What does menopause have to do with depression? The facts

depression and menopause

For some women, the journey through menopause may feel like an emotional rollercoaster at times. There may be good, happy days when everything seems fine, but the next day you might feel dull and gloomy, or get upset over the smallest thing. You might think you’re depressed — but is it really depression?

Low mood and depression are two different entities, despite sharing some symptoms. However, there is more to the term depression than simply feeling sad, and differentiating between the two and receiving a proper diagnosis is extremely important, as treatment differs.

You might feel down or sad over a loss, or following an argument or any unfavourable incident, and this is a completely normal reaction to such circumstances. Generally, sadness only lasts for a limited time, and is proportional to the degree of loss or annoyance.

Depression, however, includes a number of symptoms in addition to low mood, symptoms which last for at least to weeks. The major symptoms of a depressive episode include depressed mood, low energy, and loss of interest in previously enjoyable activities. In addition, you might experience other symptoms such as difficulty falling asleep, loss of appetite, low self esteem with feelings of guilt and unworthiness, or even suicidal thoughts.

Am I more at risk of depression during menopause?

As a woman ages, the number of primordial follicles in her ovaries declines, and this process speeds up as she reaches menopause. As a result, the production of oestrogen and progesterone by the ovaries declines. This change in hormone levels, especially the decreasing oestrogen, is likely to contribute greatly to many of the menopausal symptoms, including low mood and depression.

Hormones, neurotransmitters, and depression

Serotonin, norepinephrine, and dopamine are believed to be the main neurotransmitters (chemicals which act as messengers between nerve cells) related to mood. They are inactivated by the enzyme monoamine oxidase (MAO), with which oestrogen is known to interact.

Oestrogen increases the above neurotransmitter levels by blocking MAO, their inactivating enzyme. So when oestrogen levels become depleted, or fluctuate, it leads to a decrease or imbalance in our ‘happy neurotransmitters’.

Although evidence is lacking, this is believed to be a possible cause behind increased depression rates in women during perimenopause, and also other states of hormonal fluctuation such as premenstrual and postpartum states.

Are some women naturally more vulnerable?

Even though low mood is one of the most common complaints from menopausal women, it tends to be short lasting, and fluctuates day to day.

Depression, on the other hand, is not that common in comparison. Research states that 23% of perimenopausal women experience at least one episode of depression, and of those, only 38.1% experienced “full-blown” depression.1

Not all women going through the hormonal changes of menopause will be affected in the same way. There are certain other risk factors which increase a woman’s tendency to develop depression during menopause, and a personal history of major depression including postpartum depression and premenstrual dysphoric disorder tops the list.2 In fact, evidence suggests that having a past history of depression increases the risk of a woman developing depression during perimenopause by five times.3 Genetics play a role too, and family history of depression is also known to be a predisposing factor.

Do life stressors come into play?

Regardless of hormonal changes, menopause is also a time in life when women will undergo many changes, be they mental, physical, or social, all of which can contribute to low mood and even depression around menopause.

For example, this is an age when someone may find their physical health deteriorating. Prevalence of metabolic syndrome, including obesity, diabetes, high blood pressure, and high levels of cholesterol, and risks of heart disease and stroke is known to increase with menopause.4

Even other menopausal symptoms such as hot flushes and poor sleep may cause emotional distress and further aggravate low mood.

Midlife is also a time when you external appearance starts to change, which may worry you. You may realise you are no longer fertile, or sex may not seem as pleasurable as it once was. Your workload may be too much to handle while you are experiencing menopause symptoms, and you may feel lonely if your children are growing up and moving out.

All these changes are a lot to take in, and may seem extremely challenging at times. It’s no wonder that it can all add up to bring your mood down, but you are not alone. The changes are inevitable, but they are common. There are millions of other women who are going through the same life changes at the same time as you.

Lifestyle changes to improve mood

No matter how hard the period of menopause may seem, there are several ways you can lessen your symptoms. Self care is important, as is a good support network. Exercise is known to increase serotonin levels in the brain, so go out walking or take a bike ride, preferably in the morning when you will be exposed to bright sunlight.5

Engage in yoga, meditate, or get a massage, as all three can also boost serotonin. A healthy diet full of complex carbohydrates can also improve mood.

Spend more time with family and friends, and open up to them, voicing your problems, so that you don’t bottle up how you are feeling. Try and keep in mind that you are not alone, and while change is scary you will begin to get used to the changes, and low mood is likely to pass after menopause.

Medical therapies

All this being said, low mood and depression around menopause are not issues you have to overcome by yourself if you are struggling. Help is available, and if you find yourself distressed and unable to cope, don’t hesitate to go to your GP or doctor for advice.

Your doctor will first help differentiate where it is low mood you are suffering from, or clinical depression. Once a proper diagnosis has been made you will be offered treatment options depending on the severity. Major depression may require treatment with antidepressants like SSRIs and mild cases are likely to be helped by treatment with hormone replacement therapy (HRT).6 HRT acts by replacing the hormones (mainly oestrogen) that the body lacks during menopause, and is known to provide symptomatic relief in cases of low mood due to menopause, even without depression.

HRT may also help relieve other menopausal symptoms such as hot flushes and insomnia, which can also help lift low mood.

Finally, therapies such as cognitive behavioural therapy (CBT) may help relieve anxiety and low mood.

Low mood around menopause is common, but it’s not always depression. Symptoms may settle on their own or may require treatment. If you find yourself sad and teary too often, and wonder whether you need help or not, don’t hesitate to seek medical advice, as you need not let it affect your quality of life.

References

  1. M.T. Makara-Studzinska et al., ‘Epidemiology of the symptoms of menopause – an intercontinental review’, Przegla̜d Menopauzalny/Menopause Review, Vol.13, No.3, 2014, pp. 203-211.
  2. S.B. Gramann, ‘Menopause and Mood Disorders’, Medscape, 2015, [website], https://emedicine.medscape.com/article/295382-overview, (accessed 19 March 2018).
  3. M.T. Makara-Studzinska et al., ‘Epidemiology of the symptoms of menopause – an intercontinental review’, 2014, pp. 203-211.
  4. M.C. Carr, ‘The Emergence of the Metabolic Syndrome with Menopause’, The Journal of Clinical Endocrinology & Metabolism, Vol.88, No.6, 2003, pp. 2404–2411.
  5. S.N. Young, ‘How to increase serotonin in the human brain without drugs’, Journal of Psychiatry and Neuroscience, Vol.32, No.6, 2007, pp. 394-399.
  6. S.B. Gramann, ‘Menopause and Mood Disorders’, 2015.

Dr. Shehara Ariyaratne MBBS

Shehara graduated from the University of Colombo, with degrees in Medicine and Surgery. She has research experience in various fields of medicine, having worked at the Epidemiology Unit of Sri Lanka and National Institute of Infectious Diseases. She is currently practising paediatrics and radiology at the Lady Ridgeway Hospital, Colombo, the main paediatric hospital in the country. Though a medical doctor in profession, writing has always been her passion and she hopes her articles will help empower women.

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