Menopause & Depression: Navigating Mood Changes

As the body adjusts to a number of changes occurring during menopause, so does the mind. Fluctuating hormones can change the brain’s chemistry and increase susceptibility to depression. In fact, studies have shown that menopause increases the risk of depression by four times.⁽¹⁾ Despite the prevalence, depression is an under-discussed symptom of the menopausal transition.

Women often brush off their symptoms as a normal part of aging. Knowing the symptoms of depression and that effective treatment options are available can encourage women to seek help.

When does menopause-related depression occur?

Experts suggest that women might be more vulnerable to depression during perimenopause. An early or lengthy perimenopause further increases this risk, however, depression can occur at any phase of the menopausal transition. That said, many women may go through this transition without experiencing any mood changes at all.⁽¹⁾ 

What causes depression during menopause?

The exact cause of menopause-related depression isn't fully understood, but several factors are believed to contribute.

Hormonal Fluctuations

Fluctuating estrogen levels influence brain chemicals that regulate mood, like serotonin and dopamine. This change in brain chemistry predisposes individuals to depression.⁽²⁾ 

Declining DHEA levels may also add to the problem. DHEA is a precursor to estrogen and testosterone. Low levels of DHEA during menopause may interact with fluctuating estrogen levels to further increase the risk of depression.⁽³⁾

In addition, a decline in estrogen levels may result in vasomotor symptoms like hot flashes and night sweats. These symptoms can make it difficult to fall or stay asleep, and poor sleep is a known cause of mood changes.⁽²⁾

Vulnerability Factor

Experts explain why not all women experience depression during menopause through the theory of the “window of vulnerability.” According to this theory, certain risk factors make some women more susceptible to the hormonal fluctuations that occur during this phase, increasing their risk of depression.⁽²⁾

For instance, women with a history of depression are two times more likely to experience it during the menopausal transition.⁽¹⁾

Other risk factors include:^(1,2)

• Neuroticism, a personality trait where a person reacts more strongly to stress and tends to see ordinary situations as threatening or hopelessly difficult

• Negative perception towards menopause

• A history of premenstrual syndrome 

• Surgical menopause

• Sedentary lifestyle

• Longer menopausal transition

Life Stressors

Women are more likely to encounter stressful life events during menopause, such as caring for aging parents, children leaving home or failing to get a job, or marital problems. These stressors can amplify the emotional impact of hormonal changes, which may increase the risk of or worsen depression.⁽¹⁾

Depression Symptoms During Menopause

Some common indicators of depression during menopause are:

• A loss of interest in once enjoyable activities

• Fatigue

• Persistent sadness or hopelessness

• Decreased sleep and/or appetite

• Difficulty concentrating

• Weight loss or gain

• Unexplained joint or muscle pains

• Feeling numb or lack of emotions

In severe cases, individuals may experience suicidal thoughts and attempt to hurt themselves. It is crucial for women facing these challenges to seek immediate assistance from a psychiatrist.

How long does menopausal depression last?

The course and intensity of depression during menopause depend on factors like the stage of menopause or the age at which women enter this transition. Various studies have shown that the symptoms of depression may resolve two to four years after the last menstrual cycle. However, the timeline can also be influenced by treatment. With early intervention, women can effectively manage their symptoms and maintain a high quality of life throughout this phase.⁽⁴⁾

Finding Relief from Menopause-Related Depression

As with other symptoms of menopause, there’s no one-size-fits-all approach for managing depression. Individuals can experiment with the following strategies and find what suits them best.

Healthy Lifestyle Habits

A sedentary lifestyle, poor sleep, obesity, and caffeine intake can worsen depression. Conversely, the following habits support mental health:^(5,6)

• Eating a well-balanced diet: A whole-food diet consisting of fruits, vegetables, whole grains, legumes, nuts, seeds, yogurt, milk, and lean meats can improve mood and overall health. It also helps to include foods rich in omega-3 like fatty fish, plant oils, and avocado. Caffeine and alcohol consumption should also be limited.

• Having an active lifestyle: Exercise releases endorphins, which are hormones that improve mood. Experts recommend getting 30 minutes of moderate-intensity exercise five days a week. Some helpful exercises include brisk walking, swimming, jogging, or cycling.

• Improving sleep hygiene: A bedtime routine without technology and in a relaxed, dark environment can help enhance the quality of sleep. 

Therapy

One of the most effective therapies for depression is Cognitive Behavioral Therapy (CBT). This therapy can help identify and change thoughts that negatively influence emotions. This allows individuals to adopt more balanced thinking and manage stressful situations without becoming overwhelmed.⁽⁷⁾

Support Groups

Support groups consist of people going through similar problems or experiences. They provide support and a sense of community. Connecting with others who face the same struggles allows women to share their feelings without the fear of judgment. 

Antidepressants

Doctors may recommend selective serotonin reuptake inhibitors (SSRIs) or serotonin and norepinephrine reuptake inhibitors (SNRIs) that alter brain chemistry and reduce symptoms of depression.⁽⁹⁾

As these medicines are not suitable for everyone and may have side effects, they should only be taken after consulting a physician.

Hormone Replacement Therapy (HRT)

HRT is a viable option for managing all menopause-related symptoms. It works by stabilizing hormone levels and decreasing vasomotor symptoms like hot flashes. Studies have shown that women treated with estrogen alone or combined HRT experienced a 68%–80% improvement in their depressive symptoms, compared to 20%–23% in women not using HRT.^(1,3) 

As estrogen alone increases the risk of endometrial thickening, it’s used with progesterone in women with a uterus. Doctors recommend estrogen-only therapy in women who have had a hysterectomy.

A combination of antidepressants and HRT offers the best results for managing depression during menopause.⁽⁸⁾

Experiencing menopausal depression? Discover if HRT is right for you.

If you’ve entered the menopause transition and are struggling with depression, you don’t have to suffer in silence. Take our brief menopause quiz to see if you’re an eligible candidate for HRT. Get started with Winona to take the first step toward feeling better.