Transition to Menopause (Perimenopause)

The transition from the reproductive phase of a woman’s life to the phase when she can no longer reproduce is a process that usually begins in a woman's late 40s. During this transition known as perimenopause, which typically lasts 4-8 years, some women are more vulnerable to depressive disorders. Although some women do become depressed for the first time in their lives during perimenopause, generally those women who have a history of mood disorders are more vulnerable. Women who have had problems with depressed mood around the time of their menstrual periods may also be at higher risk in perimenopause.

During perimenopause women may experience a variety of physical changes (for example, night sweats and hot flashes) until they arrive at menopause. (Menopause is reached usually in a woman’s early 50s, and is defined as the cessation of menstrual periods for at least one year.) Many factors may influence a woman’s vulnerability to depression during perimenopause, including hormonal fluctuations, physical symptoms of these transition years, or psychological issues related to the loss of fertility and acknowledgment of one’s mortality.

Treatments During the Transition to Menopause

Treatment for depressive symptoms that occur in association with menopause depends on the severity of a woman’s symptoms and on her prior history. If a woman’s symptoms are relatively mild and she has never been depressed before, doctors commonly suggest treatment with an antidepressant. Hormone replacement therapy by itself will usually relieve physical symptoms such as hot flashes and may also improve mood significantly. However, given recent concerns regarding the long-term use of estrogen, some women prefer to avoid hormones, especially if they have few physical symptoms.

In cases where symptoms are severe, doctors typically prescribe antidepressant medication, generally in combination with hormone replacement therapy. The combination of an antidepressant and hormones may also be used when a woman has significant physical symptoms in addition to depression. Helpful information about specific medications can be found at www.medlineplus.gov (click on "Drugs and Supplements").

In all of these situations, psychotherapy is commonly recommended in addition to whatever medication is chosen. Working with a psychotherapist, however, is unlikely to help severe depression unless medication is used as well.