Perimenopausal Depression:

It is defined as the Transition state the female undergoes prior to menopause and it causes

  • Unpleasant hot flashes
  • Difficulty sleeping
  • Abnormal menstrual periods
  • Erratic fluctuations in hormone levels

What is perimenopause?

PERIMENOPAUSE: Peri means around. It means ‘ Around menopause’. It represents transmission from reproductive to non-reproductive life. The risk of depression doubles during this transition state. It is also known as the menopause transition phase because it happens before menopause.

Perimenopause vs premenopausal:

Premenopause means having no symptoms when passing through perimenopause or menopause, here periods are seen they may be regular or irregular these are considered to be in your reproductive years. Some changes in hormones were observed here but they are unknown severe noticeable changes in your body.

During perimenopause, some changes are observed within the body. These are similar to menopausal symptoms. (like changes in menstrual cycle, hot flashes, mood swings, sleep disturbances).

Premenopause and perimenopause are sometimes used interchangeably but they have different meanings technically.

What is menopause?

Menopause is defined as the permanent cessation of menstruation in a female. It means it is the end of reproduction ability in female.

Changes during perimenopause:

  • It causes irregular periods, changes in hormone levels and sleeplessness.
  • The symptoms of the PERIMENOPAUSAL period may resemble that of depression and if a woman presenting with depression before this state her depression symptoms may worse more during this perimenopausal period.

Risk factors:

  1. Nulliparous women.
  2. Who are under anti-depressant medication?
  3. Women complaining of great frequency of hot flashes is at more risk.

Major depressive disorder (MDD):

This is seen at any stage of life or during the perimenopausal period in women. Many recent studies showed that there is a connection between perimenopause and depression.

Clinical symptoms are:

Fatigue, lack of attention, lack of concentration, easily distracted, cognition is slowed, lack of interest in things which she previously loved more. No pleasure in anything. A feeling of hopefulness, helplessness.

Irritability, restlessness, mood swings, crying without any reason, sadness, anxiety, change in appetite, problems with sleep-related to night sweats and hot flashes. Suicidal tendency develops slowly.

Depression symptoms is a brain phenomenon – says Dr. Joffe.

Perimenopause women are more likely to develop depression than women who hadn’t entered this hormonal transition.

Major depressive disorder is a serious condition but it can be managed with proper treatment.


  • Stress like job loss, loss of dear and near ones, divorce – these incidents may trigger depression.
  • Positive family history of depression.
  • Negative feelings about menopause and aging.
  • Leading sedentary lifestyle
  • Severe menopausal symptoms.
  • Low self-confidence.
  • Who underwent Hysterectomy or oophorectomy
  • Have undergone cancer treatment

Many women during the transition to menopausal state will commonly experience mood swings and it is due to fluctuations in hormone levels. A decrease in the estrogen levels may bring on depression.

Estrogen is a female hormone produced by the ovaries and changes in the levels of estrogen will have an impact on serotonin, and norepinephrine levels in the brain. Serotonin, norepinephrine, dopamine are the chemicals the play an important role in setting the mood of an individual. They reduce anxiety and help improve our sleep and make us feel happy.

Hence these are called mood power players. Balance of these hormones is very useful to keep our mind calm and for well being of an individual.

Hormone imbalance- such as an increase in estrogen levels and fall of progesterone level is responsible for inhibiting the action of serotonin and norepinephrine as effective neurotransmitters. This was responsible for mood swings and it could lead to depression.

Depression and perimenopausal period and its relation:

PERIMENOPAUSE and DEPRESSION has a complex relationship. We know that the effects of PERIMENOPAUSE cause depression and depression may cause early-onset perimenopause.

Studies have found that women who experienced depression in their early 30’s and 40’s are more likely to enter perimenopause early that is before 45 years than those who had never experienced depression before.

It was proved that women who are using anti-depressants are more likely to enter into menopause early than those who were not.

Effects of low levels of estrogen hormone are:

  • Impaired cognition.
  • Stroke
  • Angina

Women who are taking anti-depressants are more likely to enter perimenopause early that who weren’t under this medication.


Depression is treatable at any stage of life. For treating mood swings during perimenopause some experts recommend a low dose of oral contraceptive pills (OCP’s) to stabilize hormone levels.

Antidepressants may reduce the severity of hot flashes and can reduce the occurrence of hot flashes when compared to placebo.

Escitalopram (Lexapro) belongs to a group of drugs called selective serotonin reuptake inhibitors (SSRI’s).

Some studies have shown that Lexapro is three times as effective at relieving depression symptoms as Hormone replacement therapy (HRT).

About 31% of women who are under Horone Replacement Therapy got relief from hot flashes whereas it was observed that 56% of women got relieved from these hot flashes who took antidepressants alone.

And also, with hormone replacement therapy, there are increased risks of stroke and heart attack.

The side effects associated with anti-depressants are dizziness, sleeplessness, stomach problems, fatigue.

Management of Perimenopausal Depression:

Daily exercise, it will increase the levels of endorphins and serotonin in your body. Regular and proper sleep such as going to bed the same time every night in a quiet, dark cool room. Electronic devices should not be used while in bed. Mindful breathing can help reduce anxiety. Slowly breathe in from the abdomen and then exhale. Doing this for 15 minutes a day will help reduce your stress levels. Plant Valerian will help to reduce perimenopausal depression. Valerian plant reduce hot flashes and lead to better sleep.

Vitamin B is useful for mental and emotional well being of PERIMENOPAUSAL women.

B -vitamin examples are:

  1. Vitamin-B1 – thiamine.
  2. Vitamin-B3-niacin
  3. Vitamin-B5-Pantothenic acid
  4. Vitamin-B6-pyridoxine
  5. Vitamin-B9-folic acid
  6. Vitamin-B12- cobalamin

Green leafy vegetables, beans, dairy products, are the foods containing B vitamins. B vitamins are also available in supplement form.

Doing gentle yoga, warm bath, avoid daytime naps, avoid large meals, quit smoking, avoid alcohol, limit intake of caffeine

Giving estrogen therapy, it is available in many forms like:

  • Pills (OCP’s),
  • Creams,
  • Gels, and
  • Estrogen skin patches.


Throughout the period of transition in the direction of menopause, the possibility of depression is greater than you expect. During the perimenopause time it would be advisable to lookout for the possibilities of depression and be aware of when to ask for assistance.

To talk about the treatment options, consult your doctor, if you are going through light, average, or simple depression.


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