Journal / Mood, Anxiety, Depression

How Does Menopause Cause Depression?

Nancy L. Belcher

Medically reviewed by Nancy L. Belcher Ph.D, MPA

Written by Winona Editorial Team

Last updated November 25, 2021

How Does Menopause Cause Depression?

Does menopause cause depression? Yes.  Menopause can be one of the reasons for depression. Women frequently experience stress, anxiety, mood swings, and depression related to the hormonal changes brought on by perimenopause, and menopause. These mood changes are specifically due to the drop in estrogen, progesterone, and testosterone. Unfortunately, healthcare providers often do not correlate these depression symptoms with menopause, and the consequences can be profound. While menopause is not a disease to be cured, the symptoms can certainly be treated.

What causes depression in menopause? The drop in hormones at perimenopause and menopause plays a critical role in a woman’s feeling of stress, anxiety, and depression. The effects of decreased hormones can lead to lowered libido, vaginal changes, sleepless nights, embarrassing hot flashes, reduced energy, poor self-image, and so much more… what a terrible mixture.  By understanding the true source of these new or exacerbated symptoms, a woman can start to feel happier and healthier.

During perimenopause and menopause, it can feel like the cards are stacked against maintaining an upbeat, stress-free outlook, but hormonal replacement therapy (HRT) can help do just that. Hormones work together to influence mood. If the hormone system doesn’t work properly women can struggle with mental health problems. Fortunately, taking HRT, improving diet, and adding a few lifestyle changes can refine mental balance.

Menopausal mood disorders are related to the decrease in the production of hormones. To maintain mental harmony, a delicate balance of all hormones is required. If hormones are thrown off, a woman can experience increased stress, anxiety, and depression can likely follow. Hormones are a communication method whereby the body tells itself what to do, and how to feel. If one hormone is off and can’t communicate properly, it alters other communication down the line. Even small shifts in hormone levels can have significant effects.

Why is it so Critical to Identify Mood Changes at Perimenopause and Menopause?

Anxiety, moodiness, and depression are some of the most commonly reported issues in women aged 42-52. But there is a recognition gap between these symptoms and the relationship to menopause. This confusion may be due to a stigma surrounding menopausal transition, loss of youth, or vitality. Or is it due to a true lack of awareness that perimenopause often causes anxiety and depression? Additionally, when the words “moody,” “anxious,” “depressed” are used, it sounds like an insult. Who would even want to admit to feeling this way?

At its most extreme, when hormone levels are off, depression can set in, and suicide can follow. Many of the depressive disorders that lead to suicide are often overlooked or misunderstood. The data speaks for itself. There is a significantly higher rate of mental illness and suicide when women experience perimenopause and menopause.1 The seriousness of mental health issues during perimenopause cannot be ignored. Suicide rates among menopausal women have increased by 45% over the past 15 years.2  The risk for depressive symptoms is elevated even in women with no prior history of depression.2

To add to the confusion, the psychological symptoms of perimenopause often start to occur about five years before the more obvious physical symptoms like hot flashes. The lack of obvious physical symptoms for women in their late 30’s and into their 40 often says, “Oh, I’m not in menopause!” And maybe they aren’t. More than likely, they are perimenopausal. 

The denial of perimenopause starting likely stems from a desire to preserve youth, AND a lack of awareness of what perimenopause symptoms are. Perimenopausal women may still experience regular monthly periods and then move to an occasional period. The delay in the obvious, recognizable physical symptoms (hot flashes or end of menses) makes the diagnosis of perimenopausal depression often retrospective. It means women only realize they were suffering unnecessarily after the fact. Women that don’t recognize perimenopause for what it is are left to suffer from mental health issues for years and years!

Perimenopause impacts both a woman’s mind and body. It is important for women who are experiencing anxiety and depression in their late 30s and early 40s to recognize that they may be in perimenopause and that treatment is available. 

This phase of a woman’s life often marks significant life changes that can adversely impact their mental health too.3 Children leaving for college, helping aging/ailing parents, facing increased career demands, and now Covid-19.4 This combination of physical and environmental changes poses an increased risk of suicidality.3

The good news is that there are effective treatments if a woman’s medical history allows. Anxiety and depression can be abated with HRT, antidepressants, or both.1  It is common for women with perimenopausal symptoms to experience depressive symptoms that do not meet the ‘clinical criteria’ for depression, and antidepressants would not be warranted. However, their low-level depressive symptoms can be treated with HRT and depression will be improved.5  

Most women with perimenopausal depression respond to appropriate HRT treatment. It is no longer acceptable to deem this type of perimenopausal depression as minor or presume it will improve with time. The process of perimenopause and menopause can take well over a decade to complete.

Perimenopause is a very vulnerable time for women. There is no need for a woman, their families, and their colleagues to suffer unnecessarily with these perimenopausal and menopausal symptoms. If left untreated, depression can impact a woman’s quality of life and that of her family.4 Tragically, suicide in middle-aged women is becoming a more common occurrence. This can be prevented with increased awareness of the root causes, and the availability, of all options for proper treatment. This phenomenon has been ignored for far too long. If continued to be neglected, the mental health, physical health, and general well-being of women and their families alike will continue to suffer.

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Why Take Hormone Replacement Therapy?

Hormone regulation is complicated. The body’s hormones are all interconnected. The hormone systems must work in harmony and continually rebalance in response to physical and emotional events in a woman’s life. During perimenopause and menopause, a woman can experience huge swings in hormone levels. 

If perimenopausal and menopausal women fail to address the hormonal root causes of stress, anxiety, and depression their mental health goals will suffer. During perimenopause, women can experience a cascade of hormone imbalances, and sometimes the results can be extreme. What was once a symphony of hormones playing a pretty good tune, suddenly becomes a screeching cacophony that can crescendo into a world of problems, including anxiety increases, surplus stress, and deep-seated depression.

Excess, low or blocked levels of the hormones cortisol, progesterone, estrogen, thyroid, and testosterone throw the symphony into hormonal dissonance. By starting HRT a woman can begin the process of repairing the imbalances of the hormones and can once again play in harmony. 

The Hormonal Pathways That Can Lead to Depression 

Estrogen, Progesterone & the Thyroid Gland

The thyroid has many jobs and plays a major role in mood.17 If thyroid hormones are low or not working properly, weight gain, fluid retention, hair loss/thinning, and depression can occur. Thyroid levels in many perimenopausal and menopausal women may be low due to decreased estrogen and progesterone. Adding hormones back via HRT can help with these imbalances. 

Estrogen helps regulate thyroid cells and stimulates thyroid growth.15 When there is too little estrogen, then not enough thyroid tissue is made, leading to hypothyroidism (not enough thyroid hormones). Depression can be a symptom of hypothyroidism. In other words, not enough estrogen can lead to not enough thyroid hormones, and depression can result. HRT can improve depression.26

Progesterone can help regulate the amounts of thyroid hormone levels in the blood. In turn, thyroid hormones stimulate the ovaries to make progesterone.16 While most people don’t associate depression with low thyroid levels, it is very common. Women with hypothyroidism can experience fatigue, sluggishness, trouble concentrating; all combined may lead to feeling depressed.

Progesterone’s Relationship with Mood & Anxiety Changes

At appropriate levels, progesterone acts as a natural antidepressant and can enhance mood and relieve anxiety. It stimulates the ‘feel-good’ center of the brain. So, if progesterone levels drop it is easy to understand why anxiety and depression can follow.17

Progesterone starts to drop in a woman’s 30s and during perimenopause, the levels drop more quickly. Research has shown that by supplementing progesterone, women can improve anxiety, irritability, and nervous tension.17,18,19 Progesterone appears to be the most potent anti-anxiety hormone for menopausal women.

Sometimes healthcare providers don’t correlate anxiety with menopause and the drop of progesterone. But they should. Instead, they will likely prescribe anti-anxiety drugs without correcting for the lowered progesterone. The side effects of these anti-anxiety drugs can include fatigue, memory impairment,  insomnia, decreased libido, changes in appetite, dizziness, and yes, anxiety. All of which menopausal women are already battling. 

When progesterone levels are restored to normal with HRT, women have noticed anxiety relief, decreased irritability, and less nervous tension.17,18,19

Cortisol

Improved sleep leads to decreased stress, but night sweats associated with perimenopause and menopause can create an endless cycle of fatigue. Sleeping 7 to 8.5 hours every night is critical to reducing stress. If sleep is regularly disrupted, the stress hormone ‘cortisol’ increases, and so does stress. 

When cortisol is chronically too high, people can behave in ways that are not healthy, like racing from task to task, feeling anxious but tired, exhibit moodiness, and are quick to anger. People with depression often have very high cortisol levels.17 High levels of cortisol will deplete the ‘happy brain chemicals’ (serotonin and dopamine) leading to depression or mood swings. 

HRT has been shown to reduce night sweats more effectively than any other treatment, allowing for restful sleep and decreased anxiety and depression by returning cortisol to normal levels, promoting the natural return of depleted chemicals in the brain.3,14

Testosterone

Low testosterone levels in women create symptoms that are often subtle. Decreased libido and a decline in sexual satisfaction are the most commonly recognized symptoms. But low testosterone can also result in fatigue, weight gain, muscle weakness, and mood changes. Testosterone replacement can improve mood and well-being, improve cognition, and restore sexual health.

Summary

The causes of depression are immense but we do know that one of the reasons for depression is changing hormone levels.  Does menopause cause depression? It can vary from woman to woman, but anxiety, and mood swings related to the hormonal changes brought on by perimenopause, and menopause can lead to depression. These mood changes are specifically due to the drop in estrogen, progesterone, and testosterone. 

When hormones are in balance, neither too high nor too low, women can look and feel their best. But when hormones are imbalanced, a range of symptoms that include fatigue, trouble sleeping, anxiety,  irritability, depression can be just the beginning of a cascade of menopausal symptoms.

Menopausal symptoms can be prevented, treated, and reversed. The key is a proactive HRT approach that deals with the natural decreases in the hormones estrogen, progesterone, and testosterone. Of course, paying attention to healthy eating habits, and leading an active lifestyle, are also important to feelings of wellness and depression prevention.

“This article is for informational purposes only and does not constitute medical advice. The information contained herein is not a substitute for professional medical advice. Always talk to your doctor about the risks and benefits of any treatment.”

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