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Perimenopause & depression

A new diagnosis of depression is 2.5x more likely to occur during perimenopausal transition than during premenopausal years.

Women with a personal history of depression are even more likely than those without to experience depressive symptoms during this life transition.

Source: Risk factors for major depression during midlife among a community sample of women with and without prior major depression: are they the same or different?

Menopause typically occurs in your 40s or 50s with an average age of 51. However, there can be variability and a good predictor is the age at which other women in your family went through menopause. Menopause symptoms can include hot flashes, sleep changes, and brain fog. Another significant symptom of menopause is depression. The depression associated with perimenopause may be related to the changes in estrogen levels that occur during that time. Estrogen is known to have neuroprotective and have antidepressant effects; during perimenopause, estrogen levels fluctuate unpredictably until they ultimately become low or undetectable after menopause. It is because of the unpredictability of the fluctuations that your obgyn and I are unlikely to check hormone levels during this time. The irregularity of your periods and other clinical symptoms are more predictive of perimenopause than hormone levels by themselves.

During this transition, you may experience fluctuations in your mood as your estrogen levels fluctuate. When these symptoms become overwhelming, intrude into your work or personal relationships, or you find yourself not feeling "like yourself", it is likely time to address them with a reproductive psychiatrist. There are many medications that can help with this transition, and some of the medications can also assist with the vasomotor symptoms of perimenopause (such as hot flashes). I will take into account whether you are on hormone replacement therapy (HRT) and also your past psychiatric history, including whether you have ever had a history of depression and/or anxiety. Sometimes, these mental health symptoms flare up during this hormonal transition and quickly resolve at menopause; I can work with you to find medications that work during this transition and discuss with you whether there is a time point at which we can taper off of the medications when you are post-menopausal.

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