Table of Contents

Perimenopausal Depression

Perimenopause is a reproductive transition phase lasting nearly 10 years. A woman moves from perimenopause to menopause one year following her last menstrual cycle. During this transition period, women experience changes in their menstrual cycle patterns, such as abnormal menstrual periods, erratic fluctuations in hormone levels, mood and anxiety symptoms, hot flashes, and insomnia. Several studies have linked perimenopause to depression, as well as worsening of existing depressive symptoms.

Signs and Symptoms of Perimenopausal Depression

Signs of depression that perimenopausal women often exhibit include:

  • Fatigue or loss of energy
  • Restlessness and irritability
  • Emotional flatness
  • The desire to disconnect from people
  • Crying for no reason
  • Decreased interest or pleasure in activities
  • Changes in appetite
  • Changes in sleep patterns
  • Difficulty concentrating
  • Feelings of guilt or worthlessness
  • Thoughts of suicide

Risk Factors for Perimenopausal Depression

Research has identified the perimenopausal transition as a time of increased risk for mental health concerns including depression, anxiety, psychosis, cognitive dysfunction, and even suicide. There are several factors, including psycho-social stressors, hormonal
changes, physical changes, and overall health that can all bring on depression.

Stressful life events such as a divorce, job loss, or the death of a parent—which are all common occurrences for women in this stage of life—can trigger depression during this time. Because the risk for depression is high, it is a good idea for women in perimenopause
to keep an eye out for these symptoms, recognize when it’s time to seek help, and know that there are resources specific to their needs.

Hormones and Mood

Imbalance and overall declining estrogen and progesterone levels during perimenopause can make women feel like they are in a constant state of Premenstrual Syndrome (PMS). When hormone levels decline, as they do in the months and years leading up to menopause,
the production of mood-regulating chemicals such as serotonin and endorphins change. This can result in mood swings, depression, and an emotional roller coaster of highs and lows.

Depression and Its Effect on Perimenopausal Women

The signs and symptoms of Perimenopausal Depression overlap with the symptoms of depression unrelated to perimenopause, but there are some unique elements including physical, psychological, and life changes that can all be contributing to the depression a
woman may be feeling.

Management of Perimenopausal Depression

Perimenopausal Depression can sometimes be managed with psychotherapy and other non-drug lifestyle interventions, such as a healthy diet, exercise, self-care, and stress management techniques. If medication treatment is needed, it will most likely involve antidepressant medications and if medically appropriate, hormone replacement therapy.

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Psychosocial Treatments

The psychological and social impact of menopause may also affect mental health. Although some women feel that menopause is a positive event, others may feel as though it has fundamentally changed their social role. Psychotherapy can help with identifying these feelings and the other social factors contributing to the depression, and help women understand and manage their thoughts and emotions.

Drug or “Biological” Treatments

Antidepressants can help correct the chemical imbalance caused during the perimenopausal stage. Many women will show a noticeable improvement with antidepressants and will experience relatively few adverse effects. Antidepressants can be most effective when used in combination with psychotherapy. The addition of hormone replacement therapy with transdermal estrogen, or transdermal estrogen and progesterone, has been shown to significantly improve mood in some women during perimenopause.

Lifestyle Recommendations for Dealing with Perimenopausal Depression

Many women choose to make changes in their lifestyle to improve their physical and mental health during perimenopause. A few evidence-based options include:

Regular exercise

Women experiencing Perimenopausal Depression may find relief through walking, jogging, biking, swimming, or any other exercise that they enjoy.

Proper sleep

Sleep disturbances increase during the menopausal transition, with the most common complaint being waking up at night. Try to maintain a healthy weight and diet, avoid nicotine, caffeine, and alcohol, and reduce stress as much as possible because anxious and stressful thoughts can make it harder to fall asleep.

Mindful breathing

Mindfulness practices, such as deep breathing and staying focused in the present, may help ease symptoms such as hot flashes and stress that often accompany perimenopause.

Valerian Root

Some women find relief from hot flashes by taking valerian root during perimenopause, but there is little scientific proof that it works.

B vitamins

Research has indicated that some B vitamins can be helpful for relieving physical and psychological symptoms during the perimenopause phase, and that a deficiency in these vitamins during this time of transition can lead to adverse health outcomes.

Diagnostic Difficulties

The physical symptoms of menopause often present themselves later than the psychological symptoms, making the diagnosis of Perimenopausal Depression difficult. It is important for a health professional to consider whether an individual is experiencing depression related to their perimenopausal hormone fluctuations or as an exacerbation of a previous depressive issue.

Long-term Outlook

The outlook for most women who experience Perimenopausal Depression is good. While treatment cannot always make the depression go away completely, it can usually make symptoms much more manageable.

References

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