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Depression and Menopause: Understanding Mental Health Changes during the Menopause Transition

Overview: depression and mental health in menopause transition

    • The menopausal transition is a significant period in women’s lives, marked by hormonal changes and potential impacts on mental health.
    • The menopausal transition, also called perimenopause, begins for most women between 45-55 and includes the years leading up to menopause.
    • Some women experience depressive symptoms for the first time during midlife, with factors like stressful life events and a history of anxiety disorder playing contributing roles.
    • The Study of Women’s Health Across the Nation (SWAN) provides valuable insights into how hormonal shifts, menopause symptoms, individual risk factors, and psychosocial stressors interact.
    • It also highlights the value of ongoing research in addressing women’s mental health needs during the menopausal transition.

Understanding menopause and mental health

Women frequently experience notable shifts in both physical and mental/emotional well-being during this life stage. In particular, some women are more susceptible to depressive symptoms around the time of their final menstrual period. Understanding the connection between menopause and mental health through research is essential for effectively addressing the challenges that emerge during this phase.

Learn about menopausal emotional well-being and depression in women in later life.

SWAN is a long-term, multi-racial and ethnic, and multicenter research project that aims to understand the physical, biological, and psychosocial changes that occur in women during the menopause transition. Researchers are examining various aspects, including hormone levels, sleep patterns, cardiovascular health, bone density, and psychological well-being. By studying a diverse population of women over time, SWAN aims to provide comprehensive insights into the menopause transition and its impact on women's health.

Link between menopause transition and depression symptoms

Considerable research has investigated associations between hormones such as FSH or estradiol during stages of menopause and mood. However, results have been inconsistent. While some studies suggest a link between higher levels of these hormones and more depressive symptoms, others haven’t confirmed this connection.

Research shows that women with a history of major depression before menopause may be more vulnerable to experiencing depressive symptoms during perimenopause and early post-menopause. However, for a minority of women, midlife is their first experience of depressive symptoms.

Menopause transitions are broken into three phases: 

    • Perimenopause: This transitional phase leading to menopause is characterized by irregular menstrual cycles and fluctuating hormone levels. The hormonal changes, especially decreases in estrogen, can contribute to mood swings, anxiety, and depressive symptoms in some women.
    • Menopause: The onset of menopause, marked by the cessation of menstrual periods, can be accompanied by a higher risk of depression due to hormonal shifts. Swan research has shown, however, that other factors like stressful life events, sleep problems, hot flashes, and past experiences from childhood often have a more significant impact on depressive symptoms..
    • Post-Menopause: While some women experience relief from depressive symptoms after menopause, others may continue to struggle with mood disturbances. Hormones are not believed to play a significant role in postmenopausal depression. Factors such as overall health, social support, and coping strategies can influence mental health outcomes during post-menopause.

Depressive symptoms in menopause

While most midlife women do not experience clinically high levels of depressive symptoms, those who do are more likely to experience them during perimenopause or post-menopause rather than perimenopause. Depression during menopause can manifest in various ways, including: 

    • Persistent feelings of sadness or emptiness.
    • Loss of interest in activities once enjoyed.
      Fatigue or lack of energy.
    • Changes in appetite or weight.
    • Difficulty concentrating or making decisions.
    • Sleep disturbances, such as insomnia or oversleeping.
    • Irritability, restlessness, or agitation.
    • Feelings of worthlessness or guilt.
    • Thoughts of death or suicide.
    • Recognizing these symptoms is essential for early intervention and effective management of depression during menopause.

Social and hormonal changes can exacerbate classic depressive symptoms, often occurring alongside menopause-related issues like hot flashes, night sweats, and sleep disturbances .

Moreover, women may face mounting stressors or challenges during the time that can compound these effects. Such as:

  • Physical symptoms like hot flashes, night sweats, and changes in libido.
  • Relationship changes or conflicts, including caregiving responsibilities.
  • Work-related stressors, such as job demands or career transitions.
  • Financial concerns, retirement planning, or economic instability.
  • Health issues or chronic conditions that may worsen during menopause.

Navigating the intricate web of factors contributing to mood disturbances during menopause is challenging, emphasizing the importance of research in understanding the interplay of menopause, hormones, lifestyle, and aging.

Begin menopause self-care now for better mental health

Menopause is a natural phase of life for women, but it can bring along challenges, including the potential for depression. Understanding how to prevent or alleviate depression during midlife and post-menopause is crucial for maintaining mental well-being and quality of life.

    • Prioritize mental health: One of the first steps in this process is being vigilant about depressive symptoms and mounting the stressors or challenges that can arise during this phase of life.
    • Adopt healthy behaviors: Healthy lifestyle choices like diet and exercise have been linked to enhanced mood and physical functioning.
    • Cultivate healthy relationships: Research shows that having a strong social support network positively affects various aspects of life satisfaction and psychological health. It can also reduce feelings of isolation.
    • Embrace care: Those experiencing depressive symptoms should not hesitate to seek professional care. They can evaluate symptoms, provide a diagnosis if needed, and recommend appropriate treatment strategies such as therapy or medications. There is some evidence that estrogen therapy has an antidepressant effect comparable to traditional antidepressant medications.

Remember that every woman’s experience with menopause and depression is unique, so finding the right combination of strategies and support is key to managing well-being.

Latest mental health news

Our ongoing research into and beyond the menopause transition

The SWAN study has made significant contributions to our understanding of the menopause transition, but there is still ongoing research to deepen our understanding of the relationship between menopause impact and overall mental health. Researchers continue to explore the complex interplay between physical function, hormonal changes, sleep patterns, quality of life, and cognitive health.

 

 

 

Reviewed by:

Nancy E. Avis, PhD, Professor, Wake Forest University

Nanette Santoro, MD, Professor, University of Colorado Denver