Perimenopausal depression is normal and there is no need to worry, but it's perfectly understandable that you may feel confused by a sudden, drastic drop in your mood, particularly if you have never experienced depression before.
What is perimenopausal depression?
Depression is a state of persistent low mood and motivation that goes much deeper than normal, everyday feelings of sadness. It is one of the most common mental health conditions, and can affect anyone, at any time. There are a number of possible causes of depression, and it can affect people in different ways. You may find that you feel unusually tearful and low, that you're sleeping or eating more or less than normal and yet feel constantly tired, or that you've lost interest in activities you usually enjoy. If this persists for more than two weeks, it's likely you are suffering from depression.
In women going through perimenopause, these depressive symptoms may be caused by the same hormonal changes that cause your periods to become more irregular. Oestrogen and progesterone are the female hormones that naturally fluctuate during menstruation, and levels of these hormones are permanently reduced as you approach menopause.
Why is this happening to me?
The range of physical and emotional perimenopause symptoms are the knock-on effect of this hormonal decline, and oestrogen in particular is linked to changes in mood that may lead to depression. This is because oestrogren stimulates serotonin: the mood-boosting neurotransmitter in your brain that's responsible for making you feel good. Declining oestrogen levels are therefore directly linked to declining levels of serotonin, and this lack of serotonin can lead to low mood, and even trigger symptoms of depression.
Besides serotonin, oestrogen also blocks the production of cortisol, the stress hormone that triggers your 'fight or flight' reflex, and progesterone has a calming effect. With lower levels of both hormones, you may find yourself feeling more panicky and experiencing symptoms of anxiety: a condition that commonly occurs alongside depression and can make it very difficult for you to feel relaxed.
These two hormones, and particularly oestrogen, therefore play a really important part in helping you maintain a positive sense of emotional wellbeing and, as their levels decrease, you become increasingly vulnerable to these distressing changes in mood.
Perimenopausal women and depression
It's no surprise then that women in the transition towards menopause are believed to be as much as three times more likely to develop depression than pre-menopausal women. Of those, women who have previously experienced periods of depression, PMS, or postpartum depression are thought to be especially susceptible to perimenopausal depression, however it can affect anyone who is going through these hormonal changes.
If your depression is relatively mild, you may be able to regulate it yourself through regular exercise and good diet. However, if you have any concerns or feel unable to cope with day-to-day life, you should always consult your doctor, who will be able to advise on the best course of action for you.
Finding the right treatment
The two main treatments for perimenopausal depression are hormone replacement therapy (HRT) and antidepressants, or a combination of the two. The most common form of antidepressants (SSRIs) works by increasing the levels of serotonin in your brain, counteracting the effect of the drop in oestrogen and giving your mood a boost. HRT, as the name suggests, replaces your depleted levels of oestrogen and/or progesterone and may help relieve your symptoms.
Remember too that, as well as hormonal changes, there are likely to be psychological factors contributing to your low mood. Stressful life changes are a common cause of depression and any number of outside issues may well be affecting you at this already emotional time in your life. Many women, as they approach menopause, are also grappling with ill or dying parents, children leaving home, or relationship breakdowns. Any of these events can understandably trigger a depressive episode at any time, regardless of hormones, so they may be especially difficult to cope with while perimenopause is playing havoc with your mood-regulating oestrogen levels.
Likewise, how you feel about this transitional period in your life – whether that's the distress caused by other, physical symptoms, or what reaching the menopause means for your identity as a woman – could well be having an impact on your emotional state. Talking all these changes through, either with a friend, older relative, or a counsellor, may help you come to terms with them and feel better able to cope.
From Sarah Graham
Sarah Graham is a freelance journalist, copywriter, editor and proofreader, specialising in women's issues and mental health. You can find her on Twitter @SarahGraham7.