Menopause and Depression: What's the Connection?

The transition to menopause can sometimes lead to symptoms that resemble depression. Menopause depression may also occur when the hormonal shifts that accompany the transition contribute to mood problems and other symptoms of depression.

Understanding the distinctions between menopause and depression (as well as how they are often connected) can be the key to getting the right diagnosis and treatment.

What Is Menopause?

Menopause is the time in a woman’s life when the menstrual period stops, most likely when the ovaries stop making estrogen. Missing a period for 12 consecutive months (in the absence of other obvious causes) is the main criterion for being menopausal. When this happens, a woman is no longer able to get pregnant.

Despite having an occasional period, many women believe they are menopausal when they are actually in a transition period called perimenopause. This refers to the time when your body makes the natural transition to menopause. It most often occurs sometime in your 40s or right around the time of menopause.

What Is Depression?

Depression is a mood disorder that causes persistent feelings of sadness or loss of interest and affects how you feel, think, and handle daily activities. The two most common forms of depressive disorders are major (clinical) depression and persistent depressive disorder (dysthymia).

Major depression is the most commonly diagnosed depressive disorder. It is characterized as having at least five symptoms of depression outlined in DSM-5 criteria most of the day, nearly every day for at least two weeks that interferes with your ability to work, sleep, study, eat, and enjoy life.

These criteria, known as "A Criteria" are as follows:

• A1: Depressed mood—indicated by subjective report or observation by others (in children and adolescents, can be irritable mood).
• A2: Loss of interest or pleasure in almost all activities—indicated by subjective report or observation by others.
• A3: Significant (more than 5% in a month) unintentional weight loss/gain or decrease/increase in appetite (in children, failure to make expected weight gains).
• A4: Sleep disturbance (insomnia or hypersomnia).
• A5: Psychomotor changes (agitation or retardation) severe enough to be observable by others.
• A6: Tiredness, fatigue, low energy, or decreased efficiency with which routine tasks are completed
• A7: A sense of worthlessness or excessive, inappropriate, or delusional guilt (not merely self-reproach or guilt about being sick).
• A8: Impaired ability to think, concentrate, or make decisions—indicated by subjective report or observation by others.
• A9: Recurrent thoughts of death (not just fear of dying), suicidal ideation, or suicide attempts.

How Menopause and Depression Are Related

Many women going through perimenopause or menopause can tell you that extreme shifts in hormonal levels often lead to feelings of depression. Whether it’s a new onset of depressive symptoms or exaggerated symptoms from an existing diagnosis, managing the mood swings along with other symptoms can, at times, feel very overwhelming. 

Some of the challenges in evaluating perimenopausal depression is due to the fact that several of the symptoms related to its hormonal changes overlap with common symptoms of depression and other menopausal symptoms that often present similarly.

Symptoms, including insomnia, hot flashes, sleep disturbances, and mood problems, are common during perimenopause and menopause.

Symptoms of Depression and Menopause

It can be helpful to understand the symptoms of both depression and menopause so you can better identify them and distinguish between the two.

Symptoms of Depression

The signs and symptoms of depression include:

• Persistent feelings of sadness, anxiety, hopelessness, or pessimism
• Feelings of worthlessness
• Decreased energy or fatigue
• Irritability
• Loss of interest or pleasure in activities once enjoyed
• Difficulty sleeping or oversleeping
• Appetite or weight changes
• Difficulty concentrating, remembering, or making decisions
• Lack of self-care
• Aches or pains, headaches, cramps, or digestive problems 
• Withdrawal from social activities
• Thoughts of death or suicide

Symptoms of Menopause

The symptoms of menopause may include :

• Irregular periods or bleeding leading to a loss of a period for 12 consecutive months
• Problems with sleep due to low levels of progesterone and estrogen
• Hot flashes and night sweats
• Problems with memory or being forgetful and struggling to focus
• Mood changes such as irritability and crying spells
• Feelings of depression or anxiety
• Changing feelings about your sexual health
• Vaginal dryness

What Causes Depression During Menopause?

The symptoms of depression that can present during perimenopause and menopause are related to a variety of factors including hormonal changes, underlying vulnerabilities to depression, and other stressors.

Declining estrogen levels that happen as you move through perimenopause towards menopause can contribute to emotional changes such as sadness, irritability, fatigue, difficulty concentrating, and mood changes.

That said, there is no evidence that menopause causes depression. If symptoms are severe or impacting your life more than occasionally, be sure to see your doctor or a mental health specialist. 

Getting a Diagnosis 

Your doctor can perform an evaluation to determine where you are in the transition to menopause and recommend the next steps for potentially treating menopausal symptoms. But if the symptoms related to depression are severe or you have a previous diagnosis of depression, being evaluated by a mental health professional is the next step.

Treatment for Depression During Menopause 

For perimenopausal and menopausal women diagnosed with depression, adhering to the proven therapeutic options for treating depression should be followed. These include treatment with antidepressants and/or psychotherapy (“talk therapy”).

There are several forms of psychotherapy, but one in particular that has been proven successful in treating depression is cognitive-behavioral therapy (CBT). 

There is some evidence that treating women entering menopause with hormone replacement therapy may help to enhance mood, but it is not considered a form of treatment for depression. Some findings suggest estrogen, which can help reduce hot flashes and night sweats, may also help with mild to moderate symptoms related to mood swings and feelings of depression.

Coping With Menopause and Depression

Coping with depression symptoms that accompany perimenopause or menopause often requires a systemic approach. And like many other recommendations for depression or menopause, lifestyle modifications can make a significant difference in your quality of life. 

Reducing or eliminating alcohol, smoking, or other substances can help with certain symptoms of menopause. Also, taking extra care to follow a diet rich in fruits, vegetables, lean protein, complex carbohydrates, and healthy fats may help with symptom management.