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Key points
- Perimenopause marks a reproductive transition involving dramatic physiological and emotional changes.
- Sensitivities to reproductive hormone changes are a mental health risk factor during perimenopause.
- Women with a history of pregnancy-related mental health complications are vulnerable to menopausal depression.
- There are effective medication and non-medication approaches to support women during a menopausal transition.
While the transition to menopause is a part of the natural developmental life cycle for women, this topic has long been left out of mainstream conversation. Only recently a light has been shed on this important aspect of women's health with celebrities also speaking out. People like Naomi Watts, Oprah Winfrey, and even Michelle Obama have recently shared their experiences with perimenopause – the time preceding menopause, in which a woman's body experiences natural yet dramatic physiological and emotional shifts. These changes include:
- Fluctuations in hormones
- Irregular periods – spotting, changes to flow, changes to length of cycles and duration of menstruation
- Physical symptoms – hot flashes, breast tenderness, difficulty with concentration
- Mental health symptoms
Perimenopause generally begins in a person’s mid-40s and averages 4-6 years. Menopause, then, is the point at which a woman has not had a menstrual period for 12 months.
Impacts to Mental Health
Throughout a woman's life she is at a greater risk of experiencing mood and anxiety disorders than her male counterparts — why is this? One of the suspected causes is that within the female body, hormones and neurotransmitters share common pathways and receptor sites in the parts of the brain linked to mood. As such, during the menopausal transition, women become more vulnerable to depression and anxiety because of drastic shifts in hormones.
Women who experience mood disturbances earlier in life during significant reproductive-related hormonal fluctuations — premenstrual (e.g., severe PMS or PMDD), pregnancy (e.g., antenatal depression), and postpartum (e.g., postpartum depression) — are at an increased risk to reexperience symptoms of depression and anxiety during perimenopause. In addition, women with a general history of mood and anxiety disorders are also at an increased risk of relapse or exacerbation of symptoms during the transition to menopause. One study found this risk to increase five-fold. It is important to note that a history of mental health conditions is the greatest risk factor for experiencing perinatal mood and anxiety disorders, so these two groups are not mutually exclusive, and both point to the previously described hormone and neurotransmitter vulnerabilities within the female body.
Suppose you are a woman who has experienced mental health concerns within your lifetime, particularly within the described reproductive-related hormonal fluctuations. In that case, you should talk with your reproductive healthcare provider as you move into the years preceding perimenopause to remain informed of potential care options in addition to self-monitoring for mental health symptoms during the menopausal transition.
Symptoms
Some menopause-specific symptoms include weight and energy changes, sleep and sexual disturbances, and cognitive shifts. While these symptoms can be distressing on their own and should not be minimized, when they co-occur during menopause they can mask mental health symptoms because they mirror the presentation of anxiety and depressive symptoms. As such, issues of mental health might be written off both by the women experiencing them and medical professionals.
Prevention and Treatment Strategies
Given the increased risk of mood and anxiety disorders in women during the transition to menopause, healthcare providers should engage in conversations and assessments for mental health concerns. There are effective medication and non-medication approaches to treating perimenopausal symptoms, including those related to mental health issues. Effective pharmacological treatments include antidepressants and hormone replacement therapies. That is, hormonal therapies with estrogen may play a role in the treatment of depressive symptoms. Psychotherapy such as cognitive behavioral therapy for menopause (CBT-Meno) has also been shown to improve depressive symptoms, even when women are not also taking medications. In addition to targeting depressive symptoms, CBT-Meno has the benefit of improving physiological symptoms like hot flashes, sleep difficulties, and sexual concerns.
