If you’re approaching menopause, you likely know that hot flashes, night sweats and vaginal dryness often come with the territory. But you may not know this: For a significant number of women, so does depression.
Women, especially those with a history of depression, have a higher risk of developing the condition during perimenopause, or the years leading up to menopause. Many aren’t aware of the increased chances, and because some symptoms overlap—like sleep issues, problems concentrating and loss of energy—some women may attribute them to menopause alone.
Even if they suspect depression, busy lives and preconceived notions may discourage women from visiting a healthcare provider. “If it’s affecting someone’s quality of life, they should not be afraid to seek help,” says Sean Edmunds, MD, an OBGYN at St. Mark’s Hospital in Salt Lake City, Utah. “Seeking help for mental health is no different than seeking help for your heart or diabetes.”
Here’s why some women develop depression during perimenopause, how they can identify serious symptoms and what they should they do if they suspect a real problem.
What contributes to perimenopausal depression
Perimenopausal depression doesn’t have any single cause; “This can be multifactorial and complicated,” says Dr. Edmunds. Playing a big role, however, is the fluctuation in hormones. Estrogen levels drop during perimenopause, disrupting the activity of serotonin and norepinephrine, both of which are believed to affect mood. Some women are particularly susceptible to those changes.
Other factors that influence depression include the hallmark symptoms of menopause, like hot flashes, night sweats and vaginal dryness. Night sweats can interrupt sleep, for example. “Lack of sleep and interruptions in sleep lead to higher rates of depressive symptoms and anxiety,” says Edmunds.
You may experience a loss of moisture in your vaginal area, as well. “Vaginal dryness can contribute to pain with intercourse,” says Edmunds. “If it’s going to hurt to have sex, you’re not going to want to be sexually active.” This can affect your mood, as can the decline in libido that often accompanies perimenopause.
Emotions, family responsibilities and personal concerns can also play in. Many women find their 40s and 50s to be particularly stressful; they’re frequently working, parenting, caring for aging parents or dealing with health conditions themselves. Some worry about aging issues, too, including physical changes, loss of fertility and even their own mortality. All of this may contribute to depression.
When to worry about depressive symptoms
If you experience any of the following for two weeks or more during perimenopause or early menopause, speak to your healthcare provider:
- Feeling sad, hopeless or discouraged
- A drop-off of interest in things you typically like doing
- Changes in appetite, weight loss or weight gain
- Too much or too little sleep
- Lack of energy
- Feelings of hopelessness, worthlessness or guilt
- Excessive impatience or snappiness
- Problems with concentration or focus
- Thoughts of suicide or death
Some of these symptoms, like weight changes and concentration issues, are common during perimenopause, and may not be related to a serious mental health problem. However, if they affect your daily function or quality of life, you should seek help either way. And, “If there’s any suicidal or homicidal thoughts, they definitely should be seeking help,” says Edmunds.
It’s important to note: While many women face symptoms of depression during perimenopause, most won’t develop what’s considered to be clinical depression. Often, depressive episodes tend to occur in women who have been previously diagnosed with the condition. “Anyone with a history of depression is at higher risk for experiencing it through these changes,” says Edmunds. If you’ve have symptoms and a history, speak with your healthcare provider as soon as you can.
Treatments for perimenopausal depression
Being diagnosed and treated is key in preventing depressive symptoms from becoming worse. Treatment will hinge on the severity of those symptoms, along with any history of depression. “In some cases, professional therapy is needed, or even medical therapy, like antidepressants,” says Edmunds, “or hormonal replacement therapy to treat menopausal symptoms that are leading to these thoughts and issues.”
Antidepressant medication is a first-line treatment for all people with serious depression. Selective serotonin reuptake inhibitors (SSRIs) are widely prescribed to ease symptoms, as are serotonin–norepinephrine reuptake inhibitors (SNRIs). Many prescriptions are believed to relieve hot flashes and other symptoms of menopause, as well.
Some healthcare providers recommend oral contraceptives for milder mood swings, which may help relieve hormone fluctuations. Tempted to try an herbal remedy? Skip it. There’s no evidence alternative medicines work for perimenopausal depression.
Talk therapy is often combined with medication to treat depression. Cognitive behavioral therapy can help people identify negative thoughts and behaviors while devising ways to cope. Psychotherapy allows patients to express their feelings and work towards resolving underlying issues.
Hormone replacement therapy (HRT) replenishes estrogen. Some research suggests it may be helpful in addressing serious depression. For women with mild depression, it can be used to alleviate perimenopausal problems like vaginal dryness and hot flashes, which often contribute to depressive symptoms. Speak with your doctor about whether HRT is right for you.
What you can do at home
As part of your treatment, your healthcare provider will likely suggest certain lifestyle changes. These steps may ease depressive symptoms and make you feel healthier overall:
- Exercising; for most adults, experts recommend at least 150 minutes of moderate activity per week
- Eating a wholesome diet full of whole grains, lean proteins and produce, while avoiding unhealthy fats and added sugars
- Limiting your alcohol intake—or avoiding it altogether
- Reducing your stress
Though you might not feel up to it, pushing yourself to socialize may also help. Boost your mood by spending time with family and friends, or participating in sports, hobbies, community activities or religious groups.
Moving forward
While treatments for perimenopausal depression abound, seeking help may not be easy—especially for middle-aged women busy with children, aging parents or work. “I see a higher rate of women putting others ahead of themselves, which is altruistic and great, but sometimes to their own detriment,” says Edmunds.
It’s crucial, however, that perimenopausal women prioritize their health and understand that treatment can help them feel better, so they can get back to their daily lives. If you or someone you know is showing symptoms of depression, reach out to a healthcare provider.
