Depression and Anxiety during the Menopause Transition

Depression and Anxiety are common symptoms during perimenopause.

In this past week, I have had three new patients come to me with their biggest concern during perimenopause not related to hot flashes, but to depression and anxiety.

This is such an important post for me, because I really want to bring awareness to why you may be feeling how you are, and that you don't have to "push through" this on your own. Perimenopause can last for years but these feelings don't have to dim your light for that long.

Let me tell you about their journey so far. Each woman described the feelings as being something their body was doing all on their own. They were not in a stressful situation or worrying about a particular 'thing', when they would be struck with intense anxiety and/or panic attacks. Each of them descibed the feeling the same: "It's like my body doing it all on it's own, without my brain telling it to".

This also paired with feeling down during the day, able to cry at the drop of a hat (which some did during our visit together). Another woman added in that she also felt removed from her regular emotions that she would have felt a year ago, as if joy she would normally have felt was almost unattainable. Perimenopause can be such an "all-in" journey that throws your body and mind into waves of change, fluctuating throughout the day.

Did you know this could happen?

Big hormone changes, like those experienced during puberty, pregnancy/fertility treatments, and perimenopause are referred to as "windows of vulnerability" for womens mental health. A staggering 45-70% of women will notice depressive or anxious symptoms during perimenopause, especially if you noticed this during a prior "window".

I think one of the worst parts about depression and anxiety is that most people are uncomfortable talking about it. Even with all the mental health awareness that we try to bring forth, there can still feel like stigma when you tell others you may be depressed or anxious. Almost like you aren't trying hard enough. When we don't talk about it happening, women who are entering perimenopause are blindsided by this emotional rollercoaster and don't know to connect the dots to hormone changes.

Why is this Happening?

Like most of the symptoms that women experience during perimenopause, the wide swings of hormones is likely the cause of mood changes.

Estrogen receptors are widely distributed throughout the brain: temperature control places, happy and relaxing hormone binding sites, etc. Some women are kind of aware of this during their regular cycle as it can be responsible for things like PMS and how you feel during different times of your menses. Well, now your getting bigger changes and they can be more or less often. Your body can't really adapt because the scene is always changing. Some women are more susceptible to the mood changes that this can cause.

Are there any solutions?

Yes. Yes there are ALWAYS solutions, and I urge you to seek out something that resonates with you! You do not have to 'push through' this. There are no medals for that in the game of life. Please seek out and start trying different options so that you can enjoy every day instead of waiting for some distant future 'day' when everything feels better.

I will now get off of my soap box and let you know that there are lots of different things to try. None have to be done in isolation and sometimes they compliment each other.

Menopause hormone therapy or birth control

Hormones are the cause, so they can obviously be part of the solution. Keeping a steady amount of estrogen and progesterone in the body with hormone therapy can really help reduce/improve mood scores. In fact, there is evidence that it works best here vs. post-menopause. To me this highlights that it's the hormone swings that are an issue during this phase as opposed to a woman who is 5 years post-menopause and has depression. Depending on your age and needs, you may choose between MHT and birth control as your source of steady hormones.

Pharmaceutical antidepressants

Of course this option has to be mentioned - even though your hormonal changes are the cause, it doesn't mean that hormones have to be the answer. Antidepressants have a long history of helping here. It may be you trying a few different types or dosages to find what works best for you.

Herbs/Supplements

There are herbs and supplements that can support mood during any time of life. Mechanisms here will mostly work on serotonin (read: happy neurotransmitter), and GABA (read: relaxing neurotransmitter), and a few others. Herbs that have the most evidence include St John's Wort, Sage, Saffron. Some supplements that can improve depression and anxiety include Creatine, Omega 3 Fatty Acids, and GABA.

CBT/Mindfulness to help with other aspects of mental health

I wish I had better training in this to offer to my patients! There is a lot of great evidence that cognitive behavioural therapy (CBT) can really improve mild/moderate depression and anxiety in people. While it is not in my wheelhouse, I wanted to mention it here in case that was an avenue you would be most comfortable starting with.