It’s not uncommon that women come see me because of their new snappiness and/or feeling bleh. Those cases hit my soft spot. It takes bravery to confess one’s impatience and unreasonable anger. I see through these women’s eyes their guilt, vulnerability, frustration, and helplessness. If you’re feeling this way, let me tell you, “it’s ok and it’s not you. There are ways
you can overcome this!”


Hand in Hand: Depression and Hotflashes
Cross culturally, women in perimenopause and in early years of menopause who report depressive and anxiety symptoms also report hotflashes and nightsweats. This has been found in western and non-western countries. There’s consensus that a reduction of endogenous estrogen can wreak havoc not just physiologically but also mentally.

In one study, Iranian women who have moderate-to-severe vasomotor symptoms are 4 times more likely to also have moderate-to-severe depressive symptoms and sexual complaints.


Curbing Menopausal Depression
Here in Canada, the Canadian Longitudinal Study on Aging (CLSA) revealed that 18.6% of its participants in between ages of 45-64 fit the criteria of being “depressed”. Women in this cohort are most likely to be depressed if 1) they don’t have children, 2) have low household income, and 3) have suboptimal social support – tangible or emotional.

Researchers are advocating for greater social engagement to combat loneliness. In China, social activities such as public square dancing, Mahjong, and Taichi have been instrumental in combating depression associated with menopause.


Depression as a Trigger of Early Menopause?
What’s interesting from the CLSA finding is that women who went into menopause early (before 45 years of age) either naturally or artificially as in the case of premature ovarian insufficiency and hysterectomy, respectively, are also at higher risk for developing depression.

More interestingly, researchers of the Harvard Study of Moods and Cycle found that women with a history of depression has 20% greater chance of entering perimenopause sooner than those without.

You can see this is a chicken or egg question: Is early menopause contributing to depression or is depression contributing early menopause?

Researchers suspect that depression negatively affects how the hypothalamic-pituitarygonadal axis responds to stressful events. In times of stress, depression negatively affects the brain-ovary communication pathway. This may lead to the early senescence of ovarian function. In an ultra simplified version, depression + stress = aging. News eh?


Low Estrogen as a Trigger of Depression & Early Onset Menopause?

Another suspicion that researchers have is that perhaps estrogen protects us from depression. Those with less estrogen in the first place may be more prone to depression and naturally because of their low estrogen level, they arrive at perimenopause or menopause early.


Clinical Implication
I’ll let researchers determine which leads to what. For the sake of your health, I encourage you to seek help as early as possible when you suspect that you’re depressed, at any time of your life, menopause or not. And, if you’re starting to experience menopausal symptoms, ask your doctors about the options for optimizing your endogenous estrogen level. Don’t leave yourself behind.

While depression may be triggered by a negative life event, an underlying low estrogen status can propagate such mental state. To answer the opening question, if your life situation is not causing a strain on your mind and spirit, but you can’t shake that apathy or low mood, chances are that it’s menopause. I invite you to have a conversation with me to explore your menopause treatment options.


Soares, CN. A Canadian perspective on depression, menopause status, and hormone therapy.
Menopause 2020;27: 733-734.


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