Depression and Perimenopause

Perimenopause is a very popular subject in women's health these days. Also referred to as premenopause or menopause transition, these terms are indicating the period of time when a woman's ovaries begin to run out of eggs and hormones are fluctuating in preparation for menopause. These fluctuations begin occurring anywhere from 6 months to 10 years before actual menopause begins. The average age for perimenopause to begin is around age 45, but some women experience these changes in their late thirties.

Until recently, women had no idea of the changes their bodies, emotions, and hormones were going through during these transition years. After all, girls are taught in school about the changes their bodies and emotions will go through during puberty. Middle-aged women have not had the same wealth of information. And the change that puberty brings to a woman is minor compared to the behavior and symptoms of perimenopause.

A woman's perceived reality begins to change as the link between her brain and her ovaries begins to shut down. Perimenopause is when both progesterone and estrogen fluctuate the most in a woman's body.

For years, women have failed to connect their symptoms to fluctuating hormones during perimenopause. Increased irritability, mood swings, decreased libido and sleeping difficulties associated with impending menopause definitely change a woman's quality of life. While she often blames herself for the way she feels, hormones can definitely lead to behavioral changes. A woman may also blame her spouse, her job, her children, her inlaws, or her own parents all without knowing that her hormones are creating this altered reality.

The signs of perimenopause are some or all of the following:

Tenderness in breasts

Worsening PMS symptoms

Fatigue

Decreased sex drive

Irregular periods

Mood swings

Difficulty sleeping

Hot flashes

Urinary incontinence or urgency

Forgetfulness or mental fatigue

About half those symptoms read like a checklist to diagnose depression. Add in the fact that these midlife years are associated with other transitions that involve changes and loss: elderly, dying, or deceased parents; the empty nest; feeling a loss of attractiveness, or youth; and possible disappointment at career options, and it is no wonder that these years are stressful for many women. So how does perimenopause affect women already prone to, or being treated for, depression?

Not surprisingly, recent studies have shown that women with depression have a higher rate of perimenopause than the general population. Depression seems to have a negative impact on the system that controls ovarian function, and therefore hormones. The studies also seemed to indicate that depressed women entered menopause much earlier than their peers. Women taking antidepressants to manage their depression were three times as likely to enter early perimenopause.

It is still unclear whether a tendency to depression can be an early marker of ovarian decline leading to early menopause, or if depression can be considered a risk factor for perimenopause. It can help that those of us struggling with depression are already accustomed to managing our moods. The advice given to manage the symptoms of perimenopause and depression is about the same:

Exercise.

Try for regular sleep times.

Take a multivitamin with calcium.

Stop smoking.

Decrease alcohol consumption.

Drink eight glasses of water a day.

Maintain a healthy weight.

Some women take an antidepressant to manage the mood swings of perimenopause. Other women alleviate many of the symptoms by a low dose birth control pill. The good news is, by many accounts, the years after menopause are some of the most productive, liberating and exciting times of a woman's life. Nowadays, women live as many years after menopause as they do before the event. So make the most of the transition!