While the majority of women go through menopause without developing psychiatric issues, about 20% may experience mood changes and depression during this time. However, there are steps you can take to mitigate the impact of menopause on your mental health.
How are menopause and depression connected?
There is a strong link between changes in hormonal systems and mental health problems, both in people with psychiatric disorders and those with endocrine issues. The transition into perimenopause and menopause may be difficult for some women due to changes in hormone levels that can affect neurotransmitters in the brain. Decreased estrogen levels during perimenopause and menopause can cause unpleasant symptoms such as vaginal dryness, irregular periods, hot flashes, and disrupted sleep, which can lead to menopausal depression symptoms like low mood, anxiety, irritability, and mood swings.
These mood swings can be disruptive to a person's psychological well-being. The irritability caused by menopausal depression can also lead to difficulty concentrating and memory lapses. Women who had severe premenstrual syndrome in their younger years may experience severe, sudden changes in mood during perimenopause. Additionally, females with a history of clinical anxiety and depression may be particularly prone to experiencing clinical depression again during the menopausal period or even years before actual menopause.
Women transitioning to menopause are more likely to suffer from depression if they have dismissive and pessimistic moods before menopause, experience interpersonal stress, smoke, do little or no exercise, feel lonely, hate their partner, or perceive their health as poor. Other stressors that may be associated with menopausal symptoms and depression include caring for elderly parents, the onset of illness in oneself or others, and changes in employment.
Psychological and Social factors
There are a number of psychological and social factors that may contribute to the development of depression in women before, during, and after menopause, including the experience of empty nest syndrome (a feeling of grief and loneliness when children leave home), changes in the process of conceiving, and infertility.
Prior history of depression
A history of postnatal depression or premenstrual dysphoric disorder (severe depression, irritation, and anxiety before menstruation) in oneself or one's family can increase the risk of experiencing depression during menopause. However, even women without a family history of major depressive disorder may be at risk of developing a perimenopausal depressive syndrome.
The emotional changes that occur during perimenopause and menopause are significant because of the role that estrogen plays in the body. Estrogen is a hormone that helps regulate many reproductive functions in women, and it also affects the production of serotonin in the brain, which helps regulate mood. When women transition to menopause, the ovaries reduce their production of estrogen, which can lead to a hormonal imbalance that can cause mood swings and irritability. There are three stages of menopause in which women may experience mood changes: perimenopause, which is the period before menopause and is characterized by sudden mood swings such as anxiety, panic, and anger; menopause, which can cause mental fogginess due to hormonal shifts; and postmenopause, during which low levels of estrogen can contribute to feelings of depression and anxiety.
Mood swings in different menopause stages
During the emotional transitions of perimenopause and menopause, women may experience significant changes in mood due to the role that estrogen plays in the body. Estrogen is a hormone that helps regulate many reproductive functions and also affects the production of serotonin in the brain, which helps regulate mood. As women transition to menopause, the ovaries reduce their production of estrogen, which can lead to a hormonal imbalance and cause mood swings and irritability. If estrogen production is low, serotonin levels may also be low, which can impact mental stability and optimism. Mood swings during menopause can occur during three stages: perimenopause, menopause, and postmenopause.
- Perimenopause: the stage before menopause when all the menopausal symptoms occur. During this time, women may experience extreme and sudden mood swings that take the form of anxiety, panic, and anger. They may also become less tolerant and easily annoyed by even minor things.
- Menopause: hormonal changes that occur during menopause can lead to a feeling of mental fogginess or confusion.
- Post-menopause: low levels of estrogen that occur during postmenopause can contribute to feelings of depression and anxiety.
How hormonal changes during menopause influence your mood
The decline in estrogen during menopause is believed to affect the way the body manages norepinephrine and serotonin, which are involved in the development of depression. Reduced levels of estrogen can also cause mood swings. Mood changes associated with menopause can range from mild feelings of upset or irritation to more severe forms of aggression. Other common feelings experienced due to hormonal changes during menopause include anxiety, depression, tearfulness, irritability, lack of motivation or energy, lack of focus, disturbed sleep, crying episodes, panic attacks, low confidence, and memory loss. These mood changes can cause considerable distress and affect a woman's overall well-being, as well as impacting the people around her, such as spouses, family members, and colleagues.
Treatment for menopause depression
Depression and mood swings that occur during perimenopause and menopause are treated in much the same way as depression at other times. If you are experiencing menopause-related mood swings and symptoms of anxiety, such as fatigue, irritation, sadness, and thoughts of suicide, it is important to consult a doctor. They can help you find the best treatment for menopause-related depression that is appropriate for your needs.
Hormone replacement therapy (HRT) can be helpful for women who have undergone a hysterectomy (surgery to remove the uterus). There are various types and doses of HRT that can compensate for low estrogen levels. These doses can be administered as pills, patches, or gel. The pills available include conjugated estrogens or estrogens. The estrogen patch is worn on the abdomen and can help reduce the risk of osteoporosis. Another option for increasing estrogen levels is topical estrogen, which is applied as a cream, gel, or spray. Vaginal estrogen is also available in the form of a cream, vaginal tablets, or vaginal ring.
Menopause and depression are closely connected, as reduced estrogen levels during menopause can cause feelings of hopelessness and sadness. Estrogen therapy can help boost serotonin levels, which can combat depression and promote healthy sleep. It can also increase GABA, a calming neurotransmitter, and endorphins, which can improve mood.
Lifestyle changes, such as eating a healthy diet, limiting the consumption of processed foods, reducing alcohol intake, quitting smoking, and engaging in regular exercise, can also be beneficial for managing mood changes during menopause.