Perimenopause and depression

If you're a woman in your mid- to late 40s, you may be experiencing the symptoms of perimenopause, the span of approximately four years before menstruation totally stops and menopause begins.

Symptoms of perimenopause include:

  • Changes in the length of your monthly cycle, the duration of your period and the intensity of your flow
  • Hot flashes and night sweats
  • Fatigue
  • Decreased libido

You might be among the 70 percent of women who experience irritability with perimenopause and menopause or the 50 percent who struggle with insomnia during the transition.

Perimenopause and depression

You may also be among the 20 percent of women who suffer with significant anxiety and depression during perimenopause.

Why can depression occur during perimenopause? Estrogen levels decline, and estrogen is responsible for increasing the effects of serotonin and norepinephrine in the brain, explained Rachel Spieldoch, MD, gynecologist, and an independent member of the HonorHealth medical staff. "These are important neurotransmitters for regulating mood in your brain."

While most women transition into menopause without experiencing debilitating mental health problems, she said, a number of factors can cause or contribute to depression or anxiety during this time.

Risk factors

Depression or anxiety may be related to aging or lifestyle and not directly to hormonal changes, Dr. Spieldoch said, but these factors can boost your risk of emotional symptoms during perimenopause.

"It's thought that perimenopause can exacerbate or cause a relapse of depression and anxiety for people at higher risk but does not cause the disorder," she said. "Insomnia, health disorders, medication side effects, sedentary lifestyle and poor eating habits, low self-esteem, changes in childbearing status and social stressors such as aging parents, lack of social support or unemployment can all negatively affect the risk for depression and anxiety."

You're also at higher risk if you have a preexisting tendency toward anxiety or depression, a history of postpartum depression, an underlying psychiatric disorder, surgical menopause or premenopausal dysphoric disorder (a severe form of premenstrual syndrome), Dr. Spieldoch said. Women with a history of mood disorders related to fluctuating hormone levels prior to menopause are more likely to experience significant symptoms during the menopause transition period, she said.

Several studies suggest that infertility drugs and treatments such as in-vitro fertilization may put women at higher risk for early menopause and mood disorders during perimenopause.

"Onset and exacerbation of schizophrenia, panic disorder and obsessive-compulsive disorder can occur during the perimenopausal period," she said. "Worsening symptoms for people with underlying bipolar disorder and major depression can also occur during this transition period."

Childbearing likely is not associated with perimenopausal symptoms, Dr. Spieldoch said.

Managing depression during perimenopause

"Healthy eating habits, cessation of smoking and increased exercise can be beneficial," said Dr. Spieldoch. To boost your mood during perimenopause she also recommends these lifestyle considerations, activities and medications:

  • Meditation and yoga: Studies show these can be particularly helpful with mood during the menopause transition.
  • Rule out other health conditions associated with mood changes. Ask your doctor about hypothyroidism or other endocrine disorders, anemia, autoimmune disease, drug addiction, dementia or malignancy.
  • Over-the-counter and prescription mood boosters. "St. John's Wort is a non-prescription herbal supplement that can positively affect depressive mood changes with perimenopause. Antidepressants (most commonly selective serotonin reuptake inhibitors), increase serotonin levels in the brain and are often prescribed during the menopause transition."
  • Hormone replacement therapy. This "has been well studied and can be very beneficial with regard to treating mood changes and insomnia."
  • Other medications for insomnia or hot flashes and sweating.
  • Educational groups or reading material can be beneficial for those suffering with adverse mood changes during perimenopause.

After perimenopause

Depression and anxiety often resolve with menopause, "at which time hormone fluctuations stop and the low hormone levels stabilize," Dr. Spieldoch said.

Your gynecologist can assist you with managing perimenopause. Find a gynecologist in the Phoenix area.