1. Women are at an increased risk of depression in the menopause transition

Women in mid-life face a heightened risk of developing depression compared to men and women at other life stages. This increased risk encompasses both first-onset^1,2 and recurrent depression^3,4. The risk remains even when we take into consideration other factors, such as demographic factors, stressful life events, and potentially also vasomotor symptoms (such as hot flushes and night sweats).

2. Hormones are an important contributing factor to the development of menopausal depression

Mid-life often represents a convergence of demanding life circumstances for women. Many juggle careers, parenting responsibilities, and the care of aging parents, all while maintaining social networks and carrying the burden of household duties. This period can also bring fertility challenges, relationship breakdowns, and financial pressures, compounding women’s stress and vulnerability to depression.

While these stressors are significant, review of the research indicates that the hormonal changes of menopause also play a critical role in mid-life depression. Fluctuations in estrogen levels during perimenopause and menopause can directly affect brain regions responsible for mood regulation.

3. The symptom profile of menopausal depression is different to ‘standard’ depression

Despite its prevalence, depression in women experiencing menopause transition often goes underdiagnosed and untreated for several key reasons.

Menopausal depression differs from ‘standard’ depression in terms of the nature and course of symptoms. Women experiencing menopausal depression report less sadness and more anger, irritability, paranoid thinking, overwhelming fatigue, loss of libido, memory and concentration problems, and physical symptoms such as pain and weight changes. These symptoms have been observed to have a sudden onset and fluctuate in intensity.

Women often describe verbal outbursts over minor stressors which are out of character. They report paranoia which manifests as suspicious thinking and excessive guilt. Many speak of losing confidence in their abilities, feeling they are disappointing others, and that others see them as incompetent and worthless. Women also describe a constant sense of exhaustion, independent of the quality of their sleep.

4. Menopausal depression needs to be assessed using specific measures

Assessments specific to the unique symptoms profile of menopausal depression are needed for accurate assessment and diagnosis. Routine assessments of depression will not capture the symptoms of menopausal depression, leading to underdiagnosis and inadequate treatment. A well-known measure of menopausal depression is the Meno-D, developed in Australia by Professor Kulkarni and her team.

5. Menopausal depression may require a different treatment approach

The unique and complex interplay of biological, social, and psychological factors of menopausal depression means it may require a different treatment approach. Research suggests that antidepressants may be less effective when treating menopausal depression. Moreover, small-scale clinical trials ^5,6 have indicated estrogen may be an effective treatment option for menopausal depression.

Summary

Women face a complex set of factors that place them at risk of depression in mid-life. Understanding these factors, using targeted diagnostic tools, and providing tailored interventions are essential to addressing these factors and ensuring the well-being and safety of women at this time.

If you or your loved one is experiencing menopausal depression, please seek help and support from a menopause-informed healthcare provider.

Image credit: Photo by Briana Tozour on Unsplash