Perimenopause and Depression
If you’ve ever felt grumpy around the time of your period, you know firsthand that hormone fluctuations can have an impact on your mood. The same thing can happen during perimenopause — but in this time of up-and-down hormone levels, the chance of having mood swings and your risk of depression increase.
Occasionally you may feel anger, anxiety, and irritability, but not enough to interfere with or decrease your quality of life. And then there are women who feel downright liberated by the freedoms that come with perimenopause and, even more, when menstrual periods stop completely. "There is the freedom from fear of pregnancy, which for some women increases the pleasure of intimacy with their partner," says ob-gyn Jan Herr, MD, a menopause expert at Kaiser Permanente Northern California. Menopause puts an end to PMS and to the cyclic changes in appetite and mood, menstrual headaches, and cramping that plague so many women. Best of all, there’s no more monthly bleeding. "At last, you can wear white pants with impunity," she says.
For some of us, however, mood swings are a real concern, and the overall rate of depression during perimenopause does rise substantially. Although the majority of us experience no serious mood problems during perimenopause, depression is about four times more likely to strike now than during other times of a woman’s life.
Women are more likely to experience symptoms in perimenopause even if they have no lifetime history of major depression, according to the Harvard Study of Moods and Cycles. In this 2006 project, researchers followed 644 women between the ages of 36 and 44. The 365 women in the study who entered perimenopause during the observation period were two times more likely to develop depressive symptoms than women of the same age who were not perimenopausal. "Depression is one of the most important public health problems facing perimenopausal women today," says Bernard L. Harlow, PhD, professor of epidemiology and community health at the University of Minnesota School of Public Health and a lead researcher on the study.
The Harvard study also looked at the connection between hot flashes and depression. Researchers discovered that for perimenopausal women who experienced hot flashes, the risk of depression was more than double that of the women without hot flashes. When researchers reclassified the women who entered perimenopause based on whether they used hormonal therapy to ease symptoms, they saw a similar association between the menopausal transition and the risk of new depressive symptoms. The percentage of women experiencing severe depressive symptoms for the first time was greater for those who did not use hormones. Women who used hormones were still as likely to develop depressive symptoms, but they had a somewhat decreased risk of actually developing depression.
There’s more. Women with a history of major depression and chronic PMS are more likely to experience depression during perimenopause, develop symptoms such as hot flashes and menstrual cycle changes, and begin the transition earlier than those who have never had depression.
However, when it comes to mood and hormones, it’s something of a chicken-and-egg situation: Do women with early perimenopause get depressed, or does depression cause an early transition? Do hormones trigger depression, or does depression alter the action of hormones? "It’s very possible that depression impacts the normal production of hormones tied to reproduction, especially those in the brain," Harlow says.
Whatever the reasons for perimenopausal depression, if the quality of your life is being seriously affected by feelings of sadness, irritability, or anxiety, see your doctor. "If you notice symptoms of depression, get treatment," says Jan Shifren, MD, director of the Vincent Menopause Program at Massachusetts General Hospital, in Boston. "Don’t just say ‘it will pass.’"
You may be treated with several different types of medication, including hormone therapy, birth control pills, and antidepressants. Hormone therapy may help alleviate depression. Birth control pills help some women because they stabilize erratic hormone levels.
Nonpharmaceutical approaches include psychotherapy and mind-body techniques such as visualization and cognitive restructuring. Regular exercise can also help.
Consider meditating rather than medicating: It’s easy to learn relaxation techniques. (For more details, see Leslee Kagan’s book, Mind Over Menopause.) These tools can help trigger your body’s inborn ability to calm down. Tapping into that response on a regular basis can also reduce hot flashes, improve sleep, as well as boost your mood.
One positive fact to remember: Depression rates decline in women who are officially menopausal.
Mind/Body Approaches to Coping with Perimenopause
Changing the way you think can make this major life transition easier, according to Leslee Kagan, director of the menopause program at Mass General’s Benson-Henry Institute for Mind-Body Medicine.
"Are you thinking of it as a new stage of life, or as a stage of loss?" Kagan says. "Youth is valued, so a changing body image can be upsetting." Be aware of black-and-white thinking (It’s all downhill from here!) and "should" statements (I should not be feeling so moody!). Ask yourself: Am I using a mental filter, focusing only on all of the negative parts while ignoring the positives? Is this phase really as bad as it seems? Does it serve me well to think this way? "Negative thoughts lead you into the stress response," Kagan says. Instead of dwelling on the negative, try to move your thoughts to appreciation: "What about my day am I thankful for? Avoid saying perimenopause is awful; instead, ask: What is in store for me in this next phase of life? What do I want?
"It really does help when you can change your thoughts so they can serve you better," Kagan says. "It gives you a greater sense of control."
Kagan also suggests two other mind-body approaches to help you ease your own passage.
- Share your experiences with other women who are going through the same experience: "That normalizes things — it’s reassuring to know that a lot of women are feeling what you’re feeling."
- Spend time with friends. "Just being with your girlfriends, gossiping, giggling, can help your mood," Kagan says.
Originally published in MORE magazine, October 2008.
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