Menopause & Depression: Connections, Signs, & How to Cope

Usually between the ages of 45 and 55, when the menstrual cycle stops for 12 consecutive months, women transition from perimenopause to menopause. Due to hormonal fluctuations, depression is one of the most frequent mood disorders that women can experience during menopause. This is especially true for women with a history of depression.

Psychotherapy and medication management are common treatment options that offer successful outcomes for menopausal depression.

Can Menopause Cause Depression?

There is a direct relationship between menopause and depression. Falling estrogen and progesterone levels can trigger mood swings that make you less able to cope with stress. Hormonal dips can also set off a depressive episode. Interrupted sleep due to hot flashes also contributes to depression. Additionally, menopause occurs at a time when women experience loss and stress. The cumulation of life changes can fuel symptoms.

Those who have experienced depression, including postpartum depression, are at a higher risk of developing menopause depression.¹ Another higher risk group is women who have had severe premenstrual syndrome (PMS). The North American Menopause Society reports “women who had severe PMS in their younger years may have more severe mood swings during perimenopause.”²

11 Signs & Symptoms of Menopausal Depression

Experts on women’s health believe that estrogen interacts with chemicals in the brain, ultimately affecting mood. In some women, the decrease in estrogen during the time period surrounding menopause (i.e., perimenopause) may lead to depression.³ In addition to mood swings, signs of menopause depression include reduced energy and ability to concentrate. Researchers note that depressive symptoms may differ due to the woman’s age and specific stage of the menopausal transition.⁴

Eleven signs and symptoms associated with depression during menopause include:

1. Interrupted sleep (often due to hot flashes)
2. Reduced ability to concentrate or focus
3. Reduced energy
4. Feelings of helplessness
5. Mood swings
6. Ongoing episodes of irritability and anger
7. Feelings of sadness/hopelessness
8. Restlessness
9. Decreased libido
10. Thoughts of self-harm
11. Social isolation

Does Depression Dissipate Post-Menopause?

When menopause is over, the resulting hormonal imbalance stabilizes. As such, depression and other mood fluctuations tend to stabilize, too. However, if there was a previous diagnosis of depression, there is a higher risk of continued depression. One report concluded that most women transition to menopause without mood disturbance, but perimenopause may represent a more vulnerable time with risk increasing from early to late perimenopause and decreasing postmenopause.⁴

Treatment of Depression in Women With Menopause

If you experience four or five common symptoms of menopause depression daily for two weeks or more, consider seeing a healthcare professional. Mental health professionals can screen you using tools like the Patient Health Questionnaire-2 (PHQ), which confirms the presence of depressive symptoms, and the PHQ-9, which rules out physical or medical causes for those symptoms.

Here are four treatment options for depression with menopause:

1. Hormone Replacement Therapy (HRT)

This treatment helps stabilize mood swings due to hormonal imbalance. It centers on adjusting estrogen levels and can be done by endocrinologists, internists, family medicine physicians, and obstetrician-gynecologists. HRT has been successful at alleviating symptoms of depression; however, there are risks. Speak to your physician about the pros and cons of HRT to determine whether it’s the best treatment option for you.

2. Medication

If your depression is severe and impacting your ability to function, medication for depression may be used. The recommended medications for depression stemming from menopause are selective serotonin reuptake inhibitors (SSRIs).³ These include fluoxetine (Prozac), sertraline (Zoloft), paroxetine (Paxil), and citalopram (Celexa).

3. Psychotherapy

There are two types of therapy effective for treating depression stemming from menopause. The first is interpersonal therapy, which focuses on strengthening relationships and enhancing communication. Second, cognitive behavioral therapy (CBT) is a short-term therapy that involves associating physical symptoms with thoughts, feelings, and behaviors. It teaches patients to alter negative thoughts and feelings to create positive outcomes.

4. Exercise

Exercise boosts endorphins that can reduce depression and increase your sense of well-being. In addition, it is a way for women with menopause to regain control of a seemingly out of control body.

How to Get Help for Depression

If you notice depressive symptoms emerging and lingering during menopause or perimenopause, discuss your concerns with your primary care physician (PCP) or obstetrician-gynecologist. Describe your symptoms and how they impact your daily life. From there, look for a therapist with experience in women’s health and depression. Consider starting your search with an online directory, making sure the therapist is licensed and certified. Be sure to check the specifics of your insurance coverage for mental health services as well.

7 Ways to Cope With Menopause Depression

Lifestyle changes can improve your quality of life while coping with menopause depression. These techniques are designed to help you regain control over your body and mind during challenging times. Do some research to determine which options feel most comfortable for you.

Here are seven ways to cope with menopause depression:

1. For mild to moderate depression, use herbal remedies such as St. John’s Wort.
2. Break large tasks into smaller ones, set some priorities, and do what you can, as you can.
3. Postpone important decisions until the depression has lifted.²
4. Practice mindfulness techniques. Yoga, meditation, deep breathing, and guided imagery are excellent coping methods that help you relax and slow down.
5. Get as much sleep as you can. Make an effort to grab a nap whenever you can.
6. Be cognizant about connecting with others. Isolation can enhance and perpetuate depression. Try to maintain social interactions with family and friends as much as possible, and be with people who make you feel relaxed. If you have women in your network who are experiencing menopause, reach out for support.
7. Engage in exercise at a comfortable level, but first, consult with your doctor. Physical activity is a proven stress reducer, which can alleviate depression.

Final Thoughts on Dealing With Menopause & Depression

If you find that menopause depression is altering your relationships, ability to work, or the quality of your life, take action and consult a healthcare professional as soon as possible. Learn as much as you can about depression linked to menopause so you have a better understanding of what is happening and why. Take charge in terms of your self-care, and remember, you’re not alone.