“I cry at the drop of a hat.”

“I just don’t have the energy or desire to do anything.”

Does this sound like you? Many midlife women experience mood swings and occasional depressed mood, and some who have previously been depressed may experience longer periods of depression. The perimenopause, or menopause transition, is considered to be a “window of vulnerability” for depressive symptoms and major depression, for a few reasons.

Fluctuating hormones, as well as other physiological changes during perimenopause, such as hot flashes, insomnia and low libido, can all contribute to a depressed mood. Additionally, changes associated with midlife and aging, such as “empty nest” issues, the loss of fertility, or the stresses of caring for an aging parent may impact a midlife woman’s mental health. Women who experienced a depressive episode earlier in life are also more susceptible to depression during perimenopause.

Fortunately, there are treatments. For mild mood swings and occasional depression, research suggests that exercise, healthy diet, and stress-reducing techniques such as mindfulness and yoga or other activities alter brain chemistry and can help improve mood. Research also shows that for some perimenopausal women, low-dose oral contraceptives (estrogen-progestin combination) can help stabilize hormone levels and diminish mood swings (smokers over 35 should not use oral contraceptives). Lastly, for women with more prolonged mood disturbances and more severe symptoms, antidepressants are often highly effective. Counseling, or talk therapy, also has been shown to be very beneficial, alone or in combination with medication. 

Especially if your depression is prolonged or your symptoms are severe, talk with your health care provider. Your enjoyment of life should be a high priority for taking care of yourself!

Dr. Lisa Larkin is a board-certified internist practicing internal medicine and women’s health since 1991. She is the Founder and CEO of Ms. Medicine, LLC, a national membership organization for women’s health clinicians and a concierge women’s health primary care network. She is also the owner and President of Lisa Larkin, MD, and Associates, an independent, multispecialty practice offering direct primary care (DPC), concierge primary care and women’s health care in Cincinnati, Ohio. In addition, she serves as Director of Women’s Corporate Health for TriHealth, and she is the Founder and Executive Director of the Cincinnati Sexual Health Consortium, a non-profit designed to improve the sexual health and wellness of individuals in the Greater Cincinnati region through improved clinician collaboration and community outreach.

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