During our reproductive years, there’s a predictable ebb and flow to our hormones. Once women are fully into menopause our hormones are low, but steady. The peri-menopausal period, on the other hand, is a time of hormonal chaos, with levels of estrogen and progesterone varying wildly. In studies, mood changes have been observed in up to 23% of peri-menopausal women. Additionally, symptoms of anxiety—tension, nervousness, panic, and worry—are reported more frequently during peri-menopause than during reproductive years, regardless of whether symptoms of depression are present or not. Women with pre-existing mental health conditions, such as depression, bipolar ,and obsessive-compulsive disorder, may find their symptoms worsen.
Researchers believe that the mood disruption of peri-menopausal women may have several causes. Fluctuating estrogen provokes night sweats, which are known to cause disrupted sleep that subsequently results in emotional reactivity, poor decision-making, difficulty concentrating, and a new inability to find words, as well as increased stress and appetite. The unexpected experience of "brain fog" and heightened emotional states (anger, crying, irritability, nervousness, feeling "on edge"), contribute to even more stress and anxiety. Decreased progesterone further exacerbates sleep disruptions since GABA, a neurotransmitter that producing a calming effect, decreases alongside progesterone. And even without swinging hormones, peri-menopausal women already have a lot of stressors - they are likely to be a high level in their career, may have teenage children still at home or college, are caring for elderly parents - which will make matters even worse. Stress and fluctuating hormones also contribute to menopausal weight gain for many women. And the body image issues that can result, including those related to a woman's sexual desirability, further increase stress, anxiety, mood disruption, decreased self-esteem, and decreased sex drive. Finally, there is significant cultural stigma associated with aging for some women, and the reality of reaching the threshold of menopause can contribute to depression.
If you experience some of these signs and symptoms of depression, and they are interfering with your work, hobbies, or personal relationships, you should see your doctor. If you are having thoughts of harming yourself or others, seek medical assistance immediately.
Persistent sad, anxious, or “empty” mood
Feelings of hopelessness or pessimism
Feelings of guilt, worthlessness, or helplessness
Loss of interest or pleasure in hobbies and activities
Decreased energy or fatigue
Moving or talking more slowly
Feeling restless or having trouble sitting still
Difficulty concentrating, remembering, or making decisions
Difficulty sleeping, early morning awakening, or oversleeping
Appetite and/or weight changes
Aches or pains, headaches, cramps, or digestive problems without a clear physical cause and/or that do not ease even with treatment
Your doctor can prescribe evidence-based treatments to manage your depression and/or the underlying causes of it. Your doctor may suggest menopause hormone therapy or other drugs to reduce the frequency and severity of hot flashes and night sweats, which may improve your sleep. Progesterone, taken at night, can have a calming effect that also may improve sleep. Your doctor also may consider use of anti-anxiety and/or anti-depressant drugs. Psychotherapy alone or in combination with anti-depressant drugs also might be helpful. Lifestyle changes like eating a nutritious diet, exercising regularly, limiting caffeine and alcohol consumption, and stress reduction with yoga, mindful breathing, meditation, guided imagery, or even positive self-talk are steps you can take to reduce your symptoms. Some studies have shown that exercise and mindfulness can have as significant of an effect on mild-to-moderate depression as first-line prescription drugs.
In good news, the roller-coaster of hormones likely will end once you make it fully into menopause. Be kind to yourself. Depression in peri-menopausal women is common, not "all in your head," and treatable.
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