“Hormonal changes around the time of menopause
can lead to anxiety and depression,
but other factors may also cause these feelings”.1

Umbrella
What may the Menopause Depression umbrella include?

Depending on the Source (DotS) this Umbrella may include:

  • Clinical Depression
  • Depression
  • Depressive Disorder
  • Major Depression
  • Major Depressive Disorder
  • Menopause Blues

Depression

What is depression?

DotS the definition of depression may vary. In Depressive Disorder (Depression): Overview, 31 March 2023, the World Health Organization’s definition is:

“Depressive disorder (also known as depression) is a common mental disorder. It involves a depressed mood or loss of pleasure or interest in activities for long periods of time.

Depression is different from regular mood changes and feelings about everyday life. It can affect all aspects of life, including relationships with family, friends and community. It can result from or lead to problems at school and at work”.2

In Depression: What Is Depression? last reviewed April 2023, the (United States) National Institute of Mental Health’s (NIMH) definition is:

“Depression (also known as major depression, major depressive disorder, or clinical depression) is a common but serious mood disorder. It causes severe symptoms that affect how a person feels, thinks, and handles daily activities, such as sleeping, eating, or working.

To be diagnosed with depression, the symptoms must be present for at least 2 weeks”.3

Sadness or Depression

Is sadness the same as depression?

In Depression In Women: 5 Things You Should Know the NIMH explain:

“Being sad is a normal reaction to difficult times in life. But usually, the sadness goes away with a little time. Depression is different—it is a mood disorder that may cause severe symptoms that can affect how you feel, think, and handle daily activities such as sleeping, eating, or working”.4

Perimenopause

Is there an association between perimenopause and depression?

In Depression In Women: 5 Things You Should Know – 3. Certain Types of Depression Are Unique To Women: Perimenopausal Depression the NIMH note:

“Perimenopause (the transition into menopause) is a normal phase in a woman’s life that can sometimes be challenging. If you are going through perimenopause, you might be experiencing abnormal periods, problems sleeping, mood swings, and hot flashes. Although these symptoms are common, feeling depressed is not. If you are struggling with irritability, anxiety, sadness, or loss of enjoyment at the time of the menopause transition, you may be experiencing perimenopausal depression”.5

In Symptoms of Menopause: Mood and Emotional Health the (Australian) Jean Hailes for Women’s Health (JH) elaborate on:

Menopause Depression“Research suggests that women are more likely to feel depressed during the menopause transition.

Women who have a history of depression or premenstrual syndrome (PMS) may be more likely to develop depression during this time”.6

Menopause

What are some mental health symptoms associated with menopause?

In Menopause and Mental Health: Mental Health Symptoms Related To Menopause, content updated February 2023, the Australasian Menopause Society (AMS) elaborate on:

“Mental health symptoms related to menopause can include feeling:

  • Irritable
  • Sad
  • Anxious
  • Hopeless
  • Less able to concentrate or focus
  • Tired
  • Unmotivated

Some women might experience these symptoms in a mild form. Others might have more severe symptoms of depression (including thoughts of suicide) lasting for at least two weeks. This is known as a major depressive episode and is more likely in women who have a history of major depression during their pre-menopausal years.

While many women do not have mental health issues during the menopausal transition, unstable oestrogen levels can have an impact on the brain, predisposing some women to feelings of depression and anxiety”.7

Cause

What may cause depression during menopause?

On page 777 in The 2022 Hormone Therapy Position Statement of The North American Menopause Society: Depression, published July 2022, the North American Menopause Society note:

“Depressive symptoms worsen as women transition through menopause, although evidence is mixed as to whether depressive disorders are more common during the menopause transition relative to premenopause. Most women who present with depressive disorders during the menopause transition are women with a history of depression before the menopause transition, and women with a history of depression are at high risk for recurrence during the menopause transition”.8

In Managing Your Symptoms: Managing Mood and Emotional Health – Anxiety and Depression the JH explain:

“Hormonal changes around the time of menopause can lead to anxiety and depression, but other factors may also cause these feelings.

If you experienced anxiety before reaching menopause, some symptoms could make your anxiety worse. For example, hot flushes could lead to an anxiety attack.

Also, symptoms such as night sweats can affect your mood and make you feel exhausted, grumpy or depressed.

At this stage of life, you may experience depression for different reasons. For example, if you are having relationship problems or feeling more stress than normal.

You might also reflect on negative past experiences during this time, leading to feelings of depression”.9

In Mood and the Menopause, content updated 09 February 2023, the AMS elaborate on:

“Risk factors for depressive symptoms/disorders are multiple and include VMS, previous mood disorders including prior MDD, reproductive related mood disturbance (severe premenstrual syndrome (PMS) or postpartum depression), other health factors, psychological and socioeconomic factors, and hormonal changes such as variability in FSH and oestradiol”.10

What is VMS?

VMS can be an abbreviation for Vasomotor Symptoms such as hot flushes and night sweats.

What is MDD?

MDD can be an abbreviation for Major Depressive Disorder.

What is FSH?

FSH can be an abbreviation for Follicle Stimulating Hormone.

Treatment

How may perimenopausal and menopausal depression be treated?

In Menopause and Mental Health: Treatment Options for Mental Health Symptoms the AMS elaborate on:

“Women should have an individualised assessment with their doctor in order to discuss the most appropriate treatment pathway. Options may include lifestyle changes, psychological therapies and medications such as menopausal hormone therapy (MHT) or antidepressants.

While some international guidelines do not recommend MHT as first line therapy, many doctors have seen a positive effect on mood with the use of MHT in the first instance. There is evidence that oestrogen has antidepressant effects, particularly in perimenopausal women. We emphasise an individualised approach with treatment tailored to the individual patient.

Oestrogen is not recommended for women with a history of breast cancer.

At this stage, there is no evidence to recommend alternative or complementary therapies for treatment of perimenopausal depression”.11

In Depression: A Major Challenge of the Menopause Transition, October 2022, Professor Kulkarni, Professor of Psychiatry at The Alfred Hospital, Melbourne; Head of Department of Psychiatry at Monash University, Melbourne; and Director of the Monash Alfred Psychiatry Research Centre, Melbourne, Victoria, explains:

“Guidelines recommend antidepressant medications as first-line treatment; however, emerging evidence suggests menopausal hormone treatment may also be effective. A biopsychosocial approach to management, including treating depressive symptoms and addressing relevant psychological and lifestyle factors, offers the best outcomes and improvement in quality of life”.12

Health Care Provider

What if I feel depressed?

If you feel depressed, it may be in your best interest to choose to talk to your health care provider abut this, soon as possible.

In Menopause and Mental Health: Untangling Physical and Mental Health Symptoms Related To Menopause the AMS elaborate on:

“Speaking with your doctor about your menopausal symptoms, life circumstances and clinical history can help them to recommend the best treatment options and lifestyle and behavioural changes for your situation”.13

In Menopause and Mind Health the JH remind us:

“Everyone experiences menopause differently. Talk to your doctor if:

  • You are experiencing strong emotions
  • You think you have anxiety or depression
  • Menopausal symptoms are impacting your quality of life
  • Your brain fog is long lasting or stopping you from doing daily activities”.14

Health Topics A-Z

Where may I find Health Topics A-Z related to Menopause Depression?

In Health Topics A-Z you may find:

Links

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Sources

Where may I find the Sources quoted?

You may find the Sources quoted at:

Sources

  1. Managing Your Symptoms: Managing Mood and Emotional Health – Anxiety and Depression. Last Updated: 19 December 2023 | Last Reviewed: 19 August 2022. Jean Hailes for Women’s Health https://www.jeanhailes.org.au/health-a-z/menopause/managing-your-symptoms#managing-mood-and-emotional-health Accessed: 26 December 2023
  2. Depressive Disorder (Depression): Overview. 31 March 2023. World Health Organization https://www.who.int/news-room/fact-sheets/detail/depression Accessed: 26 December 2023
  3. Depression: What Is Depression? Last Reviewed: September 2023. National Institute of Mental Health https://www.nimh.nih.gov/health/topics/depression/index.shtml#part_145398 Accessed: 26 December 2023
  4. Depression In Women: 5 Things You Should Know. Revised: 2020. National Institute of Mental Health https://www.nimh.nih.gov/health/publications/depression-in-women/index.shtml Accessed: 26 December 2023
  5. Depression In Women: 5 Things You Should Know – 3. Certain Types of Depression Are Unique To Women: Perimenopausal Depression. Revised 2020. National Institute of Mental Health https://www.nimh.nih.gov/health/publications/depression-in-women/index.shtml#pub3 Accessed: 26 December 2023
  6. Symptoms of Menopause: Mood and Emotional Health. Last Updated: 19 December 2023 | Last Reviewed: 19 August 2022. Jean Hailes for Women’s Health https://www.jeanhailes.org.au/health-a-z/menopause/menopause-symptoms#mood-and-emotional-health Accessed: 26 December 2023
  7. Menopause and Mental Health: Mental Health Symptoms Related To Menopause. Content Updated: February 2023. Australasian Menopause Society https://www.menopause.org.au/health-info/fact-sheets/menopause-and-mental-health Accessed: 26 December 2023
  8. The 2022 Hormone Therapy Position Statement of The North American Menopause Society: Depression. Menopause: The Journal of the North American Menopause Society Vol: 29, No. 7, pp 767-794. North American Menopause Society https://www.menopause.org/docs/default-source/professional/nams-2022-hormone-therapy-position-statement.pdf Accessed: 26 December 2023
  9. Managing Your Symptoms: Managing Mood and Emotional Health – Anxiety and Depression. Last Updated: 19 December 2023 | Last Reviewed: 19 August 2022. Jean Hailes for Women’s Health https://www.jeanhailes.org.au/health-a-z/menopause/managing-your-symptoms#managing-mood-and-emotional-health Accessed: 26 December 2023
  10. Mood and the Menopause. Content Updated: 09 February 2023. Australasian Menopause Society https://www.menopause.org.au/hp/information-sheets/mood-and-the-menopause Accessed: 26 December 2023
  11. Menopause and Mental Health: Treatment Options for Mental Health Symptoms. Content Updated February 2023. Australasian Menopause Society https://www.menopause.org.au/health-info/fact-sheets/menopause-and-mental-health Accessed: 26 December 2023
  12. Kulkarni, J. Depression: A Major Challenge of the Menopause Transition. October 2022 https://medicinetoday.com.au/mt/2022/october/feature-article/depression-major-challenge-menopause-transition Accessed: 26 December 2023
  13. Menopause and Mental Health: Untangling Physical and Mental Health Symptoms Related To Menopause. Content Updated: February 2023. Australasian Menopause Society https://www.menopause.org.au/health-info/fact-sheets/menopause-and-mental-health Accessed: 26 December 2023
  14. Menopause and Mind Health: When To See Your Doctor. Updated: May 2023. Jean Hailes for Women’s Health https://www.jeanhailes.org.au/resources/menopause-and-mind-health Accessed: 26 December 2023
Topic Last Updated: 01 March 2024 – Topic Last Reviewed: 26 December 2023

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