Menopause can be a difficult time. Intrusive symptoms like hot flashes, night sweats, painful sex, and sleep problems can create physical discomfort and emotional distress. Meanwhile, the transition out of your fertile years can be a time of introspection and give rise to complex feelings about your sense of self and your place in the world. For some, it is also a time when the symptoms of depression emerge, either for the first time or more severely than in the past.
While depressive symptoms are common amongst women going through menopause, they should not be taken lightly. Left untreated, these symptoms can be deeply damaging, and it is essential to seek support and get the care you need. However, there is also no single treatment that will work for all women. Rather, the best treatment for menopausal depression is that which works for your individual circumstances and symptoms. Because depression could result from a wide range of potential causes, including hormonal fluctuation and imbalance, it’s important to consider all possibilities. The right treatment for someone else might not be the best option for you.
Finding the right treatment for depression at any stage of life starts with seeking the guidance of a qualified mental health professional you can trust. For most women, that means regular appointments with a psychologist, psychiatrist, or therapist. However, if you are approaching or experiencing menopause, you may want to be particularly mindful of the potential impact of hormones on your symptoms and seek the help of a practitioner who specializes in hormonal health. Together, you and your mental health team will be able to address your symptoms of menopausal depression and help you regain a sense of well-being.
Does Menopause Really Cause Depression?
Most women know that mood swings—brief periods of emotional highs and lows—are a proven symptom of hormonal fluctuations during menopause. But not all mood episodes are brief. Today, there is growing evidence that major depression and related mood disorders may also be attributed to the hormonal changes that trigger menopause.
It is important to note that while hormonal changes alone may spur depression, there are multiple, overlapping risk factors for depression in aging women. One review found that women were more likely to experience depression during perimenopause if they also experienced the following:
- Vasomotor symptoms
- Previous history of major depressive episodes
- Postpartum depression
- Surgical menopause
- Adverse life events
- Negative attitudes to menopause and aging
Researchers have also observed that women who enter perimenopause at a younger age are at a higher risk for developing depressive symptoms. Interestingly, among women who experienced depression leading up to menopause, the risk for depressive symptoms decreases significantly after the final menstrual cycle—although their risk remains higher than women without a history of depression.
These results strongly suggest that menopause-related hormonal fluctuations contribute to depression. However, the full picture is often more complex.
Other Potential Causes of Depression During Menopause
While hormonal changes may directly cause depression, the symptoms those changes create can also make women more vulnerable to experiencing significant mood disturbances—either for the first time or by aggravating an existing mood disorder. Indeed, if you were to simulate the symptoms of menopause without the hormonal component in an otherwise healthy person, you would be likely to observe a downward turn in mood. If those symptoms continued for years, or increased in severity, there’s no question that the individual might fall into a lingering state of depression.
In many ways, menopause is the perfect storm for mental health disturbances. Mood swings are common and can cause significant emotional and social disruptions. Low sex drive and painful sex can be heartbreaking and frustrating and have a deep impact on your most important relationships. Night sweats prevent you from getting enough sleep, can undoubtedly fuel depression. On top of all of this, the end of fertility can bring up feelings of loss and even fundamentally redefine your understanding of yourself. It only makes sense that many women begin to experience depressive symptoms during this time. And the risk is even greater for those with a pre-existing mental health disorder; women with a history of depression are thirteen times more likely to experience symptoms or relapse during menopause.
Of course, your depression could also be caused by a separate medical condition altogether. A fair number of endocrine disorders, infections, neurologic problems, and cancers are known to cause depression as a secondary symptom, and your risk of experiencing these conditions often increases with age. You might also experience depression due to genetics or life circumstances unrelated to menopause. In light of this multitude of possibilities, it is important to receive a full physical and psychological evaluation to determine the root cause of your symptoms.
Discovering the Best Treatment for Menopausal Depression
It takes a great deal of expertise to unpack all the potential risk factors for a woman who experiences depression during perimenopause. That’s why the best treatment for menopausal depression might be different for every individual. But regardless of what may be causing your depression, a comprehensive approach to treatment will likely be the best path forward.
If you are just beginning your journey, your goal should be to collect all the information you possibly can about your symptoms and their possible causes. Have a full physical done by a trusted health care practitioner, including comprehensive blood tests to identify health conditions that may be affecting your mood. Meet with a psychiatrist to discuss a possible diagnosis and their treatment recommendations. Have your hormone levels tested by a specialist in hormonal health. With a complete picture of your physiological and psychological health in place, you can determine what the next steps should be.
All things considered, there is plenty of hope for women who struggle with menopause-related depression. There is a wide range of psychotropic medications on the market proven effective for treating depression, and psychotherapeutic modalities like cognitive behavioral therapy are known to reduce depression in menopausal women. Treating sleep disturbances and engaging in mind-body practices like yoga and meditation can also help alleviate symptoms.
Additionally, research suggests that estrogen therapy and estradiol therapy may have antidepressant effects for depressed women before their final cycle. A combination of antidepressant medications and hormone replacement therapy can also be highly effective for women who experience more severe episodes of depression during perimenopause. In fact, studies have found that “selective serotonin reuptake inhibitors (SSRIs) in addition to estrogen are usually more beneficial in improving mood than SSRIs or estrogen treatment alone for major depression.” A good psychiatrist will be able to work with you and your hormone practitioner to design a treatment plan and effectively monitor your progress on any of these therapies.
Depression during menopause is not inevitable, and you deserve to feel your best as you enter this new stage of life. Whatever treatment you end up choosing, getting a comprehensive overview of your health and exploring all your options puts you in the best possible position to find relief from your symptoms and achieve balance once again.
Today, there are more treatment options than ever before to help you find relief from mood disturbances during menopause, but you need the right guidance in order to get optimal results. If you are considering hormone therapy to address the symptoms of depression, BodyLogicMD can help. BodyLogicMD-affiliated practitioners are experts in hormonal health and can design a customized treatment plan using cutting-edge therapies to help you stay healthy, mind and body. Contact a local practitioner , or take the BodyLogicMD Hormone Balance Quiz to learn more about how hormone therapy could be a powerful supplement to your overall mental health.
Disclaimer: These statements have not been evaluated by the Food and Drug Administration. All content on this website is for informational purposes only. The content is not intended to diagnose, treat, cure or prevent diseases.
Charlotte is a patient care coordinator specializing in bioidentical hormone replacement therapy. She is committed to helping patients who struggle with the symptoms of hormonal change and imbalance explore their treatment options and develop effective strategies to optimize wellness.