Unfortunately, depression and anxiety are two of the common signs of perimenopause and menopause.

Not to be Debbie Downers of course. But while we’re all for using vitamin H (humour) to help us through, we understand depression and anxiety are real. We’ve lived it!

However, they shouldn’t be considered par for the course. Although, if they do raise their unwelcome head it’s important they’re taken seriously.

Depression & anxiety at menopause is under-recognised

Certainly, the mental health issues that can arise during menopause often fly under the radar. Symptoms such as hot flushes and weight gain get far more attention.

There are plenty of humourous memes out there and laughter is good! However, there is a serious side of menopause that’s been under-recognised for too long.

In fact, it appears that the first guidelines for the treatment and evaluation of perimenopausal depression were only published in 2018.

Several experts agree that perimenopausal depression is different to clinical depression. In addition, some of them believe that menopausal depression may become a sub-category under the overarching depression category.

Indeed, a woman’s risk of depression is very present¹.

Did you know?

After puberty, women are twice as likely to be vulnerable to depression than men. And this magnifies when she’s in perimenopause – Harvard suggests the risk triples or quadruples. Furthermore, Harvard state that if a woman has experienced anxiety or depression in the past she might see a resurgence of symptoms.

But let us say it again! It should be noted that not all women will experience anxiety and/or depression.

How do you know if you have anxiety or depression?

Depression

Depression is more debilitating than a touch of the ‘blues’. It’s normal to feel ‘blah’ or unhappy at times and it should pass.

In comparison, depression can cause loss of interest in life, things you’ve always enjoyed and those you love. Winston Churchill nicknamed depression The Black Dog because the experience is akin to finding yourself in a dark hole.

Untreated clinical depression is also linked to thoughts of suicide which becomes a danger for those experiencing it.

And for women aged 45-54 the suicide statistics are not only deeply disturbing, they’re also increasing.²

To clarify: what is clinical depression?

Although ‘depression’ is often used as an umbrella term to cover several emotions it’s not always correct. Clinical depression is a serious illness and any amount of ‘pulling yourself together’ won’t lessen it³.

The definition is when there is a change in normal life function for two weeks or longer. Common signs include appetite shifts, loss of pleasure, over-sleeping or insomnia and feelings of worthlessness.

Anxiety

On the other hand, anxiety – while also common in menopause – is characterised by feelings of dread or fear.

Panic attacks triggered by extreme anxiety also come into play here. To date, there is not much information available regarding anxiety and menopause.

Nonetheless, it appears that if a woman hasn’t experienced high anxiety premenopause she may be more susceptible to it in perimenopause and beyond.⁴

What causes depression and anxiety at menopause?

One of the hallmarks of menopause is a lowering of estrogen.

There are several estrogen receptors in the brain making estrogen an excellent mood regulator.

But, for some women, when estrogen levels lower their brains can take a tiny, negative thought and magnify it. By the same token, this can trigger irritability, mood swings or menopausal rage.

These hormonal fluctuations can be behind anxiety and depression at perimenopause.

It’s important to realise that you’re not going mad, that you’re not weak and that you don’t need to tough it out.

Related: Why does our brain change at menopause?

Could it be something else?

While your hormones can cause many signs and symptoms, other life happenings can contribute to depression and anxiety also.

For example, many women are affected by growing older, relationship breakdowns, and financial concerns. Moreover, empty nest syndrome or the grief of infertility may raise their heads. And yes, even for women who hadn’t wanted children.

Further, you may be looking after ageing parents or have increased career responsibilities. The truth is peri/menopause often comes at a busy time in our lives.

12 symptoms of perimenopausal depression

Low energy
Paranoid thinking
Irritability or hostility
Decreased self-esteem
Isolation
Anxiety
Somatic symptoms (extreme anxiety about physical symptoms such as pain)
Sleep disturbance
Weight gain
Decreased sexual interest
Problems with memory and concentration
Thoughts of suicide

Source: Australian Prescriber²

16 possible triggers for depression and anxiety at menopause

An Australian study of women transitioning to menopause revealed more depression in women with the following states⁵

Negative mood before menopause
Pessimistic attitude toward menopause and ageing
Smoking
Little or no exercise
No partner
Poor self-perceived health
Adverse feelings toward partner
A number of perceived problems
Interpersonal stress
The onset of illness in self or others
Care of ageing parents
Changes in employment
Change in the childbearing role
Loss of fertility, which may be associated with a loss of an essential meaning of life
Empty nest syndrome
The societal value of youth (in societies where age is valued, women tend to report having fewer symptoms at the menopause transition)

Source: Postmenopausal Syndrome Indian J Psychiatry

8 things you can do if you have anxiety or depression

There are several lifestyle tools that will impact your mood but it’s also very important that you seek help and support. Reach out to friends and family and specialist professionals.

In addition:

Eat real food. You need more of most nutrients during menopause and if you’re skipping meals you may disrupt your blood sugar. This may, in turn, impact your mood. So focus on eating healthy, whole foods and always include a fist-sized serving of lean protein with a thumb-sized good fat. It may be the last thing you feel like but if you’re not eating regularly or well you could experience a mood dip.
Avoid foods such as refined sugar and carbohydrates because they will act the opposite way to the nutrients we’re advocating above. They can cause blood sugar to spike settting off hot flushes, mood swings and anxiety.
Omega 3 essential fatty acids have been shown to be beneficial for the treatment of depression⁸. You can find omega 3’s in extra virgin olive oil, hemp seed oil, fatty fish, soybeans, walnuts and flax and chia seeds.
Exercise changes the brain and encourages it to release neurochemicals such as endorphins, serotonin and dopamine. As a result, it naturally increases feelings of well-being.
Ensure you gut health is doing well. The gut-brain axis and the microbiome have been associated with depression, anxiety and other mood disorders. Recognition of this is one reason we formulated Happy Go Tummy™.
Diarise time for self-nurture and self-care to help you manage your mood in menopause. This is not fluff and woo woo, science backs this up⁶.
Try cognitive behavioural therapy (CBT) which has been shown to be especially helpful for women going through perimenopause. It’s a form of brain training and teaches ways to deal with negative self-talk. Ongoing studies are pointing to its benefits for anxiety, depression and sleep.
See your medical professional.

Conclusion

Menopause can be a time of deeply personal and complex hormonal, physical and emotional change. The signs and symptoms can sometimes be overwhelming and baffling. Coupled with that midlife may come with a variety of life impactors which can leave us reeling.

Therefore, depression and anxiety during perimenopause and early post-menopause should never be taken lightly. And as it can take women quite some time to even realise they’re in perimenopause, they may not connect depression and anxiety with menopause.

Women also need to understand that the mood and brain effects of perimenopause are usually temporary. As you transition through into post-menopause know that many women in their 60s report feeling happier⁸ and less stressed. And you’ve gotta love that, don’t you?

Seeking help

If you or someone you love is struggling with depression and anxiety at menopause, please seek help. We are always here as a sounding board and you can find us in our private Facebook group here.

Other resources include:

Merry Peri™ and Perky Post™ contain ingredients to support your menopausal moods too.

Disclaimer: Our articles are a guideline only and should not take the place of medical advice.

References:

Bromberger JT, Epperson CN. Depression During and After the Perimenopause: Impact of Hormones, Genetics, and Environmental Determinants of Disease. Obstet Gynecol Clin North Am. 2018 Dec;45(4):663-678. doi: 10.1016/j.ogc.2018.07.007. Epub 2018 Oct 25. PMID: 30401549; PMCID: PMC6226029.
Kulkarni J. Perimenopausal depression – an under-recognised entity. Aust Prescr 2018;41:183–5.https://doi.org/10.18773/austprescr.2018.060
University of Berkeley, Clinical Depression
Bromberger JT, Kravitz HM, Chang Y, Randolph JF Jr, Avis NE, Gold EB, Matthews KA. Does risk for anxiety increase during the menopausal transition? Study of women’s health across the nation. Menopause. 2013 May;20(5):488-95. doi: 10.1097/GME.0b013e3182730599. PMID: 23615639; PMCID: PMC3641149.
Dalal PK, Agarwal M. Postmenopausal syndrome. Indian J Psychiatry. 2015 Jul;57(Suppl 2):S222-32. doi: 10.4103/0019-5545.161483. PMID: 26330639; PMCID: PMC4539866.
Karimi, L., Mokhtari Seghaleh, M., Khalili, R. et al.The effect of self-care education program on the severity of menopause symptoms and marital satisfaction in postmenopausal women: a randomized controlled clinical trial. BMC Women’s Health22, 71 (2022). https://doi.org/10.1186/s12905-022-01653-w
Wani AL, Bhat SA, Ara A. Omega-3 fatty acids and the treatment of depression: a review of scientific evidence. Integr Med Res. 2015 Sep;4(3):132-141. doi: 10.1016/j.imr.2015.07.003. Epub 2015 Jul 15. PMID: 28664119; PMCID: PMC5481805.
Wani AL, Bhat SA, Ara A. Omega-3 fatty acids and the treatment of depression: a review of scientific evidence. Integr Med Res. 2015 Sep;4(3):132-141. doi: 10.1016/j.imr.2015.07.003. Epub 2015 Jul 15. PMID: 28664119; PMCID: PMC5481805.