Depression During Perimenopause and Menopause

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As women approach menopause, a time known as perimenopause, they may be at greater risk for experiencing depression, especially if they have a previous history of having it. In fact, an eight-year study found that women with a prior history of depression had four times greater risk of having a high depression score during the perimenopausal period. In addition, they had double the risk of having depression severe enough to receive a diagnosis of Major Depressive Disorder as they entered menopause.

Yet another study, which involved women with no history of depression, found that these women were also more vulnerable to depression during the transition into menopause. In this study, it was found that menopausal women had twice the risk of premenopausal women for developing significant depression symptoms. Other similar studies have also yielded outcomes which support the findings of these two studies.

Why Are Women at Greater Risk for Depression During Menopause?

Depression during menopause and perimenopause may occur for several reasons. Firstly, menopause occurs during midlife, a time when women are growing older and dealing with many issues related to aging, such as illness and loss of youthful functioning.

Secondly, menopause itself comes with many unpleasant symptoms, like hot flashes and insomnia, which can leave women feeling tired and irritable, contributing to feelings of frustration and depression.

And, finally, menopause brings declining levels of the hormone estrogen, which is likely to be a large contributing factor to low moods during menopause.

What Are the Symptoms of Depression?

If a woman has never been prone to depression before menopause, she may overlook its symptoms or believe them to simply be the effects of getting older.

It is very important that all women, even those without a history of mood disorders, be aware of the following symptoms as menopause approaches:

  • Sadness and depression
  • A loss of interest in things once enjoyed
  • Irritability or restlessness
  • Sleep difficulties
  • Changes in appetite or weight
  • Problems with thinking, remembering or making decisions
  • Tiredness
  • Feeling guilty
  • Feeling worthless
  • Feeling hopeless
  • Feeling helpless
  • Having suicidal thoughts

    When Should You Seek Help?

    If your symptoms are bad enough that they are interfering with you having a normal life and they don't seem to be getting better, then this is a very good reason to seek out help. In addition, if you are having thoughts about death or suicide, this is a very clear sign that you need to speak with someone about how you are feeling. A good place to start would be to speak with your ob/gyn doctor or your family doctor, who often treat these types of concerns.

    How Is Depression During Menopause Treated?

    Currently, it appears that a combination of hormone replacement therapy (HRT) and antidepressants is the most effective approach for depression associated with perimenopause and menopause, especially if depression is more severe. While it is somewhat uncertain just what role estrogen does play in menopausal depression, supplementation appears to help both the mood symptoms of menopause as well as other symptoms, such as hot flashes and sleep difficulties.

    One form of hormone therapy which doctors may prescribe is a low-dose oral contraceptive containing estrogen and progestin. These pills help keep hormones levels stable and may control moodiness in perimenopausal women.

    Other doctors may opt to use various combinations of conjugated equine estrogens (derived from the urine of pregnant horses), progestins (synthetic progesterone) or bioidentical estrogen and progesterone (chemically identical to human estrogen and progesterone).

    You should speak with your doctor about the risks and benefits associated with the various forms of HRT as they have been associated with increase risk for certain cancers and cardiovascular problems.


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