Is Menopause Messing With Your Mood?
- Dr. Claudio N. Soares
- Jul 30, 2024
- 4 min read
Updated: Oct 1, 2024
You’re Not Going Crazy. Your Hormones Are!
Illustration by: Cé Marina
Barbara rarely lets challenges and setbacks—personal or professional—daunt her. She faces and tackles them. At age 48, Barbara feels blessed to have a loving, supportive husband, two (relatively) sane teenage daughters, and a rewarding career in the media.
Despite her gratitude, Barbara has been an incessant worrywart since grade school. She worried about homework, exams, and whether her father would stop breathing during the night. She worried whether a boy she liked would call, when the pimple on her chin would go away, what college would accept her.
A young married, working woman, Barbara worried about whether her husband had an accident when he was late getting home. How she'd ever meet all her writing deadlines. If her editor would approve the article she wrote.
When she became a mom, she worried about illnesses her baby son could have, whether his nursery school teacher was emotionally abusive, and lots more.
Barbara has had two “mini breakdowns,” as she describes them—one as a college freshman and the other as a magazine publisher—but she got past them and continued moving ahead.
Approaching her 50th birthday, Barbara had trouble falling asleep, and would frequently wake in a pool of perspiration. She began to lose her laser-like focus and motivation. When she hadn't had a period for a couple of months, she worried she was pregnant.
For the first time in her five decades, Barbara couldn’t seem to shake off her melancholy. All her symptoms signaled she had entered perimenopause.
Barbara, Meet Dr. Soares
Barbara doesn’t know Dr. Claudio Soares, a professor in the Department of Psychiatry at Queen’s University School of Medicine in Ontario, Canada, but he knows precisely what she’s experiencing. His foundational studies over the last 25 years have brought him face to face with countless women whose midlife experiences were just like hers.
Importantly, the results of his tireless research on how estrogen affects mood, why perimenopause can trigger depression, and what role hormone therapy can play in its treatment, are giving physicians new understanding of how to interact with patients like Barbara.
“Doctors rarely ask women whether they see connections between their moods and their hormonal or menstrual cycle changes,” Dr. Soares noted. Even if a physician asks if a patient’s depression is deepening, he won’t necessarily associate hormonal changes and vulnerability with her anxiety and depression, he added.
Instead, practitioners typically focus on the possible role of issues including iron deficiency, thyroid conditions, and changes at home and at work on a woman’s state of mind.
The brain-menopause link wasn’t on radar screens in the medical community over two decades ago, when Dr. Soares began his research. Thanks to his groundbreaking work, healthcare providers are becoming aware that there can be roles for different types of therapy.
Thankfully, women suffering from depression related to menopause are a giant step closer to getting the treatment they need.
10 Takeaways About Estrogen & Midlife Depression
Menopause and Mood, Dr. Soare’s recent article in the medical journal Psychiatric Clinics of North America, provides an excellent overview for physicians of The Role of Estrogen in Midlife Depression and Beyond. But having this valuable knowledge will help ensure that you get effective treatment if you’re experiencing issues like Barbara.
Following are key points from the article:
1. Depression is a prevalent, disabling condition. Women have a 1.5 to two-fold increased risk for depression and anxiety across their life cycle.
2. Estrogen working in the brain helps regulate mood. Several studies link intense, at times chaotic fluctuations of estradiol with perimenopausal depression.
3. Women with greater sensitivity to hormone shifts during perimenopause are at increased risk for depressive symptoms (new onset or recurrent), often associated with vasomotor symptoms (hot flashes, night sweats), sleep problems, and other menopause-related health conditions. They may also experience the compounding effects of physical changes such as cardiovascular disease, diabetes, osteoporosis, and chronic pain during midlife transition.
4. You're most vulnerable if you’ve experienced previous major depressive disorders and suffered from premenstrual mood symptoms or postpartum depression.
5. If you’re at risk for developing mood and anxiety symptoms during the menopause transition, your healthcare provider should be able to recognize—and appropriately manage —this ‘window of vulnerability.’
6. Your doctor shouldn’t manage your depression or anxiety alone, however. He must consider the presence and severity of sleep problems, cognitive complaints, and sexual dysfunction, as well as your relevant life stressors, to help him create a comprehensive, effective treatment plan for you. You are a whole person, and your treatment plan should take that into account.
7. Transdermal estradiol—delivered through a skin patch—has markedly improved new depressive symptoms early in menopause. The benefits of this estrogen therapy should be considered for some symptomatic women.
8. Conventional antidepressants and behavioral therapies remain, however, the treatments of choice for depression and anxiety across the lifespan , including the midlife years.
9. Anxiety, irritability, nervousness, and fearfulness increased during late perimenopause for women with high anxiety before menopause, declining in postmenopause. When associated with hot flashes and symptoms such as rapid heartbeats, dizziness, and chest pain, hormone treatments such as transdermal estradiol therapy could be helpful!
10. Evidence-based drug, hormonal and/or behavioral options should be tailored to your unique needs, considering their safety, how you’ll tolerate them, and how well they’ll work.
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