Menopause and Depression: Causes, Symptoms, and Treatments

Feeling depressed while dealing with menopause? You’re not alone. Keep reading to learn about the link between menopause and mental health struggles.

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Menopause is a stage of life associated with many changes, both physical and mental. While some women go through this phase of aging relatively seamlessly, others endure intense symptoms and mood changes that impact their functioning and quality of life. 

There’s an undeniable link between menopause and depression, thanks to fluctuating hormones during this time. Other mental health challenges, such as anxiety and mood swings, can also arise during menopause and perimenopause. Here’s what you need to know about menopause and depression, including how hormonal changes impact mental health, common symptoms, and the most effective treatment options.

Does menopause cause anxiety and depression?

Menopause does not directly cause anxiety and depression, but it does increase your risk of experiencing these mental health challenges. “The hormonal fluctuations during menopause, particularly the decline in estrogen and progesterone, can influence brain chemistry and mood regulation,” says Bree Williams, LPCA, a Group Facilitator at Charlie Health. 

Although estrogen and progesterone are technically reproductive hormones related to the menstrual cycle and pregnancy, they also affect mental health. These hormonal changes directly impact your neurotransmitters, which are chemical messengers in the brain. 

“Menopause can lead to depression due to estrogen fluctuations, which can impact the brain’s serotonin levels,” says Nicole Lonano, MS, a Charlie Health Group Facilitator. Serotonin is a neurotransmitter linked to mood, and low levels of serotonin are often associated with a depressed mood. Another key neurotransmitter related to mood is dopamine. Williams says that declining estrogen levels can also affect dopamine, which also impacts overall mood regulation.

An estimated 35.6% of menopausal women experience depression, making this mood disorder quite common during this phase.  

Anxiety is another common mental health concern during menopause. “Hormonal changes can heighten the body’s stress response, leading to feelings of restlessness, racing thoughts, and even panic attacks,” Williams says. “Additionally, physical symptoms like hot flashes, heart palpitations, and sleep disturbances can fuel worry, creating a cycle of heightened anxiety.”

Menopause and depression symptoms

Depression is more than just feeling sad. Other depression symptoms include:

• Persistent emptiness or hopelessness
• Losing interest and pleasure in things you used to enjoy
• Low energy and motivation
• Feeling worthless or guilty
• Changes to appetite and weight
• Sleep disturbances (either having insomnia or sleeping too much)
• Trouble concentrating or remembering things
• Otherwise unexplained aches, pains, or digestive symptoms
• Thinking of death or suicide 

Additionally, there are some symptoms that may come along with perimenopausal or menopausal depression, including the following:

1. Menopause anger and depression

When estrogen levels drop and serotonin levels subsequently lower, this can increase irritability, Williams says. “Anger during menopause often arises from hormonal shifts, stress, and sleep problems,” she says. 

Anger and irritability can also arise during perimenopause. One study found that 82% of perimenopausal women with depression experience irritability. Women who experienced vasomotor symptoms (AKA hot flashes and night sweats) were even more likely to feel irritable — understandably so.

“Over time, frequent anger or irritability can contribute to feelings of guilt, hopelessness, and fatigue, all of which may worsen or lead to depression,” Williams adds. However, research shows that anger levels decrease after age 50, as menopause progresses. 

2. Menopause rage and depression  

“Menopause rage is extreme, heightened bouts of anger and irritability caused by hormonal fluctuations during perimenopause and menopause,” Lonano says. Add to that life stressors common during midlife, like caregiving, relationship changes, or work pressure, and emotions can easily reach a boiling point.

3. Menopause fatigue and depression

Fatigue is a common symptom of perimenopause, menopause, and depression. 52.4% of perimenopausal women report fatigue.

“Menopause often brings chronic fatigue, which may be due to sleep disruption from night sweats, hot flashes, or hormonal shifts,” Williams says. “This exhaustion can make it difficult to engage in activities, exercise, or maintain routines that usually support good mental health.”

She notes that this lack of energy can further contribute to feelings of sadness, disconnection, and depression. 

4. Menopause mood swings

Mood swings are common during both perimenopause and menopause. 40% of perimenopausal women have premenstrual syndrome-like mood changes, including mood swings.

These emotional ups and downs are thought to stem from the fluctuating hormone levels (especially estrogen and progesterone) that occur as the body transitions into menopause. While PMS mood swings occur predictably before your period, menopause-related mood swings are rather unpredictable. 

Perimenopause and depression

Perimenopause refers to the time period leading up to menopause, when your estrogen levels start dropping and your periods become more irregular. The average duration of perimenopause is four years, but for some people it can be much shorter or longer.

Similar to menopause, perimenopause can also increase your risk of depression, thanks to the hormonal changes occurring. “Perimenopause is often the time when mood changes first appear,” Williams says. “This stage involves more unpredictable hormone fluctuations, which can be particularly destabilizing for mental health.”

A large meta-analysis found the prevalence of depression in perimenopausal women to be 33.9%, and other research suggests that women are up to five times more likely to develop a mood disorder (such as depression) during perimenopause. Additionally, if you have a history of prior major depression, you’re at an even higher risk of developing depression during perimenopause. 

“Recognizing this connection early and seeking professional support can make a significant difference in preventing more severe depressive episodes,” Williams says.

Perimenopause and anxiety  

Similarly, hormonal changes occurring during perimenopause can also cause anxiety. 

There aren’t as many studies surrounding perimenopause and anxiety as there are about depression, but some research suggests that perimenopausal women are also at a higher risk of developing anxiety, which is also related to hormonal fluctuations. 

Some anxiety symptoms include:

• Excessive worrying 
• Feeling on edge or restless
• Feeling unable to relax
• Difficulty concentrating
• Trouble sleeping
• Otherwise unexplained aches and pains (like headaches and stomachaches) 
• Trembling
• Feeling short of breath or lightheaded
  

If you have already struggled with anxiety in the past, you are at a higher risk of experiencing anxiety during perimenopause, Williams says. 

Menopause and depression treatment 

When treating depression during menopause, it’s important to take a well-rounded approach to care. Treatment options include the following.

1. Therapy for menopause and depression 

Psychotherapy, AKA talk therapy, plays a key role in treating any form of depression. One of the most common forms of therapy for treating depressive symptoms is cognitive behavioral therapy (CBT), Lonano says. CBT involves examining how your thoughts, feelings, and behaviors are interconnected. You’ll learn to identify and challenge cognitive distortions, which are unhelpful, unhealthy thought patterns. 

Research shows that CBT can improve depressive symptoms related to menopause, as well as other menopause symptoms like sleep troubles, sexual concerns, and even vasomotor symptoms. 

Additionally, CBT is helpful for coping with anxiety. You can learn to deal with irrational thoughts, as well as build coping skills and learn relaxation techniques. 

2. Hormone therapy

Since the hormonal shifts related to perimenopause and menopause are what contribute to the mood changes, hormone therapy may help combat this. Research suggests that menopause hormone therapy can reduce depressive symptoms by combating fluctuating and declining hormone levels. 

On top of benefiting your mood, hormone therapy can improve other menopause symptoms, such as:

• Hot flashes
• Night sweats
• Vaginal symptoms (such as dryness or painful sex)
• Bladder symptoms (like frequent or painful urination)

If these symptoms are impacting your quality of life and contributing to your depression, it’s possible that alleviating them could, in turn, improve some depression symptoms. 

However, it’s important to note that hormone therapy isn’t FDA-approved for mood disorders or anxiety disorders. Plus, hormone therapy does come along with certain health risks. Talk to your healthcare provider to determine whether this is the safest fit for you. 

3. Antidepressants for depression and menopause 

Antidepressants may also play a role in depression treatment. Common antidepressants include selective serotonin reuptake inhibitors and serotonin and norepinephrine reuptake inhibitors (AKA SSRIs and SNRIs). These medications are also often prescribed for anxiety disorders.

Interestingly, SSRIs and SNRIs can also help relieve vasomotor menopause symptoms. 

A mental health professional (such as a psychiatrist or psychiatric nurse practitioner) can assess your symptoms and determine if you’re a good fit for an SSRI or SNRI. 

Additionally, some people may benefit from both an antidepressant and hormone therapy. It all depends on a case-by-case basis. 

4. Lifestyle changes

On top of treatment, lifestyle changes can also help menopausal women cope with depression, Lonano says. Some examples of beneficial lifestyle changes and self-care practices include:

• Getting enough high-quality sleep
• Exercising regularly
• Quitting smoking
• Limiting alcohol and caffeine consumption
• Meditation/mindfulness
• Doing yoga
• Socializing with loved ones and leaning on social support

How Charlie Health can help

If you are perimenopausal or menopausal and struggling with depression or anxiety, Charlie Health can help. Our virtual Intensive Outpatient Program (IOP) provides more than once-weekly mental health treatment for people dealing with mental health conditions — including depression, anxiety disorders, and other mental health challenges.

Our compassionate clinicians incorporate evidence-based therapies, such as cognitive behavioral therapy, into individual counseling, family therapy, and group sessions. We also offer medication management if antidepressants such as SSRIs or SNRIs are a good fit for you and your treatment plan. With this kind of support, you can take control of your mental health during menopause. Fill out the form below or give us a call to start your healing journey today.