Perimenopausal Depression and Hope for the Future

 

‘Women are 40% more likely to experience depression in the perimenopause than those who aren’t experiencing any menopausal symptoms, finds a new study led by UCL researchers.’

This is one of a growing body of evidence that shows that women experiencing perimenopause symptoms, sometimes from as early as 35 years old, may be wrongly diagnosed with clinical depression and given antidepressants.

The study, published in May 2024, comprised of an analysis of seven studies that included over 9,000 women around the world. Published in the Journal of Affective Disorders, the study found that there was no relationship with a woman’s history of depression or low mood, indicating that her previous mental health history is not a factor in whether she will develop depression during her perimenopausal years, which as we will see later, can go on for over 15 years between the ages of 35 and 50 (and in many cases, later).

This study comes just a few months after the same journal and study group published the results of a study that confirmed that talking therapy could be an effective treatment for the non-physical symptoms of perimenopause, such as mood swings, low mood, memory and concentration problems.

In a recent talk at MenoConnect a support group for perimenopausal women in the Forest of Dean, I was asked to talk more about why our mental health suffers during perimenopause and what we can do to ease those symptoms.

I concluded that the decline in mental health is due to three main reasons – our general time of life; perimenopause symptoms leading to mental health problems; and Menopausal Mood Disorder (MMD), caused by a drop in estrogen, which is our body’s natural antidepressant.

According to figures published in August this year by the Office for National Statistics, the highest suicide rate among women in 2023 was in the age-range 50-55, followed closely by those in the age-range 40-45. My feeling is that this is not a coincidence, when we think about what women are experiencing at this time in their lives.

A 2021 article published in the Independent, stated that one in ten women going through menopause had experienced suicidal thoughts and nine out of ten experience mental health problems. In the study, eight out of ten women had not thought to seek help for their mental health difficulties and 74% said that they had not experienced mental health symptoms before perimenopause.

Additionally, in 2022, UK health think tank Forth conducted a survey of 4,000 women and asked them the most important and debilitating symptoms of perimenopause.

88% sited low mood, increased anxiety, anger outbursts & depression as their most significant symptom. This was compared with just 44% who stated hot flushes.

Poor sleep and brain fog were the second and third most common symptoms at around 72% each.

 

The Three Conditions for Poor Perimenopausal Mental Health

• Lifetime Changes
• Perimenopausal Symptoms
• Menopausal Mood Disorder

 

Lifetime Changes

So firstly, let’s take a look at what might be going on for us between the ages of 35-55 (yes, that’s a long time, isn’t it!!!)

• We might be mothers, either new mothers or dealing with teenagers. We might even have adult children who bring their own worries (because we never stop worrying about our children).
• It might be a pivitol time for our work/career – are we top of our game? What are the expectations on us? Have we recently returned to the workplace following children? Do we want to retrain? What are our financial commitments and how have they changed?
• What about our own parents? Are they still with us? Able? Starting to notice that they are getting older and have different needs that may fall on to us?
• What about our relationship? Have we now been with our partners for 25/30 years, or have we become single? What are the stresses around our relationship and are we starting to question it? (bearing in mind that most divorces occur for women, when they are between the age of 40-45) How’s your sex life? Good? Stressful? Do you experience vaginal dryness? Lacking in desire? This may all put added pressures on us.

 

Perimenopausal Symptoms

So now let’s think about all that and add in a few perimenopause symptoms.

There are currently 34 identified perimenopausal symptoms but let’s look at the ones that are most likely to affect our mental health, either directly or indirectly:

• Low mood,
• anger,
• anxiety,
• panic attacks,
• weight gain,
• vaginal dryness,
• brain fog,
• memory loss,
• loss of sex drive.
• Disrupted sleep
• aching joints,
• palpitations

So how is that going to make you feel? Even someone who is not going through menopause would be feeling pretty rubbish – think about how it feels when you have disrupted sleep for even one night.

• the fear of a hot flush in a place that you can’t get out of (anxiety, claustrophobia),
• no longer being able to do your job as well (worry, lack of self-esteem) younger, perkier colleagues who don’t understand (self-esteem),
• changes in body shape (self-esteem),
• migraines that can affect work and personal life (anxiety (causes migraines) and fear of one coming on),
• sudden heavy periods – anxiety.

 

All of this can lead to symptoms of low mood, anxiety and depression, with or without chemical imbalances that come with perimenopause!

 

Menopausal Mood Disorder (MMD)

So let’s add hormones into that mix: from the age of around 35 (varies from person to person) our estrogen levels start to drop.

• Estrogen affects our levels of Seratonin, Dopamine & Noradrenaline. These are our body’s natural antidepressants
• When estrogen drops, so do our natural antidepressants. This can lead to low mood, irritation, lack of purpose, fatigue.
• So as well as going through all the changes discussed above, we are also seeing a drop in our body’s natural antidepressant.

Where previously we could cope, we no longer have the tools that our body has given in the past.

 

Is there hope?

The short answer is yes, there is hope. Many women can develop a set of robust strategies that help them to cope during this difficult time. Here are some suggestions:

Firstly, forgive yourself!

• If you have an understanding of what’s going on for you, forgive yourself. This is not you, it’s not your fault. You didn’t ask for this and you certainly don’t deserve it.
• This will give you confidence to have those conversations with friends and family.
• After all, if you were suffering age-related sight loss or mobility issues, you would expect (and deserve) compassion.

Be proactive!

• Being proactive in managing your symptoms can be hugely empowering and in itself give you self-confidence. This can include contacting the GP, doing some online research to become better-informed, coming to groups like this one, making lifestyle changes…

Educate yourself

• Knowledge is power – find out as much as you can from books, magazines, podcasts, insta, fb

 

Making lifestyle changes

• Reducing caffeine and alcohol – these are important for many reasons but if you want to reduce your anxiety, improve sleep and reduce hot flushes, reducing or cutting out alcohol & caffeine should be top of your list. Remember, alcohol is a depressant.
• This will lead to an automatic improvement in coping and therefore, your mental health.
• Improved diet – a reduction in processed foods that are full of chemicals, reducing sugar can be hugely beneficial and lead directly to improved mental health. This may also promote weight loss, which can help with self-esteem.
• Introduce a good magnesium citrate supplement – invaluable for sleep, restless legs, palpitations and joint pain.
• B12 injections (I am not a doctor) improve fatigue and brain fog
• Movement (notice I’m not saying exercise) – not only can it lead to weight loss (good for self-esteem and self-confidence) but the endorphins released make us happy. Particularly if you choose something like dancing.
• Weight training – building muscle is really important for menopause – better than endurance training.

Self care

• This is not selfish! You need to make time for yourself. What do you enjoy? What can you introduce that is just for you and involves self-reflection, stillness, calm – meditation, a quiet walk in nature, reading, singing – ringfenced time.
• Introduce boundaries and stick to them. You need it and you will garner respect for it.

Therapy

• How often do you get to talk through your problems, worries, reactions, trauma, relationships. How does it feel to get older? What about elderly parents, pressure? Financial worries? Children leaving home/their relationships/
• What do I want from life? What have I achieved? Is it what I expected and what I am happy with? Is it too late to do something different?
• Navigating the past and exploring trauma through counselling – this helps to manage stress reactions.
• This might be the time to assess your life and whether it is what you want it to be. Remember the stats – divorce rates are highest among women 40-45 – that’s no coincidence.

Journalling

• Getting is all down can be a huge relief. You can keep it, hide it, burn it, delete it, but you will feel better after you write it down!

Making changes to manage your symptoms

• Sleep in a cooler room, promote good sleep and don’t get upset if you do wake in the night.
• Take 5 regularly, particularly if you feel that you are getting frustrated
• Invest in clothes that feel cool and airy
• Admit when you’re having a bad day – I’ve lost count of the amount of times recently that I’ve said to my kids – I just can’t make a decision today – please can someone else make the decisions.
• Tell everyone what you’re going through – this is empowering! You’re not guilty, you’re going through a massive life change. So tell your employer, your partner, your kids, your parents.

Go to the GP

• And keep going until you’re happy with the treatment that you’re given.
• Question antidepressants – is there something more appropriate?
• And remember, one blood test is not conclusive; throughout the month, our hormones fluctuate so one day our estrogen levels might be within normal range. That doesn’t mean that a week later, it isn’t bottomed out. You need a few blood tests spaced out to get a good idea of what your hormones are up to.

 

If you feel you would like to discuss any of these points or book in a free 20-minute counselling consultation, please feel free to contact me: info@kellyworgan.co.uk