Mental health and menopause: Is it me or my hormones?
A question you have most probably asked yourself and you most definitely are not alone in wondering this question.
As many as 70% of women may encounter depressive symptoms during perimenopause (Learn more here). The Harvard Moods and Cycles Study, which observed 460 late peri-menopausal women, revealed a twofold increased risk of significant depressive symptoms among those entering perimenopause compared to age-matched premenopausal women (Read more here).
The transition through perimenopause and menopause brings about a plethora of changes not only to our bodies but also to our minds and emotions. While physical symptoms like hot flushes and night sweats are commonly acknowledged, the full extent of the impact on our mental state and emotional well-being is often underestimated. Feelings of anxiety, low mood, and difficulty concentrating are prevalent symptoms of menopause, alongside emotional and cognitive changes such as anger, brain fog, crying spells, depression, irritability, loss of confidence and self-esteem, loss of joy, mood swings, panic attacks, and poor motivation.
Why does it happen? Window of vulnerability
During the menopausal transition and the years following menopause, women seem to be particularly vulnerable to worsening mental health. One specific explanation is that there is a “window of vulnerability” for some women; where they are more sensitive to the hormonal fluctuations that occur during perimenopause and put them at greater risk for depression. Because hormones are extremely variable and are fluctuating up and down a significant amount during this phase of life, some women have an increased vulnerability to these changes. This also may explain why certain women also experience worsening mental health during their luteal phase of menstrual cycle, postpartum period and/or during menopause transition. So If you ever struggled with hormonal fluctuations in the past ie PMS/PMDD or postpartum depression, anxiety you are at a greater likelihood of experiencing depression or mood related concerns in perimenopause - likely due to the heightened hormone sensitivity.
Risk factors
As always, mental health is multifactorial and there are many things impacting our physical and mental health during this phase of life.
A previous depression episode throughout your life is the strongest predictor for depression during midlife.
There are many challenges and changes going on during midlife that impact our overall well being and mental health.
Life stressors
Changes in health
Work
Social relationships
Caregiving responsibilities
Other factors
Common perimenopause and menopause symptoms can also impact our mood. Vasomotor symptoms (hot flashes, night sweats) impact our mood and quality and duration of sleep. Things like vaginal dryness can cause pain, or impact our sexual pleasure and relationships with our partners. Sleep on its own is often affected during this transition both quality and duration, either with or without night sweats. Lack of sleep quantity and quality impacts our energy, mood and our ability to handle stress.
What treatments are available?
There is NO SIZE ONE FITS ALL. What works for your friend/sister/mom may not work fo you! That’s why finding the right practitioner who takes the time (more than a 5 minute appointment) to discuss your symptoms, how you are feeling and go over all of the options is so important.
Here is what I recommend to ensure you are getting the best care
Build your Team
Engage support from various sources: family, friends, healthcare providers, and local resources like CMHA and helplines
Get a proper assessment - aka bloodwork to ensure nothing else is contributing to your health that could also be impacting your mood and energy - thyroid, iron, vitamin D, vitamin B12, to name a few
Seek support from mental health professionals – psychotherapist, counselor, psychologist - find one you like!
Lifestyle is as important as ever
Prioritizing sleep, stress management, exercise/movement, reducing/elimination alcohol, staying connected and social, practicing mindfulness, making time for yourself and what brings you joy
Consider prescription medications and/or natural health products
Learn about Menopause Hormone Therapy (MHT)/Hormone Replacement Therapy (HRT) and if it is a good fit for you!
Estrogen therapy has been shown to be helpful in the treatment of depression and depressive symptoms in perimenopause. There seems to be a specific window of opportunity for this transition where estrogen therapy seems to helpful before the last menstrual period (menopause) and not post menopausal.
Antidepressants. There is a lot of misinformation and stigma around using medications for mental health concerns. Medications can be necessary and extremely helpful for certain women and should be offered to you as an option to help with managing mental health during this transition.
Herbs and supplementations - omega 3s, saffron, saint john's wort and others can be used as adjuncts to prescriptions or in certain cases as alternatives for mental health care depending on severity. As always, it's important to talk to a healthcare provider before starting any natural health product.
Be proactive, Don’t wait!
If you have a history of depression or other mental health concerns it's important that we incorporate regular routine check ups. It's also important that we start working on putting important things in place now to help build resilience and stress management skills. We need to have conversations early and often.
Remember, support and treatment is always available for you! If you are struggling with your mental health and need support book a meet and greet and let’s make sure you feel supported during this transition of your life.
Resources to review with reliable, evidence based info