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Perimenopause, Anxiety and Depression

Writer's picture: Sacha CrouchSacha Crouch



Are you 40-55 years of age?


Have you experienced a sudden peak in anxiety, irritability, and rage?


Do you worry you are forgetful and struggle to “find that word”?


If so, you may have started to go through the joys of perimenopause.


During perimenopause, our hormones are changing. We are in a transition “period” (excuse the pun!) from menstruating to ceasing menstruation. The three main hormones shifting within your system are oestrogen, progesterone, and testosterone. These neuroendocrine changes can contribute to an increased risk of mood symptoms (even for women who have not previously considered themselves “anxious” or “depressed”).

 

Estradiol (Oestrogen in the body) is a hormone the body naturally produces. It plays an important role in protecting our brain cell structure and functioning. Fluctuations in estradiol occur during perimenopause which affects our cognitive functioning. This is why we experience the so-called “brain fog”. Brain fog includes symptoms like difficulty concentrating, difficulty retrieving information, confusion, or forgetfulness.


Some women worry that they may be experiencing early onset dementia when they go through perimenopause. The increased awareness of adult ADHD has meant that women also commonly worry that symptoms of brain fog are symptoms of ADHD. Knowing that these symptoms are common during menopause can help alleviate those concerns.

 

Other women experience depressed mood once perimenopause hits. This can mimic symptoms of major depression – flat mood, low motivation, and fatigue. However, there is evidence that perimenopausal depression is distinct from Major Depression. Perimenopausal depression is associated with more anxious symptoms like panic, worry that others will talk about them, and irritability. It is also associated with weight gain rather than the weight loss characteristic of major depression.


Women can also be misdiagnosed with bipolar disorder because the mood is impacted variably at different points within the menstrual cycle and because of the cognitive symptoms experienced. For some women, perimenopause causes an extreme “up and down” mood over the cycle which can mimic the mood cycling of bipolar disorder.

 

Risk factors for perimenopausal anxiety and depression

Three groups of women may be at greater risk of developing perimenopausal depression or anxiety:


  • Women who have experienced early life childhood trauma, particularly emotional trauma – harsh critical parenting, invalidation, loss, separation, and bullying. These emotional traumas affect brain neurocircuitry via the glutamate system.


  • Women who have experienced premenstrual dysphoric disorder (PMDD) which is a severe form of PMS.


  • Women who experienced postnatal anxiety or depression.


These last two groups of women may be particularly susceptible to the hormonal fluctuations of menstruation, giving birth to a child, and perimenopause.

 

What to do about it?

There is an endless supply of resources to help you manage perimenopause or menopause. Equip yourself with knowledge about hormone changes, hormonal treatments, diet, and exercise.

 

1.      Ask an expert! If you are experiencing any of the above symptoms it could be helpful to talk to your GP about possible treatments or visit a mental health care professional. Seek a professional who is informed about the latest perimenopausal research.

 

2.      Understand the advancement in hormonal treatments during menopause (MHT – Menopause hormone treatment). Hormone therapy was previously linked to an increased risk of breast cancer. Research now shows that this fear is unfounded if you are not at risk of breast cancer in the first place. The hormones used in MHT are naturally occurring compounds rather than the synthetic hormones used previously.

 

3.      Engage with a psychologist to process unhealed childhood trauma and to teach you tools to manage anxiety, sleep, and poor lifestyle habits.

 

4.      Learn the unique needs and limitations of your body during menopause. Research suggests that caffeine and alcohol increase perimenopausal symptoms for some women. Experiment with a reduction of caffeine and alcohol. Research also shows the importance of resistance training and high-intensity sprints in your exercise routine to strengthen your body and minimise the loss of lean mass.  


Perimenopause and menopause signify an important transition period in your body. Work with your body to support your mental health during the transition and your physical needs to age well.

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