Beyond the Blues in Perimenopause
We all have days when we feel low—those moments when you're just not yourself. Maybe everything seems to go wrong, or you come across a piece of news that leaves you unsettled. Typically, these feelings pass within a day or two, and you find yourself bouncing back, re-engaging with life and the activities you enjoy.
But depression is something different. It's more than just a bad day or a rough patch. Depression is a persistent shift in mood and mental state that lasts for more than two weeks and begins to affect your daily life in a significant way. You might feel detached from things you usually enjoy, avoid social interactions, and experience a deep sense of lethargy or hopelessness. Even routine tasks—like going to work or preparing meals—can feel overwhelming. You might have trouble sleeping, changes in appetite (eating too little or too much), and difficulty concentrating.
When it comes to women, depression is even more common. In fact, one in eight women will experience depression at some point in their lives—twice the rate seen in men.
Perimenopausal Depression: A Different Experience
To add another layer of complexity, depression during perimenopause (the transitional time leading up to menopause) can look different than typical depression. Hormonal fluctuations during this stage can intensify symptoms or cause them to appear in new ways. In addition to classic signs of depression, women may also experience:
Increased irritability or hostility
Anxiety
Paranoid thoughts
Low self-esteem
Memory and concentration problems
Decreased sexual desire
A sense of isolation
An article from the National Institutes of Health (NIH) highlights a critical issue: there is still a lack of research focused specifically on women in perimenopause. Complicating things further, physical symptoms of menopause—like hot flashes—may not show up until years after the emotional or psychological symptoms begin. As a result, healthcare providers may overlook depression in women in their 40s, failing to connect it to the hormonal changes happening during this stage of life.
Why This Matters
If a woman has experienced depression in the past, she may be at higher risk for a recurrence during perimenopause—even if her symptoms had previously been well-managed. Traditional treatment approaches often focus solely on antidepressants without addressing the hormonal shifts that could be contributing to the problem.
A more effective strategy may include a combination of hormone therapy and antidepressant medication. Other supportive options include talk therapy, lifestyle changes (like improved nutrition and regular exercise), acupuncture, and other complementary approaches.
Know When to Seek Help
Understanding the difference between everyday sadness and something more serious is crucial. If you're noticing persistent mood changes, fatigue, or other symptoms that are interfering with your daily life, it's important to speak with your healthcare provider. They can help you sort out what you're experiencing and recommend a treatment plan tailored to your needs—especially if you're in midlife and navigating hormonal changes.
You’re not alone, and there are resources and treatments available to help you feel like yourself again.
Kelly Rigo is the creative force behind Menopause Evolution.