The time leading up to menopause (called perimenopause) is a physical and emotional roller coaster for some women. The so-called “change of life” comes with a host of symptoms triggered by hormonal shifts — hot flashes, insomnia, mood fluctuations and even depression.
“When women go through sudden hormonal changes like those that come with perimenopause, puberty, postpartum and even their monthly cycle, they’re at a higher risk for depression,” says Jennifer Payne, M.D., psychiatrist and director of the Women's Mood Disorders Center at Johns Hopkins. In general, women are twice as likely as men to develop the condition.
How Menopause May Contribute to Depression
Menopause is technically one day in a woman’s life that occurs 12 months after her last period. Afterward, women are considered postmenopausal. Before then, you’re in the perimenopause stage when reproductive hormones are shifting and can make you more vulnerable to major depression.
“Most of the time, when people are talking about menopause or going through ‘the change,’ they’re actually referring to perimenopause,” says Payne. “During this phase, the menstrual cycle becomes irregular — longer, shorter, heavier, lighter, infrequent or closer together. Everything is up for grabs.”
The same hormones that control your menstrual cycle also influence serotonin, a brain chemical that promotes feelings of well-being and happiness. When hormone levels drop, serotonin levels also fall, which contributes to increased irritability, anxiety and sadness.
“Falling estrogen and progesterone levels can trigger mood swings that make you less able to cope with things you’d normally let roll off your back,” says Payne. “For some women, these hormonal dips can set off a depressive episode, especially for those who’ve gone through major depression in the past.”
It’s common for women to experience bouts of insomnia during perimenopause, partly because of nighttime hot flashes. Poor sleep can make you up to 10 times more likely to become depressed.
Perimenopause typically occurs when women are in their 40s. Turbulent hormones aside, this can also be a stress-filled stage of life with events that impact emotional health, such as:
- Aging parents
- Career pressure
- Health problems
- Kids leaving home
These external pressures can make mood swings worse, as well as trigger or increase depression.
If You’ve Been Diagnosed with Depression in the Past
Having a history of depression makes it more likely you’ll experience an episode as you approach menopause. Talk to your doctor if your previous symptoms return or if you have new ones, including:
- Persistent feelings of sadness, hopelessness or irritability
- Low appetite or overeating
- Oversleeping or insomnia
- Overwhelming fatigue and lack of motivation
- Loss of interest in activities previously enjoyed
- Difficulty making decisions and absorbing information
- Thoughts of suicide
Treatment for Menopause-Related Depression
If you’re having frequent mood swings or other symptoms of depression that are affecting your life, it’s important to talk to your primary care doctor or obstetrician-gynecologist.
Many women in perimenopause respond well to hormonal medications, says Payne. “For some women, that may be an estrogen patch with progesterone pills,” she says. “For others, a very low-dose oral contraceptive pill will offer relief.”
However, taking hormonal medications for depression may not be a good option if you:
- Have high blood pressure
- Have a history of blood clotting problems
- Are postmenopausal
“Antidepressants may be helpful for mood symptoms for those who aren’t candidates for hormonal medications,” says Payne. “Certainly, those with major depression may need antidepressant treatment coupled with cognitive behavioral therapy, which studies show is the most effective combination for people with depression.”
Lifestyle adjustments can also help reduce perimenopause symptoms and promote good postmenopausal health. Healthy habits include eating a nutritious diet, exercising regularly, and limiting caffeine and alcohol consumption.
For many women, reaching menopause is a relief. “Once hormones settle down, most women stop having those mood fluctuations,” says Payne. “But if you have major depression, it’s hard to predict if you’ll experience postmenopausal improvement. Depression is a recurrent illness — sometimes it gets better for long periods of time and sometimes it gets worse out of the blue.”
When to Seek Help
The good news: Mood fluctuations are treatable. If emotional ups and downs during perimenopause impact your normal daily activities (work, school, hobbies) or your relationships, talk to your doctor about your options.