perimenopause or early post-menopausal, particularly women who have a history of major depressive disorder, than women who hadn’t gone through perimenopause. On the other hand, pre-existing depression may lead to early-onset perimenopause in women in their late 30s and early 40s. While women may present with mood changes and depressive symptoms during menopausal transitions, many do not meet the clinical criteria for depression.
Symptoms of major depression at any stage in life may include:
- Fatigue and restlessness
- Slowed cognitive function
- Difficulty concentrating
- Loss of interest in once-enjoyable activities
- Feelings of guilt, worthlessness, hopelessness, or helplessness.
Symptoms related to perimenopausal depression may include:
- Mood swings
- Frustration and irritability
- Crying for no reason or excessive crying
- Heightened anxiety
- Profound despair
- Insomnia from hot flashes or night sweats
Risk factors for depressive symptoms and disorders during menopause include: sleep problems; have never given birth; history of sexual abuse or violence; health-related problems (prior depression, poor self-rated health, prior premenstrual issues, use of psychotropic medications, overweight or obese, history of postnatal depression, history of anxiety, chronic health condition, poor physical health, current use of antidepressants, severe menopausal symptoms); smoking; major life events and stresses; social isolation; low self-esteem; low social support; and fluctuating hormones.
Although antidepressants are associated with earlier onset of menopause and to perimenopausal depression, the combination of psychotherapy, and antidepressants and hormone replacement therapy are recommended for severe perimenopausal depression to reduce the severity of hot flashes and correct chemical imbalances to mood swings. When symptoms are mild and a woman does not have a history of depression, either antidepressants or hormone replacement therapy may be suggested.
The potential of experiencing depressive symptoms during menopausal transition is higher than expected and should not be viewed as a “normal” event, so it is important to be aware of symptoms and know when to seek help.
For more information
JT Bromberger, et al., ‘Major depression during and after the menopausal transition: Study of women’s health across the nation (SWAN)’, Psychological Medicine, vol. 41., no. 9, 2011, pp. 1879-1888.
PM Maki, et al., ‘Guidelines for the evaluation and treatment of perimenopausal depression: Summary and recommendations’, Journal of Women’s Health, vol. 25, no. 10, pp. 1069-1085.