What You Need to Know About the Link Between Menopause and Depression

Depression appears to be more common during perimenopause, the first stage of menopause. But research has not proven a causal link between the two.

A 2018 review states that depression is common during the menopausal transition. The risk decreases within 2-4 years following someone’s last period.

Scientists aren’t sure why depression is more common during perimenopause, but a mix of physiological and psychological factors may play a role.

Read on to learn more about the link between menopause and depression and the treatment options available.

Depression is a mental health condition that affects a person’s feelings, thoughts, and behaviors. Symptoms may include:

  • lack of interest in activities that a person enjoys
  • feelings of sadness, apathy, or emptiness
  • tiredness or lack of energy
  • difficulty remembering, concentrating, and making decisions
  • appetite changes, weight changes, or both
  • difficulty sleeping or oversleeping
  • slow movement or speech

There are several types of depression. The medical name for one of the most common is major depressive disorder (MDD). Menopausal people appear to be more likely to develop MDD, according to a 2018 review.

Not all studies the authors looked at found an association. However, two well-designed studies have shown that the risk of developing a depressive disorder during perimenopause may be two to five times higher than during the late premenopausal years.

Does menopause cause depression?

Researchers aren’t sure why depression is more common during perimenopause, but several factors may contribute.

Physiological Factors

During perimenopause, a person’s hormone levels change unpredictably. Estrogen and progesterone can rise and fall while generally falling. These hormonal changes can affect brain chemistry, structure, and function.

It enhances the action of certain neurotransmitters such as estrogen, serotonin, and norepinephrine. These neurotransmitters help regulate mood. When estrogen levels drop, it can affect the balance of these chemicals.

Some people may be particularly sensitive to hormone-related mood changes. A 2015 study reports that clinical depression during perimenopause may be more common in people who:

  • personal or family history of depression
  • history of premenstrual dysphoric disorder
  • history of postpartum depression

However, the study’s authors emphasize that all people who have gone through perimenopause, regardless of personal or family history, have a higher risk of depression.

Psychosocial Factors

The psychological and social impact of menopause can also affect mental health. While some people think that menopause and aging can be positive, others may feel:

  • menopause or aging is a negative thing
  • makes them less youthful or feminine
  • menopause symptoms are stressful or affect their ability to work
  • they lack social support

These feelings can affect a person’s mental health. However, they may not be inevitable.

Some cultures highly value youth, while others value age and experience. A 2021 review notes that people from cultures that care about older age report fewer menopausal symptoms, which may suggest that this may contribute to how the transition of social norms affects people.

Gender roles and expectations can also affect how people experience menopause. Despite the increase in the number of women entering the workforce, in heterosexual relationships, women still generally do most of the childcare and housework. Managing these responsibilities alongside the symptoms of menopause can cause stress.

Although this role may change in middle age, women are more likely than men to take on the caregiver role. Children may leave home and older relatives may begin to need care due to illness or disability. Any of these events can contribute to stress or depression.

Other Health Factors

In addition to menopause, other health-related factors can affect the risk of depression:

  • Chronic health conditions: Having a chronic health condition can be a risk factor for depression in midlife and may coincide with menopause.
  • Lifestyle: Studies have found an association between depression and certain behaviors, particularly smoking and lack of physical activity. This doesn’t necessarily mean that smoking or not exercising causes depression, but it does mean that depression is more common in people with these habits.
  • Surgical menopause: If a person has surgery to remove their ovaries, they will enter menopause faster than usual. This and the procedure itself can cause stress.

Treatment Options

Treatment for depression often includes a combination of antidepressants and psychotherapy.

Doctors may recommend selective serotonin reuptake inhibitors (SSRIs) or serotonin and norepinephrine reuptake inhibitors (SNRIs) for mood changes associated with menopause. These drugs alter neurotransmitter levels and can reduce symptoms of depression. They can also make someone feel good enough to begin psychotherapy.

Psychotherapy can help identify factors that contribute to depression, such as life events or stress. A therapist can help someone understand and manage their emotions.

A 2018 study notes that the Food and Drug Administration (FDA) has not approved estrogen therapy to treat perimenopausal depression. However, this therapy can help reduce hot flashes, sleep disturbances, and other symptoms that can affect mood.

When to Seek Help

It’s important to talk to a healthcare professional about symptoms that may indicate depression. Depression is not an expected part of menopause or aging, and effective treatments are available. Anyone experiencing this at this life stage should reach out to a doctor or therapist who understands menopause and its potential effects on mental health.

If a person is considering harming themselves or committing suicide, they should contact a doctor or mental health professional immediately.

Source: Medical News Today. 2021. Menopause and depression: Is there a link?

References

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    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7840006/
  • Bromberger, J.T., take meat. (2018). Depression during and after the perimenopause: Impact of hormones, genetics, and environmental determinants of disease.
    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6226029/
  • Dalal, PK, take meat. (2015). Postmenopausal syndrome.
    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4539866/
  • Depression. (2018).
    https://www.nimh.nih.gov/health/topics/depression
  • Expert Q & A: Depression. (2020).
    https://www.psychiatry.org/patients-families/depression/expert-q-and-a
  • Global factsheet. (2019).
    https://www.unwomen.org/-/media/headquarters/attachments/sections/library/publications/2019/poww-2019-fact-sheet-global-en.pdf?la=en&vs=0
  • Maki, PM, take meat. (2018). Guidelines for the evaluation and treatment of perimenopausal depression: Summary and recommendations [Abstract].
    https://pubmed.ncbi.nlm.nih.gov/30179986/
  • Menopause treatment. (2019).
    https://www.womenshealth.gov/menopause/menopause-treatment/#8
  • Mosconi, L., take meat. (2021). Menopause impacts human brain structure, connectivity, energy metabolism, and amyloid-beta deposition.
    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8190071/
  • Seedat, S., et al. (2021). Women’s wellbeing and the burden of unpaid work.
    https://www.bmj.com/content/374/bmj.n1972

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