Menopause and Mental Health

What is perimenopause?^back to top

Perimenopause is the stage of a woman’s reproductive life that begins 8 to 10 years before menopause, when the ovaries gradually begin to produce less estrogen. Perimenopause lasts up until menopause, the point when the ovaries stop releasing eggs. In the last one to two years of perimenopause, the decrease in estrogen accelerates. At this stage, many women experience menopausal symptoms.

What is menopause?^back to top

Menopause is period of time when a woman stops having her monthly period and experiences symptoms related to the lack of estrogen production. By definition, a woman is in menopause after her periods have stopped for one year. It is a normal part of aging and marks the end of a woman's reproductive years. Menopause typically occurs in a woman's late 40s to early 50s. However, women who have their ovaries surgically removed undergo "sudden" menopause.

The drop in estrogen levels during perimenopause and menopause triggers physical as well as emotional changes — such as depression or anxiety and changes in memory. Like any other point in a woman’s life, there is a relationship between hormone levels and physical and emotional symptoms. Some physical changes include irregular or skipped periods, heavier or lighter periods, and hot flashes.

Midlife is often considered a period of increased risk for depression in women. Some women report mood swings, irritability, tearfulness, anxiety, and feelings of despair in the years leading up to menopause. But the reason for these emotional problems isn’t always clear. Research shows that menopausal symptoms such as sleep problems, hot flashes, night sweats, and fatigue can affect mood and well-being. The drop in estrogen levels during perimenopause and menopause might also affect mood. Or it could be a combination of hormone changes and menopausal symptoms.

But changes in mood also can have causes that are unrelated to menopause. If you are having emotional problems that are interfering with your quality of life, it is important to discuss them with your PCP. Talk openly with your PCP about the other things going on in your life that might be adding to your feelings. Other things that could cause feelings of depression and/or anxiety during menopause include:

• Having depression before menopause
• Feeling negative about menopause and getting older
• Increased stress
• Having severe menopausal symptoms
• Smoking
• Not being physically active
• Not being happy in your relationship or not being in a relationship
• Not having a job
• Not having enough money
• Having low self-esteem (how you feel about yourself)
• Not having the social support you need
• Feeling disappointed that you can't have children anymore

Coping with the symptoms of menopause^back to top

There are many other ways you can ease menopause symptoms and maintain your health. In general, these tips include ways to cope with mood swings, fears, and depression:

• Find a self-calming skill to practice such as yoga, meditation, or slow, deep breathing.
• Avoid tranquilizers.
• Engage in a creative outlet or hobby that fosters a sense of achievement.
• Stay connected with your family and community; nurture your friendships.
• Seek emotional support from friends, family members, or a professional counselor when needed.
• Take steps to stay cool during hot flashes, such as wearing loose clothing.
• Keep your bedroom cool to prevent night sweats and disturbed sleep.
• Take medicines, vitamins, and minerals as prescribed by your PCP.
• Eat healthfully and exercise regularly.

What are my options for treating depression during this phase of my life?^back to top

• Your PCP will try to exclude any medical causes for your depression, such as thyroid problems.
• Depression during perimenopause and menopause is treated in much the same way as depression that strikes at any other time; however, there is a growing body of evidence to suggest that estrogen replacement can provide relief of minor physical and emotional symptoms, as well as prevent osteoporosis.  However, there may be a slight increase in breast cancer and blood clots. However, hormone replacement therapy alone is not effective in treating more severe depression. Antidepressant drug therapy and/or psychotherapy may be necessary.

If you need treatment for these symptoms, you and your PCP can work together to find a treatment that is best for you. Depression during perimenopause and menopause is treated in much the same way as depression that strikes at any other time life. If your mood is affecting your quality of life, here are a few things you can do:

• Try to get enough sleep. Go to bed and wake up at the same times every day. Keep you room cool and dark. Use your bed only for sleeping and sex. Avoid alcohol, caffeine, large meals, or physical activity before bed.
• Engage in physical activity for at least 30 minutes on most days of the week.
• Set limits for yourself, and look for positive ways to unwind and ease daily stress. Try relaxation techniques, reading a book, or spending some quiet time outdoors.
• Talk to your friends who are in perimenopause or menopause or go to a support group for women who are going through the same thing as you. You also can get counseling to talk through your problems and fears.
• Ask your PCP about therapy or medicines. Menopausal hormone therapy can reduce symptoms that might be causing your moodiness. Antidepressants might also help.

http://my.clevelandclinic.org/disorders/menopause/hic_perimenopause_menopause_and_depression.aspx
http://www.womenshealth.gov/menopause/mental/