Women experience this transition in different ways. Some women have mild, easily managed symptoms. Others experience extremes in both moods and menstrual cycles. Your friend may barely notice a change in how she feels and even celebrate being free of periods, while you feel like you’re losing your minad.
Factors contributing to mood changes can be thought of as happening inside or outside of the body.
You may find yourself diagnosed with anxiety, depression, or a sleep disorder for the first time. Medical studies show that a woman in perimenopause is 2.5 times more likely to be diagnosed with depression than before that stage of life. As well, hot flashes can have an effect. Women who experience them frequently, especially during the night, are more susceptible to depression.
If depression was an issue earlier in your life, you may find that symptoms return during perimenopause. This can be true if your menstrual cycles affected your mood, as with premenstrual dysphoric disorder. It also applies to women who experienced depression during pregnancy or in the postpartum period. Changing hormone levels sometimes result in increased worry, tension and anxiety.
What’s my M3?
A three-minute online test screening for mood and anxiety disorders.
Society of Obstetricians and Gynaecologists of Canada (SOGC)
Canadian information website about menopause created
Canadian Network for Mood and Anxiety Treatments
Canadian Mental Health Association
The North American Menopause Society
Women’s Health Matters
Women’s College Hospital, Toronto
Mind over Mood
• Dennis Greenberger
The Anxiety & Phobia Workbook
• Edmund J. Bourne
During perimenopause and menopause, different hormones in the body can become out of balance. The female ovaries start making less and less progesterone and estrogen. It is not clear how exactly these hormones affect the brain. They relate to the levels of serotonin, a brain neurotransmitter that plays a role in mental health.
Changes in hormone levels can be erratic. It also takes time for your body to adjust to different lower estrogen and progesterone levels. Erratic hormone changes are linked to the ‘all over the place mood’ that some women describe. Menopause symptoms (see sidebar on next page) can become severe enough to signal mental illness, like major depression or an anxiety disorder.
Hormone fluctuations also cause hot flashes, a sudden rush of heat and sweat. These can occur many times a day, and can be especially bothersome while sleeping at night. Some women are awakened by hot flashes several times a night. This can cause insomnia and lack of sleep. Adequate sleep is a key part of mental and physical health. Even a few nights of poor sleep can affect your ability to cope.
Perimenopause and menopause also happen in middle age. At this point in life, a woman is facing her own aging. She may be caring for aging parents, beginning to experience health issues, or grieving the loss of her fertility. Any one of these situations can be overwhelming, and can lead to being less able to regulate emotions.
At every stage in life, it is important to stay aware of mental health. Talking about it is particularly valuable during times when hormone changes may also play a role. Talk with your doctor about how you are feeling and what you are experiencing. Together you can figure out if your symptoms are part of hormonal changes or severe enough to be diagnosed as a mental health disorder. Telling the difference will help with finding the right help.
To feel your best during perimenopause and menopause, you need:
Quitting smoking, managing obesity, and being responsible about alcohol and other drugs will improve your overall health and help you age in a healthier way. Talking with people you trust about changes in how you feel is important. These conversations are an opportunity for you to share your experiences and to educate those close to you about what you are going through.
Hormone replacement therapy (HRT) replenishes the decreasing estrogen and progesterone hormones in the body during perimenopause and menopause. This makes the natural hormone level fluctuations more bearable. Hormone replacement can help to improve mood and relieve depression and anxiety. HRT is especially effective for hot flashes and so can significantly improve sleep. HRT may not be safe for some women because it can increase their risk of certain cancers or blood clotting complications. Women who smoke, are obese, or have uncontrolled high blood pressure also have higher chances of complications with this treatment.
Women who would benefit from HRT, but cannot have this treatment, may find antidepressant medication provides some relief from hot flashes. Women who have a new diagnosis of depression or anxiety in menopause, but do not have significant hot flashes, should consider medications like SSRI antidepressants. Women with a depression diagnosis and with bothersome hot flashes may need both SSRI antidepressants and hormone replacement therapy.
Other medications, such as gabapentin and clonidine, work on the physiologic reaction of the hot flash itself and reduce their intensity and frequency.
Alternative treatments, such as herbal or ‘natural’ preparations so far have not been tested with the same rigor as prescription medications. These alternative medications have not been shown in medical studies to make a significant enough difference. These products are not tested for side effects the same way that prescription drugs are, and so are not recommended. Also, these products can sometimes interact with prescription medications.
If you, or someone close to you, are struggling with increased anxiety or depressed mood during perimenopause and menopause, take some time to read about the signs and symptoms of depression and anxiety. Journaling your own experiences can give you more insight into their extent and magnitude. If how you are feeling during this time of hormonal change is affecting your everyday life, please book a visit with your family doctor to find out how you can go about getting help to feel better. Perimenopause and menopause are challenging transitions for many women. However, much information and support is available.