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12 Common Signs Of Depression & Anxiety At Menopause | How To Get Help

Depression-and-Anxiety-menopause

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. 

According to Professor Jayashri Kulkarni AM founder and director HER Centre Australia, 30-50% of us struggle with this,

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.

 

depression-and-anxiety-at-menopause
Image by Cottonbro @pexels

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.

What causes depression and anxiety at menopause?

depression-and-anxiety-at-menopause

One of the hallmarks of menopause is a lowering of progesterone and estrogen

Indeed, this happens far earlier than some think, Progesterone drops around mid-30s and she’s a very calming hormone. Subsequently, we may begin to feel less tolerant and more susceptible to mood changes.

There are also 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. However, it’s not only about our reproductive hormones, it’s an extremely complex biological process. And the HPA (hypothalamus-pituatary-adrenals) axis as well as the gut/brain axis con be contributory also.

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

  1. Low energy
  2. Paranoid thinking
  3. Irritability or hostility
  4. Decreased self-esteem
  5. Isolation
  6. Anxiety
  7. Somatic symptoms (extreme anxiety about physical symptoms such as pain)
  8. Sleep disturbance
  9. Weight gain
  10. Decreased sexual interest
  11. Problems with memory and concentration
  12. 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

  1. Negative mood before menopause
  2. Pessimistic attitude toward menopause and ageing
  3. Smoking
  4. Little or no exercise
  5. No partner
  6. Poor self-perceived health
  7. Adverse feelings toward partner
  8. A number of perceived problems
  9. Interpersonal stress
  10. The onset of illness in self or others
  11. Care of ageing parents
  12. Changes in employment
  13. Change in the childbearing role
  14. Loss of fertility, which may be associated with a loss of an essential meaning of life
  15. Empty nest syndrome
  16. 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:

  1. 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.
  2. 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.
  3. 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.
  4. 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.
  5. 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
  6. 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.
  7. 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.
  8. See your medical professional.

Conclusion 

depression-and-anxiety-at-menopause
Photo by Priscilla du Preez @unsplash

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:

  1. 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.
  2. Kulkarni J. Perimenopausal depression – an under-recognised entity. Aust Prescr 2018;41:183–5.https://doi.org/10.18773/austprescr.2018.060
  3. University of Berkeley, Clinical Depression
  4. 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.
  5. 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.
  6. 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
  7. 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.
  8. 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.
Main image: Yaroslav Shuraev @Pexels

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Post-menopause


This is the time when menstruation is well and truly over, the ovaries have stopped producing high levels of sex hormones and for many ladies, perimenopause symptoms subside.

Estrogen has protective qualities and the diminished levels mean organs such as your brain, heart and bones become more vulnerable. It’s also a key lubricant so your lips may become drier, your joints less supple and your vagina might be drier. In addition, your thyroid, digestion, insulin, cortisol and weight may alter.

At this juncture, a woman might experience an increase in the signs of reduced estrogen but she should have a decrease of perimenopause symptoms. That said, some women will experience symptoms like hot flushes for years or even the rest of their lives.

Perimenopause

Peri = ‘near’

Most females begin to experience the symptoms of perimenopause in their mid-forties. Your progesterone levels decline from your mid-30s but it’s generally from around 40 that the rest of your sex hormones begin to follow suit. 

Perimenopause is a different experience for every woman and some women may barely notice it. The first indicators are usually changes to the monthly cycle. This means that for some ladies, this can be accompanied by things like sore breasts, mood swings, weight gain around the belly, and fatigue as time goes on.

For those with symptoms it can be a challenging time physically, mentally and emotionally.

Importantly, perimenopause lasts – on average – four to 10 years. The transition is usually a gradual process and many women enter perimenopause without realising.