By Leanna Coy, FNP
During menopause, mental and emotional well-being can shift. Some women notice depressive symptoms. Certain women are more vulnerable to experiencing depression during these changes. For some, the symptoms can become severe and very difficult to manage.
Research has found hormones are not the only reason women will have depression during the menopause transition. Most women experiencing depression during this phase in life have a history of depression. To understand how to best manage depression during the menopause transition, you need to understand how menopause, mental health, and emotional well-being are all connected.
What is depression?
According to Psychiatry.org, depression is a common and serious mental disorder that negatively affects how you think, act, feel, and see the world. Depression can limit someone’s quality of life and make it hard for them to function normally in relationships and at work. Worldwide, depression is the main cause of disease related disability for women.
Depressive symptoms can look different for each person, ranging from mild to severe. Common symptoms include:
•Persistent sadness, hopelessness, or feeling ‘empty’
•Losing interest or enjoyment in activities you once enjoyed
•Increased fatigue, tiredness, and lack of energy
•Irritability, restlessness, or agitation
•Feeling worthless or guilty
•Decreased appetite or weight loss
•Slowed movements or speech
•Difficulty concentrating or making decisions
•Thoughts of death, suicide, or self-harm
Women going through the menopause transition may also notice low sexual function. To receive a major depression diagnosis, someone must have five or more symptoms nearly every day for at last two weeks.
Depression and the menopause transition
Beginning in perimenopause women may start having symptoms of depression. These symptoms can be new or a worsening pattern of existing depression. About 36% of women experience depression during the menopause transition. This transition has three phases:
Perimenopause begins with changes to the menstrual cycles that can occur as early as the mid-30s. Cycles may become irregular due to hormone levels fluctuating. This is a vulnerable time when women are more likely to develop depression. As the hormone levels rise and fall, some women notice mood changes, including depression.
Menopause is when the last menstrual period occurs. This is confirmed after going at least 12 months without a period. Ongoing hormone changes, life stressors, sleep interruptions, and physical symptoms can make some women’s depressive symptoms worse.
Post-menopause is the stage after menopause. During this stage, some women’s depressive symptoms improve as hormone levels drop and stop fluctuating. Other women may still struggle with their depression. At this stage, depression is thought to have causes other than hormones since the hormones have stabilized.
Factors for depression during the menopause transition
Not everyone going through the menopause will have depressive symptoms. Women who never had a major depressive episode are unlikely to have their first episode during this life phase. However, those with a history of depression are at higher risk.
Many other risk factors can lead to depression during menopause. Social changes and symptoms from hormone shifts can lead to depression during this stage. Women are more likely to have depressive symptoms if they:
•Experience a long menopause transition
•Struggle with severely interrupted sleep due to hot flashes or night sweats
•Have work-related stressors, including job demands, transitions, or financial instability
•Go through relationship difficulties, transitions, or conflicts, including caregiving responsibilities and empty-nesting
•Develop new health issues or worsening chronic health conditions
Many women also feel negatively about menopause. This may include feeling sadness over the loss of fertility or bothered by the physical symptoms from the hormone changes.
Spotting depressive symptoms early can help you assessed and treated sooner. Having depressive symptoms do not always mean you have a serious depressive disorder. If you are notice signs or symptoms of depression, talk with your healthcare provider. They will review your prior mental health history and current life issues to better understand your symptoms.
Managing menopausal depression
Once your provider determines if your symptoms are related to pre-existing depression or menopause, they can create a treatment plan that will work best for you. All depression treatment is always tailored to your past experiences and current health.
If it is safe for them, treatment for perimenopausal and newly menopausal women often starts with hormone therapy. Hormone therapy can help manage the physical symptoms caused by hormone changes that lead to depression. This includes hot flashes and disrupted sleep.
For women who’s symptoms meet the criteria for major depression, hormone therapy alone is often not enough. Other treatments may include talk therapy or antidepressant medications. If you have a history of depression, an antidepressant may be the starting point for treatment of menopausal depression. Someone may use both hormone therapy and an antidepressant for their treatment.
The menopause transition is a time of vulnerability when women are more likely to develop depressive symptoms. Hormonal change and life stressors often work together in causing symptoms, especially in women who have a history of depression. Research shows that early treatment can help improve the quality of life for women. If you are having symptoms, contact your healthcare provider for an assessment. You don’t have to go through this alone. It is okay to ask for help.
If you or someone you know needs to talk to someone, call 988 or the local 24/7 crisis line at 503-842-8201