Menopause and Mental Health

Jacquelyn Stone
Jul 12, 2024
3 min read

Mood swings and hormone changes tend to go hand in hand. We all know that PMS and pregnancy can cause mood swings, but what about menopause? How does menopause affect mood and mental health? Studies in the medical literature show that the menopausal transition increases the risk of both anxiety and depression.

Incidence

A large 10-year study showed a 2-4 fold higher risk of depression during the menopausal transition compared to premenopause with rates of a major depressive episode between 11% and 16% and rates of depressive symptoms between 16% and 28%. There is less research on anxiety, but rates of anxiety also seem to be increased during the menopausal transition.

Risk Factors

While anyone can get anxiety or depression during the menopausal transition, certain things do increase risk. What are the some of the risk factors?

Previous history of mood disorders -- especially those related to hormonal factors such as postpartum depression, PMDD (premenstrual dysphoric disorder), or PMS.
Vasomotor symptoms -- hot flashes and night sweats are also associated with depression during this time
Surgical menopause is more likely to be associated with depression than is natural menopause likely due to a sharper decrease in estrogen.
Chronic medical conditions or poor health
Adverse perception of menopause
Life stressors -- financial stressors, low socio-economic status, and stressful life events

Having social and family support is protective against depression and anxiety. Women who have six or more close friends are much less likely to be depressed than those who have fewer close relationships.

Treatment

For hormone therapy, timing matters. Systemic menopausal hormone therapy has been shown to help treat and prevent anxiety and depression caused by menopause and to elevate mood in women without anxiety and depression when started during the perimenopausal period (< 12 months after the final menstrual period). However, it doesn’t seem to have the same effect on mood when started after menopause (12 or more months after the last menstrual period).

Usual treatments should still be used. Depression and anxiety during menopause should still be treated with appropriate medications (antidepressants and anxiety medications). SSRIs (a particular class of antidepressant/anti-anxiety medications) are usually the first line treatment for both anxiety and depression. There is no evidence that any one SSRI works better than another, and sometimes there may be a reason to choose a different medication. Medicine is both a science and an art. So, be sure to choose a doctor who is familiar with menopause when getting treatment for your mental health condition.

In women with hot flashes and night sweats, some SSRIs and SNRIs can also help to treat these as well. These include citalopram (Celexa), escitalopram (Lexapro), paroxetine (Paxil, Brisdelle), venlafaxine (Effexor), and desvenlafaxine (Pristiq). Weight gain and low libido are common complaints during the menopausal transition, and these can also be side effects of certain mental health medications (many SSRIs cause weight gain and both SSRIs and SNRIs can cause decreased libido). These should be considerations when choosing a medication or monitoring treatment.

Therapy or counseling is also a great treatment for depression and anxiety, and this should also be considered. Therapy can be used either alone or in conjunction with medication. Medication plus therapy often works better than either alone.