Depression and mood symptoms in perimenopause are quite common. During perimenopause, the transitional phase leading to menopause, you may notice changes in your mood that seem different from the usual ups and downs. These mood symptoms are not just in your head; and often the hormonal fluctuations that are characteristic of this life stage are at play.
Your body’s production of estrogen and progesterone, hormones that are known to influence mood, become more erratic during perimenopause. This can result in mood swings, rage, sadness, and other mood-related symptoms that are often sharper or more intense than what you’ve experienced before. For some, fluctuating hormones can trigger depression. Especially if they’ve experienced depression previously or have a family history.
Provided they live long enough, everyone with ovaries will experience perimenopause. Studies show that perimenopause and the years immediately after achieving menopause are a particularly vulnerable period in terms of mood disruption. Indeed, women have double the rates of depression during this phase of life. As both perimenopause and mental health have traditionally been shrouded in shame or quite simply ignored, it’s important to shed light on these important topics.
While depression and mood symptoms are common, that does not mean you need to suffer. By being informed about what can contribute to depression during perimenopause, you empower yourself to get care and support that is right for you.
Understanding Emotional Changes in Perimenopause
Perimenopause is the phase leading up to menopause, which is the point when you have not had a menstrual period for 12 consecutive months. This transition typically begins for women in their late 40s but can start as early as the mid-30s. And can last anywhere from a few years to 10 or more. During this time, significant changes occur in your reproductive hormones, that can cause a wide variety of symptoms.
In addition to the physical symptoms of perimenopause, like hot flashes, period changes, migraines, and vaginal dryness, this phase of life can also affect your mental health. For some, these emotional changes can be significant.
Common Emotional Changes
During perimenopause, you may experience a range of emotional changes that are more intense than your typical mood fluctuations. These can include:
- Sudden feelings of sadness
- Decreased motivation
- A sense of loss or grief
Mood swings can be a prominent sign, but it’s important to distinguish them from other mood disturbances that might indicate a mental health disorder. If you have a history of depression, you should be particularly vigilant as changes in estrogen and progesterone can exacerbate depressive symptoms.
Depression is a medical condition associated with sadness that won’t go away. The incidence of depression in perimenopausal women is significant. Studies show that 28% of women with no history of depression will experience this medical condition during perimenopause. And 58% of women with a history of depression will experience a reoccurrence during the menopause transition.
To recognize a depressive disorder, look for a cluster of symptoms that persist for most of the day, nearly every day, for at least two weeks:
- Persistent feelings of sadness, hopelessness, or emptiness
- A marked loss of interest in almost all activities
- Significant weight change or appetite disturbance
- Trouble sleeping or excessive sleeping
- Fatigue or loss of energy
- Feelings of worthlessness or excessive guilt
- Difficulty concentrating or making decisions
- Recurrent thoughts of death or suicide
It’s important to get help from a qualified medical professional if any of these symptoms are affecting your life. Even if you don’t believe your symptoms are severe, we encourage you to seek help. Too many of us have suffered silently, thinking that this is just how life is when we get older. That is not true. You’ve worked hard, gained invaluable experience, and forged relationships; this should be a time when you enjoy the life you’ve built. Don’t settle. Get information. Speak up. Ask for help.
Contributing Factors to Emotional Changes in Perimenopause
Mood variations during perimenopause can be influenced by a complex interplay of stress, lifestyle, physiological changes, and psychosocial factors. Understanding these factors can better equip you to navigate this transitional period.
Stress and Lifestyle
Stress can significantly impact your mood. During perimenopause, you may experience increased stress levels due to lifestyle changes such as caring for aging parents or managing career transitions. Stress can lead to symptoms like anxiety, sleep problems, and fatigue, which in turn may exacerbate mood variations. It’s crucial to address stress through strategies such as relaxation techniques, physical activity, and seeking social support.
Lifestyle changes to consider for ameliorating stress:
- Regular exercise
- Adequate sleep
- Balanced diet
- Mindfulness or meditation practices
Additionally, certain habits like smoking can worsen perimenopausal symptoms, including mood swings.
Physical and Psychosocial Factors
Physical health plays a prominent role in mood variations. Fluctuations in hormone levels during perimenopause can lead to depressive symptoms. If you have a history of depression or a family history of depression, you may be at a higher risk. These factors, alongside existing physical health challenges, can contribute to feelings of sadness or a loss of interest in activities you once enjoyed.
Psychosocial factors can also add to, or even be exacerbated by the hormonal chaos of perimenopause, leading to emotional changes and even depression. These could include adverse childhood experiences (ACES), trauma, financial hardship, insufficient social support and/or the breakdown of a partnership or marriage. It’s important to acknowledge and seek help for these experiences as they can significantly affect your emotional well-being during this time.
Remember, you’re not alone in this. Reach out to healthcare providers or mental health professionals who understand the nuances of perimenopausal mood variations and can offer the appropriate support and treatment options.
Treatment Options and Considerations
When managing depression and mood symptoms during perimenopause, you have multiple treatment options. It’s essential to work closely with your doctor or mental health professional to determine the best course of action for your specific needs.
Antidepressants and Psychotherapy
Antidepressant medications are a cornerstone for addressing perimenopausal depression. Selective serotonin reuptake inhibitors (SSRIs) are often the first-line treatment. Alongside medication, psychotherapy, particularly cognitive-behavioral therapy (CBT), is a valuable strategy that can improve outcomes by helping you develop coping strategies and address negative thought patterns.
Hormone Replacement Therapy
Hormone replacement therapy (HRT) is considered the gold-standard treatment for hot flashes and genitourinary syndrome of menopause, and it has shown some benefit in treating other perimenopausal symptoms, including mood swings and milder depression. It is important to work with your healthcare provider to understand what factors are impacting your emotional health and what solutions will provide your the most relief. For example, if you aren’t sleeping due to night sweats HRT will likely help. By reducing or stopping the night sweats your sleep improves. When sleep improves so does your mood.
All medications carry potential health risks. It’s important to discuss the benefits and risks with your healthcare provider.
Lifestyle and Behavioral Interventions
Managing your mood and depressive symptoms during perimenopause can be effectively supported by targeted lifestyle and behavioral interventions. These strategies are practical and can have a significant positive impact on your day-to-day wellbeing.
Exercise and Diet
Regular exercise is essential for maintaining mental health, especially as you navigate through the hormonal changes of perimenopause. Aim to incorporate at least 30 minutes of moderate aerobic activity most days of the week to help improve mood and reduce stress. Strength training exercises also benefit bone health, which is particularly important during this life stage.
Studies have shown that exercise can have a significant impact on depressive symptoms. In fact, physical activity can have effects that are sometimes as great as taking an antidepressant. And any decision to stop a medication or pursue and alternative strategy should be done under the advice and care of a qualified healthcare provider.
Concerning diet, a balanced intake rich in fruits, vegetables, whole grains, and lean proteins supports overall health and can mitigate mood swings. Specific foods, like those high in omega-3 fatty acids, may be particularly beneficial. It’s wise to reduce your caffeine intake as well, as it can exacerbate sleep problems and night sweats.
Sleep and Stress-Reduction Techniques
Adequate sleep is crucial; strive for 7-9 hours each night. To combat sleep disruption, maintain a regular sleep schedule, create a restful environment, and consider practices like reading or meditating before bed instead of screen time. If night sweats disturb your sleep, wearing breathable clothing and using a fan can help. Speak to your doctor about whether hormone replacement therapy (HRT) is an option for managing your night sweats.
Practicing stress-reduction techniques, such as deep breathing exercises, progressive muscle relaxation, or meditation, can significantly impact your daily stress levels. These practices don’t just improve your immediate sense of calm; they contribute to better sleep and a more stable mood over time.
Navigating Personal and Social Impacts
Perimenopause often affects more than just your biological processes; it can reshape your interactions at work and home, and challenge your usual support networks. Recognizing the changes and learning to navigate them effectively is an integral part of this life phase.
Effects on Relationships and Work
Work: You may notice a shift in your capacity to handle the regular pressures and multitasking that your job demands. Perimenopausal depression can lead to a loss of interest in activities you once found rewarding, impacting job performance and satisfaction. It’s important to communicate any struggles with a trusted colleague or supervisor and to consider flexible work arrangements if necessary. Taking advantage of counsellor services through your benefit plan can also be very helpful.
Relationships: Fluctuating hormones can lead to mood swings, affecting your interactions with family and friends. If you’re caring for aging parents, the additional stress can exacerbate perimenopausal symptoms, influencing your patience and emotional bandwidth. It’s important to have open conversations with loved ones about your experience, what can happen during perimenopause, and to seek support when needed.
Perimenopause can be a time of hormonal chaos. When these hormonal changes collide with other factors like elder care, relationship breakdowns, career transitions, financial stress, and/or health challenges they often create a maelstrom of symptoms that can be hard to sort out. And while these symptoms are common, that does not mean you just need to suffer through them.
Learning about what can happen in perimenopause will help you realize you are not alone. It will also build your confidence to ask for the support and solutions you need, whether that is from your partner, family, workplace, or medical provider. And know that every time you do speak up and ask for what you need, you’re helping break the stigma associated with both perimenopause and mental health.