Your hormones are shifting. Your mood is suffering. Here’s what you can do about it.
There’s a common belief that feeling depressed during menopause is just part of the process. Something to ride out. That’s not true. Depression is a medical condition that responds to treatment, not a rite of passage.
If you’ve been feeling unusually low, exhausted, or just not yourself as your periods start to change, you’re not imagining it. And you’re not alone.
What Is Perimenopause?
Menopause is the point when your periods stop completely. But before that happens, your body goes through a transition called perimenopause. During this stretch, your periods lighten and become less regular. It can last a few months, or it can stretch on for a few years.
Perimenopause is also when depression tends to show up.
Hot flashes, poor sleep, and mood swings are common during this time. For some women, those symptoms stay mild. For others, they cross into something more serious: major depression.
Why Does This Happen?
Your ovaries produce estrogen, and as perimenopause begins, that production drops. Estrogen interacts with brain chemicals that regulate mood. When estrogen falls, mood can fall with it.
Hot flashes and broken sleep add more fuel to the fire. It’s hard to feel emotionally steady when you’re exhausted and waking up drenched in sweat at 2 a.m.
Some women are more vulnerable than others. If you’ve had depression before, experienced postpartum depression after a birth, or noticed your mood crater in the days before your period, your risk is higher.
What Is Major Depression?
Major depression is more than a bad week or a low patch.It limits daily life as much as a serious physical illness.
The two main signs are:
- Feeling down most of the day, nearly every day, for two weeks or more
- Losing interest or pleasure in things you used to enjoy
Other signs include fatigue, trouble sleeping (or sleeping too much), difficulty concentrating, restlessness, feelings of guilt or worthlessness, and recurring thoughts of death or suicide.
What Treatments Actually Work?
Treatment depends on how severe your symptoms are and whether you’ve been depressed before.
When symptoms are severe
When depression is severe, medications and psychotherapy are good places to start. They can also be combined with hormone therapy (estrogen, with or without progesterone). Mild symptoms sometimes respond to hormone therapy alone. Hormones take two to four weeks to show a response.
Light exercise and a Mediterranean-style diet are other effective strategies for depression.
When you’re fully through menopause
Hormone therapy has stronger mood benefits in the years leading up to menopause, when the fluctuations in hormones disrupt serotonin signals in the brain. Once periods have stopped completely, hormone replacement therapy may be useful for other health reasons but is no longer very effective for mood.
Hormone Therapy: Useful, But with Caveats
Estrogen reliably controls hot flashes. In mild to moderate depression, especially in women with no prior history, it sometimes improves mood on its own.
It comes as a pill (Premarin, Estrace, Estratab) or a skin patch. Your doctor can walk you through the pros and cons of each.
Progesterone is often added alongside estrogen to protect the uterus. Unfortunately, it can cause bloating, headaches, and sometimes mood changes. Different forms and schedules are available if that becomes a problem.
Rarely, hormone therapy can cause depression in women who’ve never been depressed before. This is more common in young women who are taking oral contraceptives, which have higher doses of hormones.
Other reasons to avoid hormone replacement therapy include:
- History of estrogen-sensitive cancer (a common feature of breast, ovarian, or uterine cancers)
- Unexplained vaginal bleeding
- History of blood clotting problems like deep venous thrombosis (DVT), pulmonary embolism, heart attacks, or stroke
—Chris Aiken, MD
Director, Psych Partners
Editor in Chief, Carlat Psychiatry Report
