Estimated reading time: 8 minutes
A big question in the patient community surrounding menopause is its impact on mental health. Does menopause actually cause depression, or is it merely a side effect of mood shifts?
The American College of Obstetricians and Gynecologists reports that mood changes are very real for those experiencing menopause or perimenopause. Perimenopause is the stage in a woman’s life leading up to menopause. This period of time can feel difficult and unstable. It can result in a slew of rapid changes hormonally and physically that can possibly lead to depression. It should be noted though that a direct link has not been found between menopause and depression itself.
Identifying a Connection Between Menopause and Depression
Women have been searching for answers about the connection between menopause and depression pretty consistently over the last 5 years.
So if there is there is no direct link between menopause and depression, why are women looking for answers? That's because according to a study, there is a relationship between depression and menopause and the complex interaction between the biological, psychological and social factors that inform it. In this case, researchers found that as women go through menopause—a time when their bodies stop having periods and their hormone levels change—more women report feeling sad or depressed.
Even though not every study shows a strong link, there seems to be a pattern where more women experience depression during this time.
Wait- so THIS is a Hot Flash??
Imagine being out at dinner and you experience a sudden burst of warmth through out your body, you start to sweat, and your face and neck are flushed but no one else is experiencing the uncomfortable heat wave. That is what is what it is like at any given moment during menopause. These sudden uncomfortable feelings of warmth are called vasomotor symptoms (VMS) or hot flashes.
Hot flashes are unpredictable and are often paired with night sweats which can significantly impact sleep, personal and sexual relationships with partners , and overall wellbeing. According to PatientsLikeMe's collaborative study with Astellas Global Pharma, the most common symptoms of menopause experienced where hot flashes and night sweats.
Women have described hot flashes as:
- “uncontrolled sweating from every pore”
- “anxious with a sense of dread in the pit of my stomach"
- “drenched in sweat and cold sweats”
- “hot, then cold, then hot”
- “internal fire”
- “accompanied with nausea”
- “like having a bad sunburn”
- “radiating heat”
- “sweating in places never before”
- “like an electrical jolt”
- “like a panic attack”
- “dripping sweat, but then cold chills”,
- “sweaty mess!”
“The same hormones that control your menstrual cycle also influence serotonin, a brain chemical that promotes feelings of well-being and happiness. When hormone levels drop, serotonin levels also fall, which contributes to increased irritability, anxiety and sadness.”
Johns Hopkins Medicine
Differences in estrogen and progesterone levels play a major role in our ability to cope and process information. During this transition women experience hormone-created anxiety, depression, and cognitive changes (or ‘brain fog’). Menopausal women are often accused of overreacting or being dramatic. But the reality is that these extreme shifts in hormonal balance wreak havoc on menopausal bodies and minds.
Falling levels of progesterone and estrogen cause hormonal dips can set off a depressive episode, which can affect those with a history with a mental health disorder such as depression.
History of Past Depression
If someone has experienced depression before, especially related to hormonal changes (like during pregnancy or their menstrual cycle), they might be more likely to feel depressed during menopause.
It’s time to talk to a professional if you start noticing old symptoms of depression returning such as:
- A loss of appetite
- Trouble sleeping
- A lack of motivation or desire to participate in everyday activities and beyond
We had the chance to talk to Dr. Saru Bala about depression and menopause and how it relates to hormone replacement therapy (HRT).
Fluctuating estrogen affects serotonin and dopamine, which can lead to mood swings and depression. Some women feel worse on HRT initially as their body adjusts, but this should improve, If depression worsens with HRT, progesterone type and dose may need adjusting -- synthetic progestins can worsen mood for some.
Dr. Saru Bala, a licensed Naturopathic Doctor
If you have a history of depression and are experiencing symptoms again during menopause, know you are not alone. In fact, being part of a community filled with others who experience the same symptoms can help. Join WomenLikeMe for more resources and join the discussions.
Life Challenges
Nothing in life is linear and as humans we learn to expect the unexpected. Sometimes unexpected events like divorce, a car accident, or a sudden death in the family during menopause can intensify feelings of depression.
In other cases, women feel guilty for feeling depressed because they feel ungrateful for the "good life" they have. They just don't feel like themselves and feel "dead inside". Being part of a community filled with others who experience or have experienced the same symptoms can help. Join PatientsLikeMe for more resources and join the discussions!
Sometimes how someone feels about getting older and going through menopause can affect their mood. In fact, in our collaborative study with Astellas Global Pharma, out of 196 women 60% found menopause "very difficult" despite having neutral expectations going in.
Constant Sleepless Nights
Insomnia is a common side effect during the various stages of menopause. Due to hot flashes, people suffering with menopausal insomnia have a higher risk of developing depression. And unfortunately, this is viewed as a vicious cycle. As a result of insomnia, depression risks are increased. But depression as well as anxiety also cause sleep problems and insomnia. It can sometimes prove difficult to differentiate which came first, but in the case of menopause, this lack of sleep could be causing these major shifts in mood and functionality.
How To Combat Menopausal Insomnia
Research shows that certain holistic approaches seem beneficial for managing insomnia and depression during menopause. This study's results showed that reflexology, yoga, walking, and aromatherapy massage have a significant positive impact on reducing insomnia and depression in menopausal women.
Doctor Saru Bala suggest the following tips:
- Magnesium glycinate before bed
- Support circadian rhythm; increasing morning sunlight exposure and reduce blue light at night
- L-theanine or GABA for relaxation
- Consider progesterone (bioidentical oral or topical), which has a calming effect
Researchers also found that various exercise and stretching techniques were shown to improve sleep quality, although the findings regarding their effects on depression have been inconsistent. These therapies likely promote relaxation and promote overall well-being, which makes them valuable when managing insomnia caused by menopause.
How Do I Talk To My Doctor About Menopause Symptoms?
We found in the PatientsLikeMe's collaborative study with Astellas Global Pharma, that 65% of women discussed their symptoms with their healthcare providers but only 35% were prescribed a treatment! It can be very frustrating to not feel heard and understood by your healthcare provider (HCP).
When looking for a healthcare team be sure to look for these resources:
- HCPs specifically trained in women's health
- HCPs open to discuss VMS and management
- Peer connection and support
- Better education and preparedness from HCPs
Once you found an HCP that you feel comfortable with, Dr. Saru suggests you come prepared with the following:
- A list of your tracked symptoms; make sure you have tracked your sleep patterns, energy levels, mood changes, and period changes.
- Ask about both hormonal and non-hormonal treatments; consider HRT, adaptogens, and antidepressants if needed
- Ask if for bloodwork for thyroid and nutrient deficiencies; low iron, B12, or vitamin D can mimic depression
Treating Menopause and Depression
There are a number of ways to get support if you fall into a depression as a result of menopausal hormone shifts. Whether you talk to a primary care doctor, OBGYN or psychiatrist, any of these professionals can help you to find solutions that will make your mood more manageable. You may undergo some hormonal treatment or begin an antidepressant regiment in order to get some relief. It is also recommended that everyone undergoing menopause implement some lifestyle adjustment changes. Healthy habits include eating a nutritious diet, exercising regularly, and limiting caffeine and alcohol consumption.
Women like you are looking for changes in future treatments that are non-hormonal options, affordable and covered by insurance, effective treatments that can target multiple menopausal symptoms, and treatments with minimal or no side effects. If you are suffering, break the silence! You are not alone. And join the conversation in our WomenLikeMe group to connect with others just like you.
References
Vivian-Taylor J, Hickey M. Menopause and depression: is there a link? Maturitas. 2014 Oct;79(2):142-6. doi: 10.1016/j.maturitas.2014.05.014. Epub 2014 Jun 2. PMID: 24951102.
Kulkarni J, Gurvich C, Mu E, Molloy G, Lovell S, Mansberg G, Horton S, Morton E, Uppal T, Cashell C, de Castella A, Reisel D, Dear L, Weatherburn-Reeves N, Harris K, Pietrobon K, Teagle K, Kim BY, Newson L, Szoeke C. Menopause depression: Under recognised and poorly treated. Aust N Z J Psychiatry. 2024 Aug;58(8):636-640. doi: 10.1177/00048674241253944. Epub 2024 May 18. PMID: 38761367; PMCID: PMC11308326.
Lialy HE, Mohamed MA, AbdAllatif LA, Khalid M, Elhelbawy A. Effects of different physiotherapy modalities on insomnia and depression in perimenopausal, menopausal, and post-menopausal women: a systematic review. BMC Womens Health. 2023 Jul 8;23(1):363. doi: 10.1186/s12905-023-02515-9. Erratum in: BMC Womens Health. 2023 Aug 9;23(1):419. doi: 10.1186/s12905-023-02573-z. PMID: 37422660; PMCID: PMC10329343.