The short answer is: VERY common. There’s up to three time the risk for mental health problems during perimenopause compared to beforehand.
Australian statistical data reveals:
Perimenopause (ie. the pre-menopausal transition and early postmenopause) is “… a window of vulnerability” for the development of mental health issues, even with no previous issues. Estrogen levels decline substantially from pre-menopause to post-menopause, but it is not a smooth gradual decline; the reproductive hormones can fluctuate wildly, even during the course of a day.
Prof. of Psychiatry Jayashri Kulkarni AM, simplifies the effects of reproductive homones in the brain as follows: “think of oestrogen as being a ‘good’ hormone for the brain, and progesterone as a ‘bad’ hormone for the brain.”
This means that times in the menstrual cycle when estrogen is highest (first half to mid-cycle) tend to be the best for mood, and verbal memory (talking skills) as well apparently. Times when progesterone is highest tend to be associated with a worsening mood, eg. pre-menstrually. In around 4% of women this is very severe, and they may be diagnosed with premenstrual dysphoric disorder (PMDD). This condition requires medical and psychological treatment.
Other contributing factors to mental health issues around menopause include:
There are two significant symptoms of depression; one (if not both) of these must be present for at least two weeks for a diagnosis of depression to be made:
Other symptoms can include:
Some common symptoms of depression can be difficult to distinguish from symptoms of menopause, including:
General signs and symptoms of an anxiety disorder include:
Other signs of anxiety can be split into psychological/ emotional and physical symptoms. Again, some of these symptoms can overlap with other menopausal symptoms, so paying attention to the whole range of symptoms is important.
Psychological/ Emotional Symptoms
Anti-depressants are indicated for chronic moderate to severe depression but are not effective treatment for mild depression. If they are going to help symptoms will usually respond by 4-6 weeks, although small changes may be noticed as early as 2 weeks.
Some anti-depressants can also reduce the number and severity of hot flushes by up to 50%. You might need to try differing doses or different medications, usually under the care of your GP or psychiatrist.
There is some evidence that estrogen has similar efficacy to antidepressants for depression in perimenopause (regardless of whether hot flushes or night sweats are present). It has not been shown to be effective for postmenopausal women however. This suggests a “window of opportunity” in perimenopause for effective estrogen therapy in mood disorders.
Estrogen therapy may potentially add to the effect of antidepressants. It’s important to note however that most studies have been done using estrogen-only treatment. The effect of combined HRT is not as well studied (ie. estrogen with progestin, which is needed for women who still have a uterus).
Hormonal contraceptives have also shown some mood regulation benefit in women approaching menopause. These cannot be used in women who have a high risk for unwanted blood clots (such as smokers, or those who experience migraines with aura), and cannot be used beyond age 50.
Psychological therapies might include Cognitive Behaviour Therapy, Behaviour Therapy, Mindfulness-based Cognitive Therapies and/or Interpersonal Therapy. These therapies can help you change or manage unhelpful thoughts, behaviours and/or ways of interacting with others which can otherwise help maintain depression.
Psychologists can help clients to manage unhelpful thinking, such as rumination (“getting stuck” in thoughts), self-critical thoughts and excessively thinking about the past or the future. Psychological treatment can also be provided via Telehealth, with Medicare rebates for patients who obtain a GP Mental Health Care Plan.
There is also a wealth of electronic mental health treatment options, including online courses, e-books, Apps, videos, podcasts and audiobooks. They are inexpensive, easy to access, can be used at any time of the day and have good evidence to support their effectiveness. Mood Gym, myCompass and MindSpot are good examples.
Often the best place to start is with your GP. Ask for an extended appointment to discuss your concerns or make an appointment for a GP Mental Health Care Plan. A Mental Health Care Plan allows access to 10-12 sessions with a psychologist per calendar year with Medicare rebates. Private health insurance may also cover a portion of the session cost if you are not eligible for Medicare sessions or prefer not to go through Medicare.
There may be several weeks’ or months’ wait to see a psychologist so the earlier you seek help the better. It might also help to seek out a GP who specialises in managing menopause
Australasian Menopause Society: “Mood Problems At Menopause.”
If you can’t find the professional help you need for your peri/menopausal symptoms then book a telehealth consultation with an expert WellFemme menopause doctor.
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