Menopause is the term given to the period of time when a woman ceases to have menstrual cycles due to a decline in hormones responsible for childbearing. A woman is typically thought to be in menopause after she has gone 12 months without a menstrual period. This transition is not immediate and can often take years to complete.
Perimenopause is the term given to the time period where a woman can experience symptoms of menopause without a complete cessation of menstrual periods. Symptoms of perimenopause and menopause are related to hormonal shifts ad can include hot flashes, night sweats, vaginal dryness, painful intercourse, sleep issues, memory problems and urinary incontinence. While the menopausal transition affects every woman differently, many only experience a limited number of symptoms while others experience a full array of emotional and physical symptoms. The onset of depression can also occur. In fact, the perimenopausal period is thought to be associated with a higher risk to develop a new onset of depression or a recurrent episode of depression in those that have a history of the illness.
While the exact reason for this increased risk is unknown, it is theorized that hormones play a role. Studies have shown no significant difference between men and women in the risk of developing depression with the exception of the childbearing years, where there is a 1.7 times increased risk of developing depression in women. These finds suggest a link between hormonal changes and depression. Several studies have demonstrated an increased risk for depression in those with hot flashes as part of their menopausal transition.
However, hormonal changes are only one ingredient in the risk for depression. Other risk factors for depression during the menopausal transition can include behaviors that can be modified like obesity and cigarette smoking. Other risk factors include a family history of depression, personal history of depression, prior use of a hormone therapy or antidepressants and history of premenstrual dysphoric disorder. Ethnicity is another risk factor with a higher risk in African-American populations and a lower risk in Asian populations of developing depression during perimenopause. Age is another risk factor with an increased risk in those women who complete menopause at an earlier age or who have had their ovaries removed prior to the age of 45.
While the notion of increased risk of depression during menopause is understandably scary, several treatments have been studied for this condition.
- Antidepressants. Several studies have demonstrated the efficacy of using SSRI (selective serotonin reuptake inhibitor) antidepressants or SNRI (serotonin norepinephrine reuptake inhibitors) in the treatment of depression in the perimenopausal/menopausal period. Often antidepressants can also be used to treat the hormonal symptoms associated with this transition including hot flashes and night sweats.
- Hormone Therapy. For many years, menopausal symptoms were treated with hormonal therapy until the initial findings of the Women’s Health Initiative in 2002 raised concerns about the long term safety of hormone treatments. Specifically, concerns included an increased risk of stroke, heart attack, heart disease, blood clots and cancer. Further research has shown that hormone therapy can be used safely in certain populations of women. Low doses of hormone replacement therapy along with lifestyle changes, and regular follow up with a health care provider can certainly help achieve treatment goals.
- Botanical Agents. John’s wort, soy and Black Cohosh have been
associated with a reduction in menopausal symptoms and depression in some studies. These products are available over the counter. Often, the production and quality of these supplements is not regulated and there is no guarantee that the ingredients are safe or at levels high enough to produce the desired response. These are active substances and it is important to discuss use with a health care provider to make sure there is no interaction with other forms of treatment.
- Nutrition/Exercise. Maintaining a healthy diet and exercise regimen can also help with the treatment of depression during the menopausal transition. A decrease in bone strength can also occur during this time so keeping a diet rich in calcium and vitamin D will help maintain strong and healthy bones. Regular weight bearing exercise can also help to maintain strong bones.
Often women find a combination of the above treatments helpful in treating their menopausal transition symptoms. A health care provider can be helpful in the evaluation and treatment of depression during the menopausal years.
The information provided in this blog is not a substitute for evaluation and treatment by a licensed physician.
A doctor of osteopathic medicine and certified by the American Board of Psychiatry and Neurology, Dr. Satinder Mahal provides outpatient medication management and psychiatric care for adult and older adult patients at Prairie View's Newton and McPherson offices. Her treatment specialties include Alzheimer's disease, Lewy Bodies, dementia, traumatic brain injury, Parkinson's and Huntington's disease.