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If you have any medical questions or concerns, please talk to your healthcare provider. The articles on Health Guide are underpinned by peer-reviewed research and information drawn from medical societies and governmental agencies. However, they are not a substitute for professional medical advice, diagnosis, or treatment.
Perimenopause, the period leading up to menopause, can take a physical and emotional toll on some women.
Aside from the physical symptoms that occur during this transition—like hot flashes and irregular periods—emotional symptoms like depression can also occur.
Here’s what we know about the links between menopause and depression and what you can do to overcome depression during menopause.
Can menopause cause depression?
Researchers haven’t discovered precisely how menopause causes depression in some people, but they have found that there is a connection between the two—especially during perimenopause, a period of time that can last several years in which your periods become irregular and your hormone levels fluctuate (Bromberger, 2018; Freeman, 2015).
Several studies show that women have a higher risk of developing depression during this time leading up to menopause, although other factors might also be involved (Bromberger, 2018; Freeman, 2015).
And while many women transition to menopause without any mental health challenges, an estimated 20% will report symptoms of depression at some point during perimenopause (Dalal, 2015).
Depression during menopause: risk factors
Having a history of depression is the strongest predictor of whether you have an increased risk of experiencing perimenopausal depression (Freeman, 2015; Dalal, 2015).
Other factors that can also influence your mood during midlife include (Bromberger, 2018; Freeman, 2015):
- Health concerns
- Lack of support
- Caring for aging parents
- Children transitioning to adulthood
- Conflict with spouse or partner
- Stressful workplaces
Aside from the factors above, the natural hormonal shifts that women experience during menopause can also affect their moods.
Menopause: what is it, signs, causes, and treatments
For example, symptoms of insomnia are a common trigger for depression in the general adult population. Since sleep disturbances are both a common feature in menopause and a risk factor for depressive symptoms, they can put perimenopausal women at an even greater risk of developing depression (Kalmbach, 2019).
The fluctuating levels of estrogen and progesterone that occur during perimenopause can also affect your central nervous system. In particular, changing estrogen levels can influence how your brain makes and uses neurotransmitters like serotonin and norepinephrine, impacting your mood (Dalal, 2015; Barth, 2015).
It’s important to note that the absolute levels of estrogen and progesterone aren’t connected with depression. Your provider can’t measure your hormone levels and tell you if you have depression or not.
Instead, research shows that shifts in hormone levels, not total levels, that occur during periods can predispose some women to mood changes (Dalal, 2015). In a related way, depression can occur during perimenopause because it is a time of shifting hormone levels.
What are the symptoms of menopause and depression?
Depression and menopause often have many overlapping symptoms, so it can be hard to tell which condition is causing the symptoms you’re experiencing. You can also experience depressive symptoms that aren’t severe enough to be considered a diagnosis of depression but still affect your daily life.
Common menopausal symptoms include (Dalal, 2015):
- Hot flashes
- Vaginal dryness
- Stress incontinence
- Osteopenia (bone loss that can lead to osteoporosis)
Early menopause: what is it, signs, causes, risk factors
Symptoms caused by depression include (Santoro, 2016; Bromberger, 2018):
- Significant appetite and weight changes
- Loss of interest in activities
- Feelings of worthlessness or guilt
- Feeling hopeless or helpless
- Thoughts of death or suicide
Symptoms that either depression or menopause can cause are (Dalal, 2015; Kulkarni, 2018):
- Mood swings
- Trouble concentrating
- Sad or low mood
- Low energy levels
- Decreased sexual interest
- Decreased self-esteem
Overcoming depression in menopause
If you’re of menopausal age and you’re experiencing depression, you should see a healthcare provider to rule out any other physical or mental health conditions besides menopause that could be contributing to your symptoms.
The good news is that most women with perimenopausal depression respond well to treatment. Treatment is similar to treatments used for depression in other stages of life and includes things like hormone therapy, talk therapy, and antidepressant medications. However, it can take some trial and error to find the right combination of treatments to meet your needs (Kulkarni, 2018; Bromberger, 2018).
What is perimenopause: first signs to know
The results from studies using hormone treatments for depression have been inconsistent, so opinions vary about using hormone therapy to help manage depressive symptoms during menopause.
Overall, there is some evidence that treatment with either estrogen alone or estrogen in combination with progesterone might improve your mood and quality of life (Dalal, 2015).
When talking with your women’s health professional about the risks and benefits of hormone replacement therapy (HRT), here are some points that you should know (Dalal, 2015; Kulkarni, 2018; Maki, 2019):
- Women in the perimenopausal stage are more likely to experience benefits than those already postmenopausal.
- The hormone therapy chosen should be tailored to each person.
- For mild depression, HRT alone may be appropriate; other people may benefit from HRT in combination with antidepressant medication.
- There isn’t enough scientific evidence to recommend HRT to prevent depressive symptoms in people who aren’t already experiencing them.
- Estrogen is not approved by the Food and Drug Administration (FDA) to treat depression.
Talk therapy and education
Some research shows the way you think about menopause matters. Thinking negatively about this transition can be associated with a higher risk of experiencing negative physical and mental symptoms. Educational classes that help you learn what to expect can help decrease anxiety, depressive symptoms, and irritability (Dalal, 2015).
Causes of depression: genetics, environment, and others
Also, current and early life stressors often contribute to feelings of depression during menopause. Many people benefit from psychotherapy during this time.
One type of therapy in particular, cognitive-behavioral therapy (CBT), has been shown to improve depression and insomnia stemming from menopause (Bromberger, 2018; Maki, 2019; Kalmbach, 2019).
Some approaches are recommended for depression and well-being in general but haven’t been studied explicitly in people experiencing menopause. These include (Maki, 2019; Kulkarni, 2018):
- Interpersonal therapy
- Mindfulness-based cognitive therapy (MBCT)
- Light therapy
- Regular exercise
- Healthy diet
- Minimizing alcohol intake
Just like depression that happens at other times in life, antidepressants are a standard first-line treatment when depressive symptoms occur with menopause.
Selective serotonin reuptake inhibitors (SSRIs) are the most frequently used and are considered to be safe and effective. They start working about four to six weeks after you begin taking them (Dalal, 2015).
SSRIs and a similar class of drugs called Selective Norepinephrine Reuptake Inhibitors (SNRIs) may also help with some of the physical symptoms of menopause like hot flashes and night sweats (Santoro, 2016).
Because these symptoms can disrupt your sleep—and, therefore, your mood—experiencing fewer physical symptoms may help you sleep more peacefully and may help alleviate your depression.
Antidepressants: types, side effects, uses, and risks
When to see a healthcare provider
It’s normal to have some bothersome symptoms during menopause occasionally or to sometimes experience a depressed mood. But if you find yourself having these feelings more days than not, especially if they’re interfering with your work, social, or home life, it’s time to call a healthcare provider.
If your depression becomes severe or you’re having thoughts of hurting yourself, seek medical care immediately. You can go to your local emergency department or contact the Substance Abuse and Mental Health Services Administration (SAMHSA)’s 24/7 national helpline.
The hormone changes associated with menopause can cause or worsen depressive feelings. There is help, though. If you’re struggling with menopause and depression, talk to your healthcare provider about available treatment options.
- Barth, C., Villringer, A., & Sacher J. (2015) Sex hormones affect neurotransmitters and shape the adult female brain during hormonal transition periods. Frontiers in Neuroscience, 9(37). doi:10.3389/fnins.2015.00037. Retrieved from https://www.frontiersin.org/articles/10.3389/fnins.2015.00037/full
- Bromberger, J. T. & Epperson, C. N. (2018). Depression during and after the perimenopause: impact of hormones, genetics, and environmental determinants of disease. Obstetrics And Gynecology Clinics Of North America, 45(4), 663–678. doi:10.1016/j.ogc.2018.07.007. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6226029/
- Dalal, P. K. & Agarwal, M. (2015). Postmenopausal syndrome. Indian Journal Of Psychiatry, 57(Suppl 2), S222–S232. doi:10.4103/0019-5545.161483. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4539866/
- Freeman, E. W. (2015). Depression in the menopause transition: risks in the changing hormone milieu as observed in the general population. Women’s Midlife Health, 1(2). doi:10.1186/s40695-015-0002-y. Retrieved from https://womensmidlifehealthjournal.biomedcentral.com/articles/10.1186/s40695-015-0002-y
- Kalmbach, D. A., Cheng, P., Arnedt, J. T., et al. (2019). Treating insomnia improves depression, maladaptive thinking, and hyperarousal in postmenopausal women: comparing cognitive-behavioral therapy for insomnia (CBTI), sleep restriction therapy, and sleep hygiene education. Sleep Medicine, 55, 124–134. doi:10.1016/j.sleep.2018.11.019. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6503531/
- Kulkarni, J. (2018). Perimenopausal depression – an under-recognised entity. Australian Prescriber; 41, 183–5. doi:10.18773/austprescr.2018.060. Retrieved from https://www.nps.org.au/australian-prescriber/articles/perimenopausal-depression-an-under-recognised-entity
- Maki, P. M., Kornstein, S. G., Joffe, H., et al. (2019). Perimenopausal depression: summary and recommendations. Journal of Women’s Health, 28(2), 117-134. doi:10.1089/jwh.2018.27099.mensocrec. Retrieved from https://www.liebertpub.com/doi/10.1089/jwh.2018.27099.mensocrec
- Santoro, N. (2016). Perimenopause: from research to practice. Journal of Women’s Health, 25(4), 332–339. doi:10.1089/jwh.2015.5556. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4834516/
Dr. Steve Silvestro is a board-certified pediatrician and Senior Manager, Medical Content & Education at Ro.