Too many of us don't know that perimenopause, the beginning of the menopause journey, can trigger mood and anxiety symptoms for many women, even those who have never before had mental health challenges. Knowing that you are not alone and that what you are experiencing is a part of menopause can in itself be helpful.
You do not have to “suffer through it,” as many women do. There is treatment and you can feel better.
Mental health professionals have identified puberty, pregnancy, and menopause as three windows of vulnerability for women.
The dramatic hormone fluctuations during these phases can make some women more susceptible to mental health challenges, including anxiety and depression.
From the time young women first get their period, they may experience physical and emotional symptoms after ovulating and before their period, caused by changes in hormones. Some women are more vulnerable to these hormonal changes and may experience PMS or PMDD. Women who have PMDD are at increased risk for perimenopausal depression and anxiety.
The perinatal phase is the second window of vulnerability. One in five women experiences a Perinatal Mood or Anxiety Disorder (PMAD).
Women who have a PMAD are at increased risk for perimenopausal depression and anxiety.
Perimenopause is the third window of vulnerability for increased depression, anxiety, and other mood disorders.
Much work remains to be done—as was done with perinatal mental health—to understand and research this evolving topic.
It is the roller coaster, the sudden ups and downs (see graph below) in hormone levels, that researchers believe cause these mood symptoms. Serotonin, a brain chemical that helps us feel happy, drops as estrogen drops, resulting in increased sadness and anxiety.
Progesterone, the calming hormone, also begins to decline in perimenopause.
Changes in mood may be one of the first symptoms of perimenopause. Knowing that these changes are actually symptoms of perimenopause can be helpful because you are less likely to blame yourself for how you feel.
These symptoms are unpleasant, to say the least. For many women, mood symptoms are sporadic and ultimately resolve. But whether symptoms last a few weeks, a few months, or longer, there are many ways to seek help and get relief.
Keep in mind that there is a difference between having mood or anxiety symptoms and having a Major Depressive Disorder (MDD) or any other mood or anxiety disorder. If your symptoms interfere with your functioning and last for more than two weeks, it’s important to seek help.
Hot flashes and panic attacks can look and feel similar—racing heart, breaking into a sweat, feeling panic or sense of doom. How can you tell them apart? When having a panic attack, you often feel short of breath, which does not happen in a hot flash.
The physical symptoms of perimenopause—difficulty sleeping, hot flashes, urinary and vaginal symptoms, low libido, fatigue, etc.—can contribute to the occurrence of mental health symptoms.
Physical symptoms such as low libido, weight gain, sleep difficulties, fatigue, and cognitive changes can also be mental health symptoms.
Night sweats or temperature shifts interfere with quality of sleep, which in turn can affect your mood.
History of Depression
Women who have have a history of depressive episodes during a prior window of vulnerability have a 58% greater risk for another episode during perimenopause.
Having Hot Flashes and/or Night Sweats
There is a link between vasomotor symptoms and increased depression and anxiety. Even in women with no prior history of severe anxiety, experiencing hot flashes and night sweats can increase the odds of experiencing anxiety symptoms.
Adverse Life Events
Women with a history of abuse/neglect, family problems, and low childhood socio-economic status, poverty, and unsafe environments have an increased risk of depression during perimenopause and menopause.
Symptoms are treatable. Reproductive therapists and psychiatrists are specialists in hormone-related mental health, and support women during these windows of vulnerability. The North American Menopause Society (NAMS) made treatment recommendations in 2018.
If you have had sensitivity to hormone fluctuations in the past, be sure to tell your doctor.
Please answer the questions to complete the symptoms checklist. While not a diagnostic tool, it is a printable resource to share with your doctor to have an informed discussion about perimenopause.