Is it Depression, or is it Perimenopause?

Depression, Featured Article, Menopause, Women's Health
on November 14, 2012
Differences between depression and perimenopause.

Are you between the ages of 39 and 53 and struggling with depression, perhaps for the first time in your life? Do you feel more emotionally volatile than ever before? Do your family and friends comment that you are not yourself—perhaps less lively or more serious? Well, the truth is it may not be depression you’re experiencing but perimenopause.

Perimenopause, the 2 to 10 years preceding the cessation of menses, challenges 40- to 50-year-old women with the most turbulent hormonal changes since puberty. Such hormonal changes have an enormous impact, not only on a woman’s body and how it functions, but on her emotional state, as well.

Far too many women think of events related to menopause as being a concern only for those in their middle to late 40s or early 50s. More enlightened women who are familiar with “perimenopause” too often think of it only in terms of hot flashes, night sweats, menstrual changes and some occasional mood swings. But hormonal changes in the perimenopause stage can also cause depression, anxiety and decreases in overall life satisfaction. Furthermore, these life challenges and hormonal events can combine to create additional misery, not just for women themselves, but for their loved ones, too.

How can a woman tell if her depressive symptoms are a result of perimenopause or other causes?

In Stage I of perimenopause, known as Perimenopausal Initiation, and perimenopause Stage II, or Emotional Disruption, a woman’s symptoms are most likely caused or exacerbated by her hormonal changes if:

  • her depressive symptoms escalate in the two weeks before her period begins and/or her spirits lift once menses begins;
  • her threshold for tolerating difficult situations is lower than was typical for her in times past;
  • she experiences slight changes in her menstrual cycle (it shortens or lengthens by a day or two or the flow is a bit heavier or lighter)
  • she is in the age range of late 30’s to early mid 50’s

Another signal for hormonally precipitated depression is that it will frequently mix with anxiety. Depression unrelated to perimenopausal changes does not reliably have the added component of anxiety.

In Stage III of perimenopause, or Turbulence, it is much easier to make the connection between hormonal changes and depression. In this stage, there are widely vacillating shifts between depression and anxiety. These moods have a more “acute” intensity than non-hormonal depression. In addition, there is a greater probability of sleep disruption, insomnia and disturbing dreams that accompany depressive symptoms. While non-hormonal depression can produce insomnia, it more typically produces hypersomnolence, or excessive sleepiness.

The most effective and safest way to treat moderate to severe depression, whether it is a result of hormonal or other causes, is with antidepressant medications. The SSRI’s are safer than using synthetic or animal hormone replacement therapies and will help ease other perimenopausal symptoms such as insomnia and vasomotor events (hot flashes and night sweats).

Women can also try using bioidentical hormones—natural, plant-based hormones—to help balance their shifting hormones. These are considered extremely safe and have been found in studies to reduce many perimenopausal symptoms, including depression.

A third approach is taking soy isoflavones, either in supplements or by including soy products in your diet. Soy has “phytoestrogens” which have mild estrogenic and anti-estrogenic properties. What this means is that these compounds will bind to estrogen receptors to block excess estrogen when there is too much, and will also bind to those same receptors when there is too little, helping to balance estrogen levels. This mitigates the symptoms, including depression, resulting from the perimenopausal transition.

When depressive symptoms are mild or transient, individual women can decide whether or not they need to embark on any of these treatment strategies.

Deborah Wagner, Ph.D. is a diversely trained developmental psychologist, women’s mental health expert, and author of the new book, The Fifth Decade; Is It Just My Life or is it Perimenopause?. She currently lives in Northern New Jersey with her husband and a houseful of four-legged children. For more information visit: