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Menopause is a natural part of the aging process in those assigned female at birth. While most people know this stage of life will happen, they may not be prepared for its potential side effects. One of those is depression, which can develop from changes in hormone levels. Other menopausal symptoms, such as night sweats and sleep loss, might also lead to low moods.
Hormonal therapy is an option to alleviate unwanted symptoms for those going through menopause. Nonetheless, hormone replacement isn’t suitable for everyone due to risk factors like breast cancer. Fortunately, antidepressants can be used to balance the brain’s neurotransmitters responsible for regulating moods, controlling body temperature, and reducing hot flashes. Below are more details about the relationships between menopause, depression, and antidepressants.
How Are Depression and Menopause Related?
For the most part, menopause doesn’t happen suddenly. While relatively uncommon events like radiation therapy and reproductive organ surgery can hasten menopause and its symptoms, these are exceptions to the rule. For the majority, there is a transition phase called perimenopause. This stage is when hormones like estrogen begin to decline. While its onset and duration vary between individuals, perimenopause generally starts in the mid to late forties.
During the early stages of perimenopause, approximately 18% of people will experience depression. About 38% will show symptoms of low moods as they get closer to menopause. Changes in progesterone and estrogen levels are suspected to be the link between depression and menopause.
When these hormones shift rapidly or decline, they impact neurotransmitters in the brain, specifically serotonin and norepinephrine, two of the most significant neurotransmitters. These chemicals directly influence mood, including feelings of contentment. When neurotransmitters like serotonin are out of balance, depression, irritability, and anxiety can emerge.
Some individuals approaching menopause may be more sensitive to hormonal changes, which can impact moods. Other risk factors for developing depression during this stage include a family or personal history of mood disorders and increased stress in a person’s life. A person who is predisposed to think of menopause a negative life change might experience additional stress, heightening that individual’s risk of depression.
How Is Menopause-Related Depression Diagnosed?
If you’re concerned you might have menopause-related depression, your best bet is to see a reproductive health specialist. Many people benefit from seeing a mental health professional as well. Some reproductive health clinics offer psychiatric services for menopause-related conditions, while others may provide referrals.
Health professionals might diagnose menopause-related depression based on lab tests and symptoms. They may order blood tests to measure your levels of various hormones, including those the ovaries and thyroid glands produce. In biological females, ovaries make most of the body’s estrogen. Other reproductive hormones, such as progesterone, also come from the ovaries.
Blood tests can reveal the level of reproductive hormones a patient’s ovaries are producing. When labs confirm a person has low estrogen, it may help explain menopausal symptoms like night sweats. However, high estrogen can also lead to mood swings and depression. Therefore, doctors might also ask about the individual’s menstrual cycle.
Fluctuating periods, which may be lighter or heavier, can be a sign that menopause is approaching. Skipped periods and variations in cycle lengths are other signals. A healthcare professional will ask about your mood patterns, symptoms, and lifestyle factors to eliminate other possible causes. For instance, going through a stressful event like a job loss may trigger someone’s depression.
Besides possible depression and anxiety, other symptoms often occur with menopause. A reproductive health specialist may ask you about the following changes:
- Sleep difficulties, including insomnia
- Problems with concentration and memory, sometimes called “brain fog”
- Urinary incontinence
- Libido changes or a growing disinterest in physical intimacy
Not everyone close to menopause experiences the same degree of symptoms. But the more signs you have, the more likely you’re approaching menopause. The official medical definition of menopause is when it’s been 12 consecutive months since your last period.
Depression can result in additional symptoms that coincide with the onset of menopause. These indicators may overlap with specific menopausal signals, such as insomnia and fatigue. Your doctor may ask about behavioral signs of depression, including:
- Low energy
- Feeling empty, blue, or indifferent
- Loss of interest in favorite hobbies
- Increased irritability with people and routine situations, such as heavy road traffic
Like anxiety, depression comes in different forms. For instance, major depressive disorder varies somewhat from seasonal affective disorder. Menopause-related depression is more likely to resemble major depressive disorder, which tends to be persistent. Environmental changes like increased exposure to sunlight usually don’t alleviate clinical cases. It’s why a doctor will ask about the nature of your symptoms to help reach a diagnosis.
How Is Menopause-Related Depression Treated?
A 2021 survey of U.S. women aged 40 to 65 found that 73% are not currently treating menopausal symptoms. About 20% had signs for one year or longer before they went to a doctor for relief. Yet a separate survey found 78% of women experienced disruptions to their lives due to menopause. Conventional treatments, such as hormone replacement therapy (HRT), still exist. But these treatments are declining in popularity as younger generations enter perimenopause and the risks of HRT become more widely known.
Despite this, traditional hormone replacement therapy remains a viable method of treating menopause-related depression. Antidepressants and specific types of estrogen therapy are additional options.
Simultaneously, not all treatment possibilities will be ideal for every patient. A strong family history of breast cancer or a personal history of breast cancer may rule out hormone replacement therapy. Potential interactions with other medications could make specific antidepressants infeasible. Below are brief overviews of the main treatments for menopause-related depression. Your doctor may discuss several of these options with you.
Traditional Hormone Replacement
Conventional hormone therapy usually consists of estrogen and progesterone replacement. Restoring normal levels of these reproductive hormones may improve menopausal symptoms. Most notably, balancing both hormones can reduce hot flashes and night sweats. Traditional hormone therapy may also decrease some risks associated with too much estrogen, such as thicker uterine tissue.
Increasing estrogen can keep mood-balancing neurotransmitters like serotonin in check. Drops in estrogen could raise someone’s risk for depression. This shift helps explain why some individuals experience low moods when estrogen levels decline during premenstrual syndrome.
Declines in progesterone may also play a role, as drops in this hormone correlate with the onset of postpartum depression. Boosting estrogen and progesterone to normal amounts can mitigate the risk of developing a mood disorder tied to hormonal changes. Over someone’s lifespan, hormone-related depression risk peaks between the ages of 45 and 49.
This age range is when perimenopause typically reaches its peak incidence, given that the average onset of menopause is in a person’s early 50s. Some individuals will go through this change much earlier. Early menopause, which impacts 5% of biological females, usually happens before age 45. Menopause before 40 is considered premature. Reproductive organ surgeries, lifestyle factors, and medications may cause both.
Estrogen therapy is similar to traditional hormone replacement treatment. However, patients only take estrogen supplements and not progesterone. Treatment involving just estrogen replacement might be more suitable for individuals who no longer have a uterus.
Doctors sometimes prescribe estrogen therapy with antidepressants. Some patients only undergo estrogen replacement therapy to relieve menopause symptoms. While studies reveal estrogen alone can alleviate depression, combined treatment with antidepressants might be more effective.
Selective estrogen receptor modulators (SERMs) can fall under a separate umbrella of estrogen therapy. Although clinical studies show some promise in improving memory, SERMs do not appear to alleviate depression. But medical professionals may offer SERMs to help with other menopause-related cognitive issues, such as poor concentration and memory.
Antidepressants like serotonin reuptake inhibitors (SSRIs) can be successful treatments for menopause-related depression. Your healthcare professional may recommend antidepressants along with other treatment methods. Hormone replacement might not be suitable for everyone, but lifestyle changes and psychiatric therapy can supplement the benefits of antidepressants.
SSRIs work by boosting the brain’s serotonin activity. The FDA lists major depressive disorder as one of the conditions SSRIs can treat. Not all patients will experience relief from depression with SSRIs, though. In these instances, serotonin and norepinephrine reuptake inhibitors (SNRIs) can be tried instead.
SNRIs do more than increase serotonin persistence. These antidepressants also inhibit the reabsorption of norepinephrine, low levels of which are linked to anxiety and depression. Studies with SNRIs show some promise in treating major depressive disorder among perimenopausal and menopausal patients.
Lifestyle Changes That Can Help Manage Menopause-Related Depression
Along with medication, your doctor could recommend specific lifestyle changes to help manage menopause-related depression. For example, getting more exercise can help with mild mood swings. Physical activity lasting more than 15 to 20 minutes tends to release endorphins. These hormones are sometimes associated with an effect known as a “runner’s high.”
The release of endorphins during exercise increases feelings of well-being while acting as painkillers. Endorphins can make you feel more relaxed and even euphoric. Exercise isn’t the only lifestyle activity you can use to boost your endorphins. Meditation and acupuncture also release these hormones.
In addition, your doctor may advise you to practice stress relief techniques such as meditation. Reducing stress while releasing more endorphins may help prevent low moods. A regular exercise routine with stress relief activities could better regulate your moods over time.
Getting more exercise doesn’t mean every patient with menopause-related depression can ditch antidepressants and hormone therapies. But it does mean working out may enhance the benefits of other treatments or be sufficient for some. Additional lifestyle changes include reducing your intake of alcohol, caffeine, nicotine, and processed foods. Some evidence suggests consumption of specific nutrients, such as antioxidants, can fight symptoms of depression.
Questions to Ask Your Doctor If You Think You Might Have Menopause-Related Depression
If current projections hold, about 1.1 billion individuals will be menopausal by 2025. And on average, 40% of a biological female’s lifespan occurs after menopause. The good news is that menopausal symptoms, including depression, don’t have to go untreated.
If you’re seeking treatment for the symptoms of menopause, having a list of questions to ask healthcare providers can help you identify the best approaches together. Here are a few you might want to ask.
- With my family and personal history, could I be in early menopause?
- Do my symptoms suggest menopause-related depression?
- Can you test my hormone levels to help confirm perimenopause or menopause?
- Given my medical history, is hormone replacement therapy an option? If so, what types?
- What are the risks associated with hormone replacement therapy?
- Should I take antidepressants to relieve my symptoms?
- What are the side effects of the antidepressants you’re recommending?
- Should I see a therapist or participate in group therapy?
- What lifestyle changes can help reduce my symptoms?
- When should I follow up with you?
- When will I see improvements in my symptoms?
- What happens if antidepressants don’t work?
Is Medication the Right Choice for You?
Menopause-related depression can have severe impacts on your quality of life. Relationships and work performance can certainly suffer, and the joy you experience from everyday activities may diminish. If you think changes in your reproductive hormones are causing depression, you don’t have to deal with those symptoms alone.
Schedule a consultation with a healthcare provider so you can discuss the signs of menopause you’re experiencing. With the information you provide, a medical professional can recommend depression treatments to increase your feelings of well-being. With the right treatment plan, you’ll find your menopausal symptoms easier to manage.