Earlier this year, I confided in my therapist: “I’m down, but I don’t know why.”
I had versions of this conversation with my partner on the days that we both worked remotely from our home in the leafy Oakville, Ont., suburbs. I felt a tiredness that seeped into my bones and pinned me to my bed on some mornings. Other times I’d lay awake at night ruminating over how little excitement I had left in life. I knew my days had lost their lustre, and joy was an illusive visitor.
I shouldn’t have felt this way, I’d tell myself. I was already taking antidepressants and I attended therapy regularly. My life was more stable than it had been even before the pandemic. I had steady employment and a thriving relationship.
Years earlier, I experienced a bout of prenatal depression that led to suicidal ideations. I remembered the grip depression had on me then. That’s when I began to suspect that the hormonal shifts of perimenopause might be the reason why I was feeling this way.
As it turns out, fluctuations in mood and mental health challenges are common for many people experiencing menopause. I was far from alone in how I was feeling.
In 2017, Sandra Ingram should have been enjoying a week of outdoor fun with her two children and a group of friends at a summer camp in Haliburton, Ont. “Instead, I did a lot of hiding in the cabin and crying,” she recalls. When Ingram looks at a photo of that time, she remembers just how low she felt. “I could not physically stop crying,” she says. “It was so acute and overwhelming.”
At the time, Ingram, who lives in Grimsby, Ont. and is now aged 53, had noticed a distinct change in her mood a week before her period. “I didn’t recognize it as being due to [peri]menopause,” she says. “I wasn’t thinking that far ahead.” Ingram believed depression wasn’t the issue. “I stopped myself from seeking help because I was so convinced that it was just a mood related to my cycle,” she says.
But the period of menopause transition can be an emotional rollercoaster for some women. The culprit? Hormonal chaos.
The percentage of women who experience depression during the menopause transition is up for debate. “Depending on the study, the risk of depression is increased two- to four-fold during this time,” says Dr. Jen Gunter, author of The Menopause Manifesto. “It’s more productive to think of it as a time of increased risk,” she adds.
Here’s what you need to know about depression and menopause.
“There can be a range of symptoms from feeling sad, feeling low, to really feeling like someone can’t function, they can’t focus, they can’t go to work,” explains Dr. Ariel Dalfen, a Toronto-based psychiatrist who has specialized in women’s mental health issues for more than 20 years. Dalfen is also a co-founder of BRIA, a clinic that provides evidence-based treatments to women along their reproductive journey, including menopause.
“There would be quite a few times when I’d be eating dinner with my family and everything’s fine. And the next minute I would have to run from the dinner table because I would start crying,” says Ingram. While she didn’t want her kids to think there was something wrong, Ingram knew it was something she couldn’t control.
The physical symptoms of menopause transition are risk factors for depression. “When someone has hot flashes or night sweats and their sleep is poor, it may contribute to more mood or anxiety issues,” says Dalfen. “Sleep is so important for mental health and wellbeing.”
Some studies also found that going through two or more life events during menopause is also a major risk factor. Research conducted by the U.S.Study of Women’s Health Across the Nation (SWAN) followed women through the menopause transition and found that other stressful life events, as well as financial strain and low social support are important contributors to depressive symptoms and/or anxiety during this time.
“I always like women to think about what is typically happening to them when they are in menopause transition,” Gunter explains. “Often they have kids in high school or they’re getting those kids ready for college—those are pretty stressful life events.”
When I reflect on the last year, I start to add those stressors up: supporting my partner through cancer treatment, moving house and having my eldest child start college. As Gunter says, “Multiple life events, major risk factors.”
A history of depression also put women at risk. “If you have a long history of mental health issues, it can be a lot worse because those people are at higher risk at the time of perimenopause,” says Dalfen. This includes those with a history of mental health problems around their menstrual cycle or a pregnancy.
Interestingly, Gunter says research shows negative thoughts about aging is another risk factor. “In our youth-focused society, all you see are anti-aging products,” says Gunter. “How does that not make you think negatively about aging?”
Treatment options depend on a lot of factors, including the severity of the depression. “If you have mild to moderate depression and you’re in the menopause transition, then estrogen [menopause hormone therapy] can actually be helpful for some women,” Gunter explains. “If someone has a major depressive disorder, estrogen alone would not be recommended treatment, and we’d usually recommend antidepressants at that point.”
Dalfen says working with a psychologist may also be an important form of treatment for people with depression. At BRIA, there are therapists who offer individual and couples counselling specifically for perimenopausal women.
“Couples therapy can help with marital stressors that may be affected by perimenopause like irritability, their anger or kids leaving home, and what that means for the changing dynamics of a relationship,” says Dalfen.
But be wary of cure-all treatment options, Gunter cautions. “There are no supplements that are going to make a difference,” she says. “There will be all kinds of people selling scammy supplements; just stay away from that.”
Both Gunter and Dalfen agree that women should take the time for self-care. “So often women are pushed to the margins of their own families and they are taking little care of themselves,” says Gunter.
“Make sure you’re sleeping, and eating well, and have support,” Dalfen adds. “Do those first and then the next level is paying attention to symptoms, and if someone is starting to feel well or really worried, reach out to a healthcare provider.”
For Ingram, finding the right treatment option involved plenty of trial and error over the course of two years. Her family doctor prescribed antidepressants, but once Ingram’s mood improved, she decided to go off her medication.
“I felt really good and I thought that’s it I've done it, it’s fine everything’s good,” she recalls. “Of course, I realized very quickly that was not the case.” What followed was what she described as “another really tough year” where her low mood was ever-present.
Ingram switched to another antidepressant in 2019, but she still wanted to speak to someone about her symptoms.
“The word gaslighting is overused but a lot of women go to their healthcare providers and they’re told there’s nothing you can do, just suck it up and wait it through,” says Dalfen. “That’s not true. There are many treatments that are safe.”
It was Ingram’s friend and mentor, Janet Ko, president and co-founder of the Menopause Foundation of Canada, who encouraged her to keep pushing. “At that point, no one had ever said to me there are menopause specialists,” says Ingram.
She was eventually referred to St. Joseph’s Hospital in Hamilton, Ont. After going through her history in meticulous detail, Ingram was prescribed menopause hormone therapy. “I felt really seen and heard,” she says.
“People deserve to get a proper assessment and proper treatment so they don’t have to suffer and just keep on struggling,” says Dalfen.
Researching this article was the push I needed to see if there were any other treatment options available to me. I started with my family doctor who listened to my concerns, adjusted my current antidepressant medication, and has referred me to a menopause clinic to assess whether hormone therapy is also an option.
“Sometimes you think you’re the only one in the world going through this, but you’re not,” says Ingram. “Having knowledge really is power.”
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