An Overview of Menopause and Depression

Menopause and Depression: Symptoms, Causes, Diagnosis, Treatment, and Coping

Woman talking to doctor

What Is Menopause?

Menopause is the time in a woman’s life when the menstrual period stops, most likely when the ovaries stop making estrogen. Missing a period for 12 consecutive months (in the absence of other obvious causes) is the main criteria for being menopausal . When this happens, a woman is no longer able to get pregnant. The average age of menopause is 51, with the transition occurring most often between the ages of 45 and 55. 

Despite having an occasional period, many women believe they are menopausal when they are actually in a transition period called perimenopause. This refers to the time when your body makes the natural transition to menopause. It most often occurs sometime in your 40s, or right around the time of menopause.

Many of the changes you experience during perimenopause are a result of decreasing estrogen, which along with progesterone, rises and falls as you make your way to menopause. There is some association with these hormonal changes.

What Is Depression?

Depression is a mood disorder that causes persistent feelings of sadness or loss of interest and affects how you feel, think, and handle daily activities. The two most common forms of depressive disorders are major (clinical) depression and persistent depressive disorder (Dysthymia). Common symptoms of depression include sadness, lack of interest in things you once enjoyed, irritability, fatigue, and feelings of hopelessness, worthlessness, and pessimism accompanied by physical symptoms.

Major depression is the most commonly diagnosed depressive disorder. It is characterized as having symptoms of depression most of the day, nearly every day for at least two weeks that interferes with your ability to work, sleep, study, eat, and enjoy life.

How They Are Related

Many women going through perimenopause or menopause can tell you that extreme shifts in hormonal levels often lead to feelings of depression. Whether it’s a new onset of depressive symptoms or exaggerated symptoms from an existing diagnosis, managing the mood swings along with other symptoms can, at times, feel very overwhelming. 

It is only recently that the medical community created guidelines for the evaluation and treatment of perimenopausal depression. 

Some of the challenge in evaluating perimenopausal depression is due to the fact that several of the symptoms related to its hormonal changes overlap with common symptoms of depression and other menopausal symptoms that often present similarly.

Symptoms including, insomnia, hot flashes, sleep disturbances, and mood problems are common during perimenopause and menopause.

The risk of developing symptoms related to depression is known to increase among women as they transition to menopause.

Symptoms

The signs and symptoms of depression include:

  • Persistent feelings of sadness, anxiety, hopelessness, or pessimism
  • Feelings of worthlessness
  • Decreased energy or fatigue
  • Irritability
  • Loss of interest or pleasure in activities once enjoyed
  • Difficulty sleeping or oversleeping
  • Appetite or weight changes
  • Difficulty concentrating, remembering, or making decisions
  • Lack of self-care
  • Aches or pains, headaches, cramps, or digestive problems 
  • Withdrawal from social activities
  • Thoughts of death or suicide

The symptoms of menopause may include :

  • Irregular periods or bleeding leading to a loss of a period for 12 consecutive months
  • Problems with sleep due to low levels of progesterone and estrogen
  • Hot flashes and night sweats
  • Problems with memory or being forgetful and struggling to focus
  • Mood changes such as irritability and crying spells
  • Feelings of depression or anxiety
  • Changing feelings about your sexual health
  • Vaginal dryness

Causes

The symptoms of depression that can present during perimenopause and menopause are related to a variety of factors including hormonal changes, underlying vulnerabilities to depression, and other stressors. Hormonal shifts that happen at other times in a woman's reproductive life, such as the postpartum period, are also correlated with an increase in depression and mood symptoms.

Declining estrogen levels that happen as you move through perimenopause towards menopause can contribute to emotional changes such as sadness, irritability, fatigue, difficulty concentrating, and mood changes. That said, there is no evidence that menopause causes depression. If symptoms are severe or impacting your life more than occasionally, be sure to see your doctor or a mental health specialist. 

Diagnosis 

Your doctor can perform an evaluation to determine where you are in the transition to menopause and recommend the next steps for potentially treating menopausal symptoms. But if the symptoms related to depression are severe or you have a previous diagnosis of depression, being evaluated by a mental health professional is the next step. They will be able to determine if you have a major depressive disorder or clinical depression. 

Treatment 

For perimenopausal and menopausal women diagnosed with depression, adhering to the proven therapeutic options for treating depression should be followed. These include treatment with antidepressants and/or psychotherapy (“talk therapy”). There are several forms of psychotherapy, but one in particular that has been proven successful in treating depression is cognitive-behavioral therapy (CBT). 

There is some evidence that treating women entering menopause with hormone replacement therapy may help to enhance mood, but it is not considered a form of treatment for depression. Some findings suggest estrogen, which can help reduce hot flashes and night sweats, may also help with mild to moderate symptoms related to mood swings and feelings of depression.

There are risks associated with hormone replacement therapy. That's why talking with your doctor about your health is always the best place to start. 

Coping

Coping with depression symptoms that accompany perimenopause or menopause often requires a systemic approach. And like many other recommendations for depression or menopause, lifestyle modifications can make a significant difference in your quality of life. 

Daily exercise, socializing with friends and family, meditation, mindfulness, and participating in activities that were enjoyable before depressive episodes started are just a few ways to cope with symptoms related to depression. 

Reducing or eliminating alcohol, smoking, or other substances can help with certain symptoms of menopause. Also, taking extra care to follow a diet rich in fruits, vegetables, lean protein, complex carbohydrates, and healthy fats may help with symptom management. 

A Word From Verywell

Mood swings and feelings of sadness and irritability are common occurrences during perimenopause and menopause. That said, it can be challenging to distinguish between clinical depression and the ups and downs related to shifting hormones. If you’re concerned about your physical or mental health, take the first step, and make an appointment with your doctor.

Being open and honest about how you’re feeling can help relieve the pressure or anxiety you might be experiencing. It also allows your doctor to make a proper diagnosis and create a treatment plan that focuses on your needs.

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Article Sources

Verywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial policy to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. The American College of Obstetricians and Gynecologists. The Menopause Years

  2. National Institute of Mental Health. Depression.

  3. de Kruif M, et al. Depression during the perimenopause: A meta-analysis. Journal of Affective Disorders. 2016; 06:174-180. doi: 10.1016/j.jad.2016.07.040

  4. Maki P, et al. Guidelines for the Evaluation and Treatment of Perimenopausal Depression: Summary and Recommendations. Journal of Women’s Health. https://doi.org/10.1089/jwh.2018.27099.mensocrec.

  5. Anxiety and Depression Association of America. Perimenopause and Depression. 


  6. The Cleveland Clinic. Menopause: Emotional Aspects (Including Depression): Management and Treatment


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