Spotting The Difference Between Perimenopausal Mood Swings and Anxiety and Depression
Reviews by Dr. Lisa Czanko MD, MPH
We’ve all heard “you’re hormonal” or “you’re just emotional” thrown around. And we’ve all probably spoken up, cringed, or at least raised an eyebrow. While others might not give hormones and mood the respect they deserve, they are, in fact, crucial to pay attention to, especially during perimenopause and early menopause.
Waving off mood problems as just “hormonal” can lead to more serious behavioral health concerns being ignored. According to a study from the Centers for Disease Control and Prevention, women ages 40 to 59 have the highest rate of clinical depression based on age and gender in the U.S.
Knowing the subtle yet crucial signs of depression and anxiety can help identify and address more serious issues during the menopausal transition, leading to a happier and fuller life.
In this article, we’ll explain how hormonal changes in perimenopause can cause mood changes and contribute to mental health conditions such as depression and anxiety.
The Connection Between Depression and Perimenopause
Hormonal mood changes often occur during the menopause transition. This can manifest as feeling moody, irritable, quick to anger, or experiencing worsening PMS symptoms.
These mood changes can also predispose someone to more serious behavioral health conditions such as depression or anxiety, especially for people who have a history of these diagnoses.
In fact, people born with ovaries are 2.5 times more likely to be diagnosed with depression during perimenopause (ages 35-44) than when they are premenopausal (early 30s).
Because there are many factors that contribute to being diagnosed with depression and/or anxiety, it can be difficult to determine how much of the mood changes are solely related to perimenopause.
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There are three main factors that contribute to depression and anxiety during the menopause transition:
- Biological factors
- Hormone levels can fluctuate frequently during the perimenopause stage
- Genetics also play a role in how perimenopause or mood changes present themselves
- Health factors
- Not having a balanced diet
- Not getting enough exercise
- Physical health conditions, such as those that can cause chronic pain
- Social factors
- The amount of positive support that someone has in their life
- Life stressors, such as financial, personal, work, or family responsibilities
Is It Perimenopause Or Something More?
Understanding the differences between perimenopausal mood swings and a behavioral health condition isn’t black and white. For example, anxiety symptoms such as a racing heart are closely related to other common concerns that people experience during menopause, such as hot flashes.
When it comes to understanding depression, it is important the know the symptoms, and to see a medical provider if any of the symptoms below are present for more than two weeks at a time – or if they are causing concern:
- Persistent sadness, hopelessness, guilt, or irritability
- Loss of interest in activities that were previously enjoyable
- Decreased energy levels and moving more slowly
- Difficulty concentrating, feeling restless
- Inability to sleep despite feeling fatigued
- Increased or decreased appetite
If experiencing thoughts of harming oneself or others it’s important to seek medical advice right away. For those that experience thoughts of suicide, the Suicide Hotline is available 24 hours a day, 7 days a week at 800-273-8255. 911 is also always available.
Similarly, when it comes to understanding anxiety, it is important the know the symptoms, and to see a medical provider if any of the symptoms below are present for more than two weeks at a time – or if they are causing concern:
- Not being able to stop or control worrying
- Worrying too much about different things
- Trouble relaxing
- Being so restless that it's hard to sit still
- Becoming easily annoyed or irritable
- Feeling afraid as if something awful might happen
- Feeling nervous, anxious, or on edge
It may be difficult to separate the symptoms of anxiety and depression from symptoms related to perimenopause. So it’s recommended to seek medical advice early and often when it comes to understanding behavioral health.
Options for Relief
Mental health concerns during menopause are common but may often be brushed off, so it is important to speak to a medical provider who will listen to these concerns and offer solutions.
Therapy
Non-medication options for depression and anxiety during perimenopause include therapy, journaling, meditation, and mindfulness.
Specifically, cognitive-behavioral therapy (CBT) has been shown to help with depression and anxiety across the lifespan and during perimenopause. CBT is a type of therapy that focuses on changing thoughts about oneself and their personal situation while implementing behavioral changes such as relaxation training.
Journaling and meditation can also be used in conjunction with CBT. The use of journaling and meditation can help replace core and intermediate beliefs about oneself and others with positive truths.
Antidepressants
Prescription medications that may be helpful for anxiety and depression are selective serotonin reuptake inhibitors (SSRIs). These can be taken every day, or if the symptoms are isolated to the one to two weeks prior to getting a period, can be taken during those two weeks.It may be more difficult to use this approach if periods are irregular, which is very common during perimenopause.
Serotonin-norepinephrine reuptake inhibitors (SNRIs) are another class of medications that can be prescribed for depression and anxiety. Some of these medications can also be used to treat other perimenopausal symptoms such as hot flashes. If someone is experiencing major depression and/or anxiety as well as physical symptoms, their provider may consider a medication from this class to address multiple concerns at once.
Birth Control
Hormonal birth control (pills, patch, or ring) can also be used to help with hormonal mood symptoms. Birth control can also be helpful in simultaneously helping other symptoms of perimenopause as well, such as hot flashes, irregular periods, night sweats, and painful sex.
Herbal Remedies
Herbal remedies have been advertised for anxiety and depression but the data on these is mixed. Here’s what we know:
- St. John’s Wort is not approved for depression and can interact with many other medications.
- Omega-3 fatty acids have not been shown to significantly improve depression symptoms.
- For anxiety, there are two small studies that indicate chamomile can be helpful, but more research is needed to determine how effective this option is.
- Melatonin is also being studied for anxiety with some promising results.
- Lavender oil is another herbal treatment that is undergoing research in the setting of anxiety, but no definitive recommendations have been made.
For those considering an herbal treatment for anxiety and depression, it is very important to speak to a medical provider first.
Quick Review
Hormonal changes at play during perimenopause can cause emotional shifts and mood swings. These same hormonal changes can predispose people to mental health conditions such as depression and anxiety. Some key differences are the length of time they last, how severe the symptoms are, and if they interfere with daily life. Either way, seeking out a medical provider who will listen to these concerns and offer solutions is essential.
Our Simple Note
While thoughts and emotions don’t define you, they are important to listen to. What feelings are present? How long have they been present? Are there any accompanying physical symptoms with these feelings? Can they be traced back to an event? Pay attention to what you’re experiencing and be sure to reach out to a medical provider for help.
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Citations:
Bromberger JT, Epperson CN. Depression During and After the Perimenopause: Impact of Hormones, Genetics, and Environmental Determinants of Disease. Obstet Gynecol Clin North Am. 2018 Dec; 45(4): 663–678. doi: 10.1016/j.ogc.2018.07.007
Bryant C, Judd FK, Hickey M. Anxiety during the menopausal transition: a systematic review. J Affect Disord. 2012 Jul;139(2):141-8. doi: 10.1016/j.jad.2011.06.055.
Maki PM et al. Guidelines for the evaluation and treatment of perimenopausal depression: summary and recommendations. Menopause. 2018 Oct;25(10):1069-1085. doi: 10.1097/GME.0000000000001174.
National Center for Complementary and Integrative Health. Anxiety at a Glance. U.S. Department of Health and Human Services National Institutes of Health. Updated December 2018. Accessed February 19, 2022. https://www.nccih.nih.gov/health/anxiety-at-a-glance
North American Menopause Society. Depression & Menopause, Updated 2022. Accessed February 19, 2022. http://www.menopause.org/for-women/menopauseflashes/mental-health-at-menopause/depression-menopause
North American Menopause Society. Menopause FAQs: Understanding the Symptoms. Updated 2022. Accessed February 19, 2022. http://www.menopause.org/for-women/expert-answers-to-frequently-asked-questions-about-menopause/menopause-faqs-understanding-the-symptoms
Pratt LA, Brody DJ. Depression in the U.S. household population, 2009–2012. NCHS data brief, no 172. Hyattsville, MD: National Center for Health Statistics. 2014. https://www.cdc.gov/nchs/products/databriefs/db172.htm
Premenstrual Syndrome. U.S. Department of Health and Human Services Office of Women’s Health. Updated March 16, 2018. Accessed February 19, 2022. https://www.womenshealth.gov/menstrual-cycle/premenstrual-syndrome
