In our clinic, we often see women with symptoms of depression and anxiety which emerge in the context of the menopausal transition; many of these women have suffered for years with severe symptoms before seeking treatment.  Delays in treatment often stem from misconceptions regarding menopause.  

Women are unfortunately accustomed to suffering and, just like the pain of childbirth and the annoyance of monthly menstrual cycles, many believe that menopause is just another thing they have to deal with.  

Women are often told by their doctors that the symptoms they are experiencing are not related to menopause.  You’re too young to be perimenopausal.  It’s not menopause if you are still getting periods.  

And many women do not pursue treatment because they believe that, after the findings of the Women’s Health Initiative in 2002, there are no safe treatments for menopausal symptoms or that they should be able to “tough it out”.  I don’t want to take hormones. My sister/mother or I had breast cancer, I can’t take hormones.  My mother didn’t take anything and she survived.  

An article published on NPR focuses on this long-neglected issue in women’s reproductive health and addresses some of the issues that women face as they transition into the menopause.  Many perimenopausal women experience disabling symptoms for long periods of time; yet the misconceptions regarding menopause prevent women from getting the help they need.  (This article is part of a weeklong series devoted to women’s mental health.)

Things to Know About Menopause and Mental Health

Menopause is literally the cessation of monthly cycles, medically defined as the time occurring after a woman has not had a menstrual period for 12 consecutive months. At this time estrogen levels are at their lowest but are relatively stable.

The time period preceding the menopause – the perimenopause – is the time during which a woman experiences more dramatic hormonal shifts, changes in her menstrual cycle, vasomotor symptoms (hot flashes and night sweats), sleep disturbance, and increased vulnerability to depression and anxiety.

Symptoms of depression and anxiety may precede changes in the menstrual cycle by several years.  

Women may experience perimenopausal symptoms for more than 5 and up to 10 years.  

Women with histories of mood and anxiety disorders are more vulnerable to relapse during the perimenopause.  

Hormone-replacement therapy is effective for managing menopausal symptoms and can be used safely in many perimenopausal women.

Many non-hormonal treatments can help to alleviate perimenopausal symptoms, including antidepressants, gabapentin, and cognitive-behavioral therapy.

Ruta Nonacs, MD PhD

Let’s Talk About Perimenopause (Health Central)

As Menopause Nears, Be Aware It Can Trigger Depression And Anxiety, Too (NPR)

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