Menopause and Depression: The Importance of Finding Relief

Why Does Perimenopausal Depression Occur? 

Three broad factors link menopause and depression: hormones, sleep disturbances, and life stressors.

Hormone Changes. Hormonal fluctuations are an integral feature of perimenopause. During these years, people experience fluctuating and decreasing levels of estrogen. Estrogen plays a key role in the manufacture, efficiency, breakdown, and regulation of chemical messengers such as serotonin and norepinephrine. These chemical messengers (neurotransmitters) influence mood and behavior: Normal levels contribute to feelings of wellness, calm, happiness, and contentment. Decreased or fluctuating estrogen levels in perimenopause can disrupt the normal functioning of serotonin and norepinephrine in some women, which in turn can lead to depression.

Sleep Disturbances. Sleep disturbances are a notable symptom of depression, and perimenopause is similarly associated with sleep-related issues. A third of perimenopausal people report sleep difficulties, often related to uncomfortable night sweats, and those transitioning to menopause are up to 3.5 times more likely to report severe sleep difficulties than their premenopausal counterparts. This is likely related to a perimenopausal decline in certain hormones that influence sleep patterns—estrogen, progesterone, melatonin, and growth hormone. Other non-menopausal factors can also affect sleep in midlife, including chronic illness and a natural age-related change in our sleep patterns.

Life Stressors. Menopause frequently arrives at a time when people are already experiencing significant shifts in their lives (95 percent of people have their last period between the ages of 45 and 55). The following factors, often associated with midlife, are also associated with an increased risk of depression:

• Caregiver stress: Those in midlife often must act as caregivers for their own aging parents. This can be stressful, and stress can contribute to depression. Being a caregiver also limits the amount of time you have to connect with friends, and low social support is a risk factor for perimenopausal depression.
• Career changes: For many, midlife is a time for career changes, the stress of which can contribute to depression.
• Personal aging: Shifts in familial dynamics, poorer overall health, and coming to terms with a loss in fertility are stressors that naturally come with aging. The stress of coping with such drastic changes may contribute to depression in some. (Older studies suggested that depression arose from children leaving home—known as "empty-nest syndrome"—but this has been disproven.)

Although midlife can be a time of seismic change, it's also a time where some feel especially empowered to reach out for the treatment they deserve. Finding the right treatment choice for you is the next step.

Perimenopausal Depression Treatment 

Depression isn't something you simply have to accept in your perimenopausal years. Untreated perimenopausal depression exacerbates heart disease, diabetes, and osteoporosis, so it's important to seek depression treatment early. Talk therapy and medications help many people with depression. Selective serotonin reuptake inhibitors (SSRIs) can also relieve some of the physical symptoms of menopause, such as hot flashes and insomnia.

Menopausal hormone therapy can also soothe the physical symptoms of menopause (hot flashes, night sweats, and sleep disturbances). Some studies suggest that estrogen replacement therapy can help mood and enhance the effects of antidepressants. There are two caveats about the above drug-based treatments. First, hormone therapy may not be suitable for you if you are a smoker, have high blood pressure, or have a history of breast cancer, blood clots, or active liver disease due to increased risk of adverse effects. Second, up to a third of people with depression don't respond to antidepressants.

If you don't respond to antidepressant medications, there are non-drug options you can try, including Transcranial Magnetic Stimulation (TMS). TMS applies highly focused magnetic pulses to brain regions that are crucial in the regulation of mood. TMS is a non-invasive treatment that has been cleared by the FDA for the management of Major Depressive Disorder when one medication hasn't been effective (though typically covered by insurance after two). TMS can help to relieve some or even all of the symptoms of depression in many patients and is suitable for people with depression related to perimenopause. The symptoms of menopause have long been viewed as inevitable or inescapable. Thankfully, times have changed, and effective treatments are helping people with perimenopausal depression live the lives they deserve.