Menopause and Depression: Is there a Connection?

Every person who menstruates will attain menopause one day - it’s a natural ageing process. The hormonal changes during the three stages of menopause bring along many symptoms, including hot flashes, insomnia, vaginal changes, mood fluctuations and even depression.

The three stages of menopause include:

Perimenopause: It is a menopause transition phase that spans between 4 and 7 years. During this phase women start experiencing hormonal changes contributing to irregular menstrual periods and other symptoms.

Menopause: You reach menopause when the ovaries stop producing reproductive hormones, and there are no monthly periods for twelve consecutive months. A woman cannot become pregnant naturally after this.

Postmenopause: It refers to the years after reaching menopause.

What is depression?

Depression is a syndrome characterised as having at least five out of all the symptoms mentioned in DSM-5 criteria. Furthermore, these symptoms should occur most of the day, nearly every day for at least two weeks, which interferes with your ability to work, sleep, study, eat, and enjoy life. Also, one of the criteria out of the five that you must meet, must be either A1 or A2.

These criteria, known as ‘A Criteria’, are as follows:

A1: Depressed mood—indicated by subjective report or observation by others (in children and adolescents, can be an irritable mood).

A2: Loss of interest or pleasure in almost all activities—indicated by subjective reports or observations by others.

A3: Significant (more than 5 percent in a month) unintentional weight loss/gain or decrease/increase in appetite (in children, failure to make expected weight gains).

A4: Sleep disturbance (insomnia or hypersomnia).

A5: Psychomotor changes (agitation or retardation) severe enough to be observable by others.

A6: Tiredness, fatigue, or low energy, or decreased efficiency with which routine tasks are completed

A7: A sense of worthlessness or excessive, inappropriate, or delusional guilt (not merely self-reproach or guilt about being sick).

A8: Impaired ability to think, concentrate, or make decisions—indicated by subjective report or observation by others.

A9: Recurrent thoughts of death (not just fear of dying), suicidal ideation, or suicide attempts.

How may menopause contribute to depression?

No studies are reporting that menopause can cause depression. But, the many physical, psychological and life changes occurring during menopause can become a contributory factor to depression.

1. Hormonal fluctuations

When you are transitioning into menopause, the levels of estrogen and progesterone start declining. These hormones also influence serotonin, a brain chemical that promotes feelings of well-being and happiness. When these hormone levels drop, the serotonin levels drop too, leading to irritability, anxiety and sadness.

2. Vasomotor symptoms

Hot flashes, meaning a sudden feeling of heat in the face and upper body, are commonly reported by menopausal women. Hot flashes during the night, known as night sweats, contribute to sleep disturbances that can, in turn, trigger anxiety and depression. During a hot flash, you may experience the following symptoms:

• Intense heat over the face, neck and chest
• Sudden reddening of the skin
• Flushing of the face
• Sweating, primarily on the upper body
• Increased heart rate
• A marginal increase in systolic blood pressure
• A feeling of chills in the body

3. Sleep disturbances

Night sweats can cause a disturbed sleep pattern. Constantly waking up during your night sleep makes you more likely to become anxious and depressed.

4. Vaginal changes

Vaginal dryness, itching and thinning, and inflammation of the vaginal walls can all occur due to the reduced estrogen. The dryness contributes to pain during penetrative intercourse that can, in turn, affect the sex drive as well. It can instigate feelings of anxiety and depression in women.

5. History of depression, PMDD, PMS, postpartum depression

People who experience PMS, PMDD or postpartum depression are more likely to experience severe symptoms of menopause and develop depression. Having a history of depression also makes you vulnerable to relapse of depression symptoms. If you have pre-existing depression during menopause, its symptoms can worsen because of the hormonal changes.

6. Life changes

Women start transitioning into menopause around their 40’s. It is the time when they may also be experiencing major life events and changes that can also contribute to depression, such as:

Kids leaving home

Health problems of both - self and partner

Career pressure or changes

Becoming a caregiver to parents and in-laws

Relationships ending

Feeling left out and worthless

When to seek medical help?

If the physical and psychological symptoms of menopause are so severe that they are impacting your daily routine, you must consult your healthcare provider. They will take your medical history to diagnose if you have depression and if menopause is a contributing factor to it.

What is the treatment for menopause-related depression?

Depression symptoms due to menopause can be managed in many ways.

Hormone Replacement Therapy (HRT): Estrogen replacement is one of the most common treatments that can help your body cope with immense estrogen loss. It is available in many forms like vaginal creams, vaginal tablets, vaginal rings or oral tablets.

Cognitive behaviour therapy: Going to a therapist can help you be more aware of your mood and cope with the symptoms.

Antidepressants: Antidepressants can be helpful for mood symptoms. Many women fear that taking antidepressants for depression during menopause will make them dependent on them. However, once depressive symptoms stop, you can stop taking the medicines too.

Lifestyle changes: Having a daily routine, exercising, eating nutritious food, journaling, and limiting caffeine and alcohol consumption can all help reduce menopause and depression symptoms.

Conclusion

Psychological changes such as mood swings, sadness, irritability during perimenopause and menopause are common. It can be difficult to distinguish between clinical depression and mood swings due to declining hormones during menopause. If you feel you are struggling with physical and mental health changes during menopause, it is best to consult your doctor who can diagnose the problem and chart out an appropriate treatment plan for you.

Disclaimer: This information is educational and should not be considered medical advice. Please consult with your healthcare professionals before undertaking any changes to your health and wellness practices.

 

Proactive For Her is a digital clinic for women, offering accessible, personalised, and confidential healthcare solutions. We provide products and services for out-patient health concerns of Indian women across their lifetime - from puberty to pregnancy to menopause. To know more about the sexual and reproductive health of women, visit https://www.proactiveforher.com/