Is It Anxiety, Depression, or Perimenopause?

There are three times over a woman’s lifespan when she is more susceptible to developing symptoms of depression and anxiety. Termed “windows of vulnerability,” they occur during seasons of great hormonal fluctuation, such as:

• Puberty and periods
• Pregnancy and postpartum
• Perimenopause and early menopause

Many midlife women seek therapy for increased anxiety- and depression-related symptoms, unaware that perimenopause could be the cause.

Source: Alexandru Zdrobau/Unsplash

Research indicates that in early perimenopause, women are one and a half times more likely to develop a mood disorder, even without a previous history of one. In late perimenopause, the chances increase up to threefold.

Women who have a history of PMS, PMDD (like PMS on steroids), and postpartum depression or anxiety are also at higher risk of suffering from mood disorders during this time.

Recognizing perimenopause and its accompanying mood issues prevents us from blaming ourselves for how we are feeling and wondering what in the world is wrong with us. Only then can we accept what’s not under our control and take wise action on what is.

So, how do we know when it’s perimenopause?

Mood changes (along with those irregular periods) may be one of the first symptoms, along with:

• Irritability
• Crying more than usual
• Increased worry or anxiety
• Low motivation or energy
• Lessened ability to experience joy
• Not feeling like yourself
• Mood swings
• Difficulty concentrating or brain fog

Experiencing other perimenopausal symptoms—like insomnia or continued waking with night sweats—can result in a lowered ability to cope.

Potentially confusing matters, hot flashes and panic attacks show up in much the same way—racing heart, cold sweat, and feelings of panic, doom, or dread. Knowing that shortness of breath occurs only with a panic attack, not a hot flash, can help us distinguish between the two.

Though tough when we’re in the thick of it, we might also consider this season of life to be a window of opportunity—a chance to focus on ourselves instead of everyone else, take back control of our health, reevaluate our working definition of success and balance, and revamp our habits overall.

Just as each woman’s perimenopause symptoms differ considerably, so do individualized treatment plans to address them.

We have options for treating perimenopause

Pharmacotherapy

Menopause Hormone Therapy (MHT) for perimenopause has been given a bad rap for over two decades due to widespread misinformation.

It can, however, be a life-changer. Hormone therapy is not medication but simply a restoration of hormones previously present that have now precipitously declined (leading to those troublesome symptoms).

Depending on your health history and needs, your provider might prescribe a low-dose birth control pill or a combination of estrogen and progesterone.

Though I am a huge proponent of SSRIs (anti-depressants such as Lexapro and Prozac) when warranted for anxiety or depression, perimenopausal women are unnecessarily being prescribed them when, in actuality, MHT is what’s needed. Once a woman’s hormones are addressed, her symptoms of anxiety or depression often resolve as well.

So, how do we know if anxiety, depression, or perimenopause (or a combo) is the cause of our symptoms? It’s not always simple and easy to determine—life is complex and ever-changing.

To clarify, ask yourself:

Am I in my late 30s to early 50s? Have my periods changed in length, time between, and flow? Am I experiencing other possible perimenopause symptoms?

Menopause Essential Reads

Perimenopause: True or False?

Fatigued, Female, and in Your 40s? It Might Be Perimenopause

Do I have a history of anxiety or depression, and/or have I experienced mood disturbances during previous windows of vulnerability (puberty, periods, pregnancy, or postpartum)?

If yes, you may benefit from the combination of MHT, SSRIs, and psychotherapy.

If not, but you are now struggling with anxiety-related symptoms, feeling emotionally numb, irritable, or rage, the combination of MHT and therapy might be best.

Have I experienced recent pronounced stressors that might be contributing to feelings of anxiety or depression? (Remember, just because it is a common life transition or even a positive change doesn’t make it stress-free).

If yes to this and no to perimenopause symptoms, it might be best to treat the mood disorder first with SSRIs and psychotherapy.

Psychotherapy

Cognitive behavioral therapy (CBT), mindfulness or mindfulness-based cognitive therapy (MBCT), and behavioral therapy can all be beneficial—whether used solely or as part of your treatment plan (especially if you are not a candidate for MHT or SSRIs).

Healthy lifestyle habits

Exercise, nutrition, sleep, play, mindfulness, and purpose are even more crucial during a window of vulnerability, and it’s never too late to begin.

This is not an exhaustive list and doesn’t serve as medical advice. Seeking guidance from a menopause-informed provider can help clarify and collaboratively create a course of action. Equipping yourself with knowledge and surrounding yourself with support can be life-changing.