Are Depression and Menopause Related? What Are Perimenopausal Symptoms? (“Ann’s* Story”)

Menopause and depression often go hand in hand during this time when hormonal balance is changing and the body is adjusting to new chemical levels.

Ann is a 47 year old mother of three who has been happily married for 22 years. She had always thought that she would enjoy the freedom of having grown children and being able to focus on activities that she enjoyed. Now that she has the time, however, she finds herself feeling too tired and without desire to do much of anything. She tears up often, and finds that her fluctuations in mood make it difficult to socialize with her friends and family. In addition, the hot flashes that she experiences daily are disruptive to her routine, since she is unable to function at her best in the midst of experiencing the symptoms. Her decrease in sex drive has impacted her relationship with her husband and she is unsure how to explain to him how this transition is affecting her. Ann is having difficulty sleeping at night as well. The changes in her life that she once looked forward to, such as having an empty nest and considering changes in lifestyle at work and at home now seem overwhelming and lonely. None of her friends have mentioned experiencing these feelings or symptoms, so Ann assumes that something must be wrong with her. Ann is relieved when she visits her doctor and is informed that these are normal experiences in menopause and depression, as well as other symptoms, can be treated if they are impacting her relationships and sense of wellness. Ann is referred to a therapist who over time is able to help her embrace the transitions and changes in her life due to menopause, and anxiety, trouble sleeping, as well as her decreased sex drive have all become things of the past. Ann is now able to enjoy the time that she spends with her husband, family and friends and looks forward to each day.

A major transition in a woman’s reproductive life is the transition to perimenopause and eventually menopause. Perimenopause is a time when menstrual periods gradually lighten and become less frequent. The transition to complete menopause may last anywhere from a few months to a few years. Some women will traverse the menopausal transition with little or no difficulty. Many women welcome the cessation of menstruation and look forward to new opportunities with an enthusiasm described by Margaret Mead as “postmenopausal zest.” However, for some women, symptoms such as irritability, memory problems, insomnia, hot flashes and feelings of sadness are common during perimenopause. These symptoms can progress to a more severe mood disorder known as major depression, and menopause’s physical symptoms only compound the problem for women transitioning from perimenopause to menopause. Women who have a history of depression, or who suffered from PMDD or from postpartum depression, are at the greatest risk of depression during their perimenopausal years. Some women can become depressed for the first time in their lives during this period. In the past, people have viewed menopause and depression accompanying it as a consequence of the empty nest syndrome or as a result of other feelings of loss and sadness associated with middle-age.. More recently however, scientists have focused on the biological effects of hormonal fluctuations on mood. It is at this time in a woman’s life that her ovaries begin to make less estrogen. Estrogen interacts with chemicals in the brain that can affect mood. In some women, the decrease in estrogen during perimenopause may lead to depression. There are two types of psychotherapy that are highly recommended for depression and menopause. Interpersonal therapy focuses on understanding how a change in human relationships may contribute to or relieve depression. Cognitive behavioral therapy focuses on identifying and changing the pessimistic thoughts and beliefs that accompany menopause and depression. When used alone, psychotherapy usually works more gradually than does taking medication. However, the benefits of psychotherapy are long-lasting. When symptoms are severe, it is recommended that a woman consider antidepressant medication. This can be given in combination with hormone replacement therapy. Hormone replacement therapy by itself will often relieve physical symptoms such as hot flashes and will sometimes improve mood significantly, thus breaking the bond between menopause and anxiety or menopause and depression. In women who are clearly in menopause rather than transition, experts believe that antidepressant medication is more likely to relieve depression than hormone replacement therapy. In all of these situations, experts also recommend the use of psychotherapy along with whatever medication is chosen for either the psychological effects of menopause and depression or the physical effects of menopause and anxiety.

Enormous shifts in scientific knowledge and medical recommendations surrounding the management of perimenopause, menopause and depression have occurred during the last decade. Hormone replacement therapy was advocated during the latter half of the 1990s as an essential aspect of well woman care for the prevention of heart disease, dementia, osteoporosis and as a general tonic. New studies and analysis, however, have appeared on a regular basis demonstrating the risks associated with hormone replacement therapy and have left women and their physicians in a quandary about the best course to follow. It is therefore important that when deciding whether to pursue hormone replacement therapy or not, a woman receives the guidance of a knowledgeable gynecologist who will take into account her risk factors and weigh them against the benefits of hormone replacement therapy.

For a consultation with Dr. Naomi Greenblatt about menopause and anxiety or menopause and depression, call The Rocking Chair at (201) 308-5325.  Depression and menopause are natural reactions to the changes a woman goes through and should not be feared.

* Pseudonym